PSYCHOSOMATIC ASPECTS OF DYSTONIC MOVEMEN T-DISORDERS

During the last century the bizzare symptoms of focal movement disorde rs (spasmodic torticollis, blepharospasm, writer's cramp, spasmodic dy sphonia) caused a controversial discussion about their psychogenic vs. organic nature. The neurological position classifies these abnormalit ies as focal manifestations of dystonia, which was first described in 1911 by Oppenheim. The psychodynamic understanding is based on Freud's concept of conversion neurosis. Due to methodological considerations the high frequency of antecedent critical ''live events'' and the find ings of psychosocial abnormalities in patients with focal dystonias ar e not convincing arguments for a ''pure'' psychogenic condition. Long term treatment of spasmodic torticollis with botulinum toxin showed a normalization of psychosocial functioning accompanying the improvement of the pathological movement pattern. Coping strategies reflect the s tigmatic character of dystonia. Patients with focal dystonia most freq uently report a psychosocial self-concept of disease. In focal dystoni as psychosocial and somatic aspects are interacting; thus psycnotherap eutic support in addition to botulinum toxin is indicated for some pat ients.