Current Neurology and Neuroscience Reports

, Volume 11, Issue 4, pp 396–403

An Update on Psychogenic Movement Disorders

  • Aviva Ellenstein
  • Sarah M. Kranick
  • Mark Hallett


Psychogenic movement disorders (PMD) and other conversion disorders (CD) with apparent neurologic signs (neurologic CD) plague patients and perplex physicians. Due to a lack of objective evidence of underlying brain lesions, CD were largely abandoned by neurologists and remained poorly understood psychiatric diagnoses throughout most of the 20th century. Modern neuroscience now supports increasingly comprehensive biological models for these complex disorders, definitively establishing their place in both neurology and psychiatry. Although it is often clinically useful to distinguish a movement disorder as either “organic” or “psychogenic,” this dichotomy is difficult to defend scientifically. Here we describe the neuroimaging and neurophysiologic evidence for dysfunctional neural networks in PMD, explain the diagnostic potential of clinical neurophysiologic testing, discuss the promising if increasingly complex role of neuropsychiatric genetics, and review current treatment strategies.


Movement disorder Psychogenic Motor conversion Somatoform disorder Dissociative disorder Functional disorder Medically unexplained Hysterical Neurologic symptom Diagnostic technique 


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Hallett M, Fahn S, Jankovic J, et al. Psychogenic movement disorders: neurology and neuropsychiatry. Philadelphia: Lippincott Williams & Wilkins; 2006.Google Scholar
  2. 2.
    Bogousslavsky J. Hysteria after Charcot: back to the future. Front Neurol Neurosci. 2011;29:137–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Hallett M. Psychogenic movement disorders: a crisis for neurology. Curr Neurol Neurosci Rep. 2006;6:269–71.PubMedCrossRefGoogle Scholar
  4. 4.
    Nowak DA, Fink GR. Psychogenic movement disorders: aetiology, phenomenology, neuroanatomical correlates and therapeutic approaches. Neuroimage. 2009;47:1015–25.PubMedCrossRefGoogle Scholar
  5. 5.
    Stone J, Wojcik W, Durrance D, et al. What should we say to patients with symptoms unexplained by disease? The “number needed to offend”. BMJ. 2002;325:1449–50.PubMedCrossRefGoogle Scholar
  6. 6.
    Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431–55.PubMedGoogle Scholar
  7. 7.
    Williams DT, Ford B, Fahn S. Phenomenology and psychopathology related to psychogenic movement disorders. Adv Neurol. 1995;65:231–57.PubMedGoogle Scholar
  8. 8.
    American Psychiatric Association, American Psychiatric Association Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington: American Psychiatric Association; 2000.Google Scholar
  9. 9.
    Kranick SM, Ellenstein A, Hallett M. Psychiatric comorbidities and risk factors in psychogenic movement disorders: a biopsychosocial approach. European Neurological Journal. 2010;2:1–7.Google Scholar
  10. 10.
    Krem MM. Motor conversion disorders reviewed from a neuropsychiatric perspective. J Clin Psychiatry. 2004;65:783–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Scott RL, Anson JG. Neural correlates of motor conversion disorder. Mot Control. 2009;13:161–84.Google Scholar
  12. 12.
    • Vuilleumier P. The Neurophysiology of Self-Awareness Disorders in Conversion Hysteria. In The Neurology of Consciousness Cognitive Neuroscience and Neuropathology. Edited by Laureys S and Tononi G. Academic Press; 2009:282–302. This chapter cogently discusses the neuroimaging and neurophysiologic studies of conversion hysteria in the context a developing neurobiological model that includes disrupted mechanisms of self-awareness. Google Scholar
  13. 13.
    Stone J, Carson A. Movement disorders: psychogenic movement disorders: what do neurologists do? Nat Rev Neurol. 2009;5:415–6.PubMedCrossRefGoogle Scholar
  14. 14.
    LaFrance Jr WC, Miller IW, Ryan CE, et al. Cognitive behavioral therapy for psychogenic nonepileptic seizures. Epilepsy Behav. 2009;14:591–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Stone J, LaFrance WC, Jr., Levenson JL, et al. Issues for DSM-5: Conversion disorder. Am J Psychiatry, 167:626–627.Google Scholar
  16. 16.
    Mayou R, Kirmayer LJ, Simon G, et al. Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry. 2005;162:847–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Lowe B, Mundt C, Herzog W, et al. Validity of current somatoform disorder diagnoses: perspectives for classification in DSM-V and ICD-11. Psychopathology. 2008;41:4–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Voon V, Gallea C, Hattori N, et al. The involuntary nature of conversion disorder. Neurology. 2010;74:223–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Voon V, Brezing C, Gallea C, et al. Emotional stimuli and motor conversion disorder. Brain. 2010;133:1526–36.PubMedCrossRefGoogle Scholar
  20. 20.
    Hallett M. Physiology of psychogenic movement disorders. J Clin Neurosci. 2010;17:959–65.PubMedCrossRefGoogle Scholar
  21. 21.
    Vuilleumier P, Chicherio C, Assal F, et al. Functional neuroanatomical correlates of hysterical sensorimotor loss. Brain. 2001;124:1077–90.PubMedCrossRefGoogle Scholar
  22. 22.
    de Lange FP, Roelofs K, Toni I. Increased self-monitoring during imagined movements in conversion paralysis. Neuropsychologia. 2007;45:2051–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Cojan Y, Waber L, Carruzzo A, et al. Motor inhibition in hysterical conversion paralysis. Neuroimage. 2009;47:1026–37.PubMedCrossRefGoogle Scholar
  24. 24.
    de Lange FP, Toni I, Roelofs K. Altered connectivity between prefrontal and sensorimotor cortex in conversion paralysis. Neuropsychologia. 2010;48:1782–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Stone J, Vuilleumier P, Friedman JH. Conversion disorder: separating “how” from “why”. Neurology. 2010;74:190–1.PubMedCrossRefGoogle Scholar
  26. 26.
    Gaig C, Marti MJ, Tolosa E, et al. 123I-Ioflupane SPECT in the diagnosis of suspected psychogenic Parkinsonism. Mov Disord. 2006;21:1994–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Hallett M: Psychogenic Parkinsonism. J Neurol Sci 2011. doi: 10.1016/j.jns.2011.03.019
  28. 28.
    Liepert J, Hassa T, Tuscher O, et al. Motor excitability during movement imagination and movement observation in psychogenic lower limb paresis. J Psychosom Res. 2010;70:59–65.PubMedCrossRefGoogle Scholar
  29. 29.
    Desmurget M, Sirigu A. A parietal-premotor network for movement intention and motor awareness. Trends Cogn Sci. 2009;13:411–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Schwingenschuh P, Katschnig P, Edwards MJ, et al. The blink reflex recovery cycle differs between essential and presumed psychogenic blepharospasm. Neurology. 2011;76:610–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Hariri AR. The neurobiology of individual differences in complex behavioral traits. Annu Rev Neurosci. 2009;32:225–47.PubMedCrossRefGoogle Scholar
  32. 32.
    • Caspi A, Hariri AR, Holmes A, et al. Genetic sensitivity to the environment: the case of the serotonin transporter gene and its implications for studying complex diseases and traits. Am J Psychiatry 2010, 167:509–527. Following from a detailed review of the serotonin transporter gene and stress sensitivity, the authors discuss approaches to the challenging field of gene-environment research. PubMedCrossRefGoogle Scholar
  33. 33.
    Caspi A, Moffitt TE. Gene-environment interactions in psychiatry: joining forces with neuroscience. Nat Rev Neurosci. 2006;7:583–90.PubMedCrossRefGoogle Scholar
  34. 34.
    Hallett M, Lang AE, Jankovic J, et al. Psychogenic movement disorders & other conversion disorders. Cambridge: Cambridge University Press; 2011.Google Scholar
  35. 35.
    Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev Neurosci. 2009;10:446–57.PubMedCrossRefGoogle Scholar
  36. 36.
    • Lupien SJ, McEwen BS, Gunnar MR, et al. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci 2009,10:434–445. The authors synthesize the animal and human research on the age-dependent pathophysiology of stress. PubMedCrossRefGoogle Scholar
  37. 37.
    Feinstein A, Stergiopoulos V, Fine J, et al. Psychiatric outcome in patients with a psychogenic movement disorder: a prospective study. Neuropsychiatry Neuropsychol Behav Neurol. 2001;14:169–76.PubMedGoogle Scholar
  38. 38.
    Voon V, Lang AE. Antidepressant treatment outcomes of psychogenic movement disorder. J Clin Psychiatry. 2005;66:1529–34.PubMedCrossRefGoogle Scholar
  39. 39.
    Binder EB, Owens MJ, Liu W, et al. Association of polymorphisms in genes regulating the corticotropin-releasing factor system with antidepressant treatment response. Arch Gen Psychiatry. 2010;67:369–79.PubMedCrossRefGoogle Scholar
  40. 40.
    Zhou Z, Zhu G, Hariri AR, et al. Genetic variation in human NPY expression affects stress response and emotion. Nature. 2008;452:997–1001.PubMedCrossRefGoogle Scholar
  41. 41.
    • Stone J. The bare essentials: Functional symptoms in neurology. Pract Neurol 2009, 9:179–189. This article presents important, practical advice for the neurologist’s approach to patients with CD. PubMedCrossRefGoogle Scholar
  42. 42.
    Hinson VK, Weinstein S, Bernard B, et al. Single-blind clinical trial of psychotherapy for treatment of psychogenic movement disorders. Parkinsonism Relat Disord. 2006;12:177–80.PubMedCrossRefGoogle Scholar
  43. 43.
    Speckens AE, van Hemert AM, Spinhoven P, et al. Cognitive behavioural therapy for medically unexplained physical symptoms: a randomised controlled trial. BMJ. 1995;311:1328–32.PubMedGoogle Scholar
  44. 44.
    LaFrance Jr WC. Friedman JH. cognitive behavioral therapy for psychogenic movement disorder. Mov Disord. 2009;24:1856–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Baslet G, Hill J. Case report: brief mindfulness-based psychotherapeutic intervention during inpatient hospitalization in a patient with conversion and dissociation. Clinical Case Studies 2011. doi: 10.1177/1534650110396359.
  46. 46.
    Goldstein LH, Chalder T, Chigwedere C, et al. Cognitive-behavioral therapy for psychogenic nonepileptic seizures: a pilot RCT. Neurology. 2010;74:1986–94.PubMedCrossRefGoogle Scholar
  47. 47.
    Dallocchio C, Arbasino C, Klersy C, et al. The effects of physical activity on psychogenic movement disorders. Mov Disord. 2010;25:421–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Van Nuenen BF, Wohlgemuth M, Wong Chung RE, et al. Acupuncture for psychogenic movement disorders: treatment or diagnostic tool? Mov Disord. 2007;22:1353–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Moene FC, Spinhoven P, Hoogduin KA, et al. A randomized controlled clinical trial of a hypnosis-based treatment for patients with conversion disorder, motor type. Int J Clin Exp Hypn. 2003;51:29–50.PubMedCrossRefGoogle Scholar
  50. 50.
    Chastan N, Parain D. Psychogenic paralysis and recovery after motor cortex transcranial magnetic stimulation. Mov Disord. 2010;25:1501–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC (outside the USA) 2011

Authors and Affiliations

  • Aviva Ellenstein
    • 1
  • Sarah M. Kranick
    • 1
  • Mark Hallett
    • 1
  1. 1.Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaUSA

Personalised recommendations