Abstract
IntroductionPsychogenic movement disorders in childhood have been little researched. As there are few courses of treatment which have been evaluated, further examination and case studies about the treatment and clinical course of this rare occurrence of severe psychogenic tremor in childhood and adolescence are much needed.Case presentationA 13-year-old Caucasian girl with tremor in both wrists, severe enough to prevent her from attending school, was sent to our hospital. After a complete neurological and psychiatric examination, in-patient child-psychotherapeutic treatment was started, with careful consideration given to both chronic and acute stress factors which constitute her performance and exam anxiety in school as well as the girl's parents' conflicted relationship. With the aid of a customized wrist brace our patient was able to go to school and write despite the presence of a marked tremor, which in turn reduced her avoidance behavior and exam anxiety. By the end of her in-patient treatment, the tremor was still noticeable, but markedly reduced in severity (reduction 80%). Two weeks after she was discharged from hospital, the tremor had completely disappeared.ConclusionAfter careful clinical diagnostics, this kind of dissociative disorder should be treated appropriately with age-adapted cognitive-behavioral therapy to achieve positive and lasting benefits.
Highlights
Psychogenic movement disorders in childhood have been little researched
Due to a lack of systematic studies, no accurate prediction regarding the rate of dissociative disorder during childhood and adolescence can be made
According to population-based prevalence studies using structured clinical interviews, lifetime prevalence of dissociative disorder is estimated to be between 2-7% [1,2] in North America
Summary
Dissociative disorder is characterized by the partial or complete lack of the normally integrated functions of memories about the past, identity, perception of the environment, and control of physical movements. Treatment Our patient completed a comprehensive medical-behavioral therapy which included individual and group therapy sessions (client-centered in orientation) and anxietyreducing techniques, especially in the area of performance anxiety She learned progressive muscle relaxation techniques (PMR). One important aspect of the treatment was to work with our patient to help her understand what triggered her tremors and kept them from diminishing Her performance anxiety and her avoidance of challenges relating to school can be seen as factors involved in the disorder. Outcome and follow-up Our patient had her first check-up two weeks after being discharged from our clinic, after a total duration of in-patient hospitalization of three months At this time the tremor had ceased altogether and reappeared only about once every two months in extremely stressful situations. The total duration of her treatment was nine months (Additional file 4)
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