Psychogenic Tremor

Part of the Contemporary Clinical Neuroscience book series (CCNE)


Psychogenic movement disorders are a daily challenge for neurologists. A mistake in its recognition may have important consequences for the patients. Thus, this diagnosis must be considered very cautiously in clinical practice. Psychogenic movement disorders are not unusual, mainly tremors, and a wrong diagnosis is common. Psychogenic is an unspecific term that usually hides true mental disorders. The correct psychiatric syndrome somatoform disorders, factitious disorders, malingering, depression, anxiety and histrionic personality disorder, although the absence of ­psychiatric diagnosis does not preclude a psychogenic cause. Diagnosis may be difficult and should be made by an expert neurologist. Organic movement disorders must be excluded after a detailed neurological history, examination, and appropriate diagnostic studies. Psychogenic tremor is a diagnosis of exclusion. It can be diagnosed positively by the following neurological signs the fact that it is inconsistent (variation over time) and incongruous with the organic movement. Diagnosis is mainly clinical but several tests can be used, especially accelerometry, electromyography, and the analysis of the response to placebo or suggestion. New studies are shedding light on our knowledge of the basic underlying mechanisms of such intriguing pathology. Treatment requires a strong alliance between the medical team and patient. Psychogenic tremor should never be minimized. An early diagnosis should be reached as soon as possible and treatment must always be tried.


Movement disorders Tremor Psychogenic Somatoform Depression 


  1. Arias M. Trastornos psicógenos: concepto, terminología y clasificación. Neurología. 2004;19:377–85.PubMedGoogle Scholar
  2. Bhatia KP, Schneider SA. Psychogenic tremor and related disorders. J Neurol. 2007;254:569–74.PubMedCrossRefGoogle Scholar
  3. Brown P, Thompson P. Electrophysiological aids to the diagnosis of psychogenic jerks, spasms and tremor. Mov Disord. 2001;16:595–9.PubMedCrossRefGoogle Scholar
  4. Cooper IS, Cullinam T, Riklan M. The natural history of dystonia. Adv Neurol. 1976;14:157–69.PubMedGoogle Scholar
  5. Crimlisk HL, Bhatia K, Cope H, et al. Slater revisited: 6 year follow up study of patients with medically unexplained motor symptoms. BMJ. 1998;316:582–6.PubMedCrossRefGoogle Scholar
  6. Cubo E, Hinson VK, Goetz CG, García Ruiz P, García de Yébenes J, Marí MJ, et al. Transcultural comparison of psychogenic movement disorders. Mov Disord. 2005;20:1343–5.PubMedCrossRefGoogle Scholar
  7. Desmurguet M, Reilly KT, Richard N, et al. Movement intention after parietal cortex stimulation in humans. Science. 2009;324:811–3.CrossRefGoogle Scholar
  8. Deuschl G, Bain P, Brin M, Ad Hoc Scientific Committee. Consensus statement of the Movement Disorders Society on tremor. Mov Disord. 1998a;13 Suppl 3:2–23.PubMedGoogle Scholar
  9. Deuschl G, Köster B, Lücking CH, Scheidt C. Diagnostic and pathophysiological aspects of psychogenic tremors. Mov Disord. 1998b;2:294–302.CrossRefGoogle Scholar
  10. Elble RJ, Koller WC. Unusual forms of tremor. In: Elble RJ, Koller WC, editors. Tremor. Baltimore: Johns Hopkins University Press; 1990. p. 154–7.Google Scholar
  11. Espay AJ, Goldenhar LM, Voon V, Schrag A, Burton N, Lan AE. Opinion and clinical practices related to diagnosing and managing patients with psychogenic movement disorders: an international survey of Movement Disorder Society members. Mov Disord. 2009;24:1366–74.PubMedCrossRefGoogle Scholar
  12. Fahn S. Psychogenic movement disorders. In: Marsden CD, Fahn S, editors. Movement disorders 3. Oxford: Butterwoth Butterworth-Heinemann; 1994. p. 359–72.Google Scholar
  13. Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol. 1988;50:431–55.PubMedGoogle Scholar
  14. Gironell A. Temblor. In: Grupo ARS XXI de Comunicación S.L, editor. Técnicas neurofisiológicas en los trastornos del movimiento. Barcelona: Enfermedad de Parkinson; 2008. p. 1–17.Google Scholar
  15. Gironell A, López-Villegas D, Barbanoj M, Kulisevski J. Temblor psicógeno: análisis clínico, electrofisiológico y psicopatológico. Neurología. 1997;12:293–9.PubMedGoogle Scholar
  16. 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
  17. Hallet M. Volitional control of movement: the physiology of free will. Clin Neurophysiol. 2007;118:1179.1192.Google Scholar
  18. Hallet M. Physiology of psychogenic movement disorders. J Clin Neurosci. 2010;17:959–65.CrossRefGoogle Scholar
  19. Jankovic J, Thomas M. Psychogenic tremor and shaking. In: Hallet M, Fhan S, Jankovic J, Lang AE, Clninger CR, Yodofsky SC, editors. Psychogenic movement disorders. Philadelphia: Lippincot Williams and Wilkins; 2005. p. 42–7.Google Scholar
  20. Jankovic J, Vuong KD, Thomas M. Psychogenic tremor: long-term outcome. CNS Spectr. 2006;11:501–8.PubMedGoogle Scholar
  21. Joundi RA, Brittain JS, Jenkinson N, Green AL, Aziz T. Rapid tremor frequency assessment with the iPhone accelerometer. Parkinsonism Relat Disord. 2011;17:288–90.PubMedCrossRefGoogle Scholar
  22. Kirsch DB, Mink JW. Psychogenic movement disorders in children. Pediatr Neurol. 2004;30:1–6.PubMedCrossRefGoogle Scholar
  23. Koller W, Lang A, Vetere-Overfield B, Findley L, Cleeves L, Factor S, et al. Psychogenic tremors. Neurology. 1989;39:1094–9.PubMedCrossRefGoogle Scholar
  24. Kumru H, Valls-Sole J, Valldeoriola F, Marti MJ, Sanegre MT, Tolosa E. Transient arrest of psychogenic tremor induced by contralateral ballistic movements. Neurosci Lett. 2004;370:135–9.PubMedCrossRefGoogle Scholar
  25. Kumru H, Begeman M, Tolosa E, Valls-Sole J. Dual task interference in psychogenic tremor. Mov Disord. 2007;22:2077–82.PubMedCrossRefGoogle Scholar
  26. LaFrance Jr WC, Keitner GI, Papandonatos GD, et al. Pilot pharmacologic randomized controlled trial for psychogenic seizures. Neurology. 2010;75:1166–73.PubMedCrossRefGoogle Scholar
  27. Lang A, Voon V. Psychogenic movement disorders: past developments, current status, and future directions. Mov Disord. 2011;26:1175–82.PubMedCrossRefGoogle Scholar
  28. Marjama J, Tröster AI, Koller WC. Psychogenic movement disorders. Neurol Clin. 1995;13:283–97.PubMedGoogle Scholar
  29. McAuley J, Rothwell J. Identification of psychogenic, dystonic and other organic tremors by coherence entrainment test. Mov Disord. 2004;19:253–67.PubMedCrossRefGoogle Scholar
  30. McKeon A, Ahlskog JE, Bower JH, Josephs KA, Matsumoto JY. Psychogenic tremor: long term prognosis in patients with electrophysiologically-confirmed disease. Mov Disord. 2009;24:72–6.PubMedCrossRefGoogle Scholar
  31. O’Malley PG, Jackson JL, Santoro J, et al. Antidepressant therapy for unexplained symptoms and symptom syndromes. J Fam Prac. 1999;48:980–90.Google Scholar
  32. Portera-Calliau C, Victor D, Frucht S, Fahn S. Movement disorder fellowship training program at Columbia University Medical Center in 2001-2002. Mov Disord. 2006;21:479–85.CrossRefGoogle Scholar
  33. Putnam FW. Conversion symptoms movement disorders in neurology and neuropsychiatry. London: Blackwell Scientific; 1992. p. 430–7.Google Scholar
  34. Raethjen J, Kopper F, Govindan RB, Volkmann J, Deuschl G. Two different pathogenetic mechanisms in psychogenic tremor. Neurology. 2004;63:812–5.PubMedCrossRefGoogle Scholar
  35. Ranawaya R, Riley D, Lang A. Psychogenic dystonia with organic movement disorder. Mov Disord. 1990;5:127–33.PubMedCrossRefGoogle Scholar
  36. RedondoVergé L. El signo de Pastor y el de las manos en los bolsillos. Neurología. 2000;15:321–2.Google Scholar
  37. Schrag A, Lang AE. Psychogenic movement disorders. Curr Opin Neurol. 2005;18:399–404.PubMedCrossRefGoogle Scholar
  38. Schwingenschuh P, Pont-Sunyer C, Surtees R, Edwards MJ, Bathia KP. Psychogenic movement disorders in children: a report of 15 cases and a review of the literature. Mov Disord. 2008;23:1882–8.PubMedCrossRefGoogle Scholar
  39. Seignourel PJ, Miller K, Kellison I, et al. Abnormal affective startle modulation in individuals with psychogenical movement disorder. Mov Disord. 2007;22:1265–71.PubMedCrossRefGoogle Scholar
  40. Stone J, Carson A. Functional neurologic symptoms: assessment and management. Neurol Clin. 2011;29:1–18.PubMedCrossRefGoogle Scholar
  41. Voon V, Brezing C, Gallea C, et al. Emotional stimuli and motor conversion disorder. Brain. 2010a;133:1526–36.PubMedCrossRefGoogle Scholar
  42. Voon V, Gallea C, Hattori N, Bruno M, Ekanayake V, Hallet M. The involuntary nature of conversion disorder. Neurology. 2010b;74:223–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Luis Redondo-Vergé
    • 1
  • Natividad Carrion-Mellado
    • 2
  1. 1.Servicio de NeurologíaHospital Virgen MacarenaSevillaSpain
  2. 2.Servicio de PsiquiatríaHospital de ValmeSevillaSpain

Personalised recommendations