Psychiatric Comorbidities and Risk Factors in Psychogenic Movement Disorders: A Biopsychosocial Approach

Introduction

Psychogenic movement disorders (PMD) are characterized by the presence of abnormal movements or lack of movement not attributable to a neurological disorder and thought to be psychologically mediated. Despite increasing attention to PMD in the past decade, these patients remain extremely challenging for their providers in both neurology and psychiatry. At one large movement disorders center, PMD represented 5.3% of the patients seen over a 32-year period, a higher proportion than Huntington disease or restless legs syndrome.1 These patients have been described as a “crisis for neurology” due to the difficulty physicians feel in making the diagnosis, as well as the resistance from many patients to receiving this diagnosis and accepting treatment.2 As such, the medical expenditures of this population are disproportionately high, as many patients will continue to present to new providers in search of a different diagnosis.3 When patients are accepting of the diagnosis and eager to begin treatment, few prospective treatment studies exist in this population to guide physicians in directing therapy.4

Abstract

Psychogenic movement disorders, while gaining wider recognition in the literature as well as in clinical practice, continue to present a diagnostic and therapeutic challenge for neurologists and psychiatrists. Essential to the diagnosis of psychogenic movement disorder or conversion disorder-motor subtype is that the patient's abnormal movements are considered to be psychologically mediated, rather than the result of any neurological lesion, but there remains a significant gap between the assumption of “unconscious stress” and a consensus on how to best describe, counsel, or treat these patients psychologically. In an attempt to understand these patients from a biopsychosocial perspective, we describe the current literature regarding psychiatric comorbidity in these patients and how genetic susceptibility may undermine an individual's response to stressful life events.

Keywords

Psychogenic movement disorder, conversion disorder, comorbidity, risk factor