Dissociative Movement Disorders

What is Dissociative Movement Disorders?

Dissociative movement disorders are movement disorders that are not based on objectively recorded lesions of the nervous system. They can take the following forms: pseudo-paralyzes, pseudoparesis, different or differing in the degree of incoordination, inability to stand without assistance (astasia-abasia). The most common variant of dissociative motility disorder is the loss of the ability to move a limb or a part of it or to move a limb. Paralysis can be complete or partial, when the movement is weak or slow. Various forms and degrees of impaired coordination (ataxia) can manifest themselves, especially in the legs, which leads to an artsy gait or inability to stand without assistance.

Causes of Dissociative Movement Disorders

The main cause of the disorder is psychological stress, which leads to the avoidance of conflict by escaping to the disease.

Symptoms of Dissociative Movement Disorders

Full or partial paralysis of the limb (mono-, those- and paraparesis and plegia), ataxia, astasia-abasia, apraxia, akinesia, aphonia, dysarthria, blepharospasm. Exaggerated trembling of one or more limbs or the whole body may occur. Evaluation of the patient’s mental state suggests that a decrease in productivity resulting from the loss of function helps him to avoid unpleasant conflict or to express his dependence or indignation indirectly. A significant factor is the behavior aimed at attracting attention.

Diagnosis of Dissociative Movement Disorders

For a reliable diagnosis should be both of the following criteria:

  • the lack of a physical disorder that could explain the symptoms that characterize this disorder (but there may be physical disorders that give rise to other symptoms).
  • the presence of a convincing link in time between the onset of symptoms of the disorder and stressful events, problems or needs.

and any of the two:

  • full or partial loss of the ability to arbitrary movements, which normally are under the control of the will (including speech);
  • various or differing degrees of impairment of coordination, or ataxia or inability to stand without assistance.

Differential diagnosis: with dissociative paralysis, there are no pyramidal signs, disturbance of trophism and tone, and sensitivity disorders vary.

Treatment of Dissociative Movement Disorders

The main role in the treatment belongs to psychotherapy. The task of pharmacotherapy is to create prerequisites and opportunities for subsequent psychotherapy; it is used in the form of short courses in the presence of accompanying autonomic disorders.

Psychotherapy includes psychoanalysis of caffeine-amitic disinhibition, behavioral therapy, sometimes at this stage hypnosis or narcohypnosis (drug therapy) is necessary, suggestion in a state of sleep-induced medication to restore lost function.

The following groups of drugs can be used for pharmacotherapy: tranquilizers-benzodiazepines, tricyclic antidepressants and SSRI groups, neuroleptics, with a predominantly sedative effect, non-benzodiazepine hypnotics, mood stabilizers and beta-blockers. Nootropics are not used, since their effectiveness in these disorders has not been proven.

Treatment is carried out both in inpatient and in semi-inpatient (day hospital) and outpatient settings. Inpatient treatment is indicated for marked disorders and adaptation disorders, for removing a patient from an actual traumatic situation, in diagnostically difficult cases, as well as for selecting adequate therapy for resistant cases.

Duration: inpatient treatment – up to 30 days, ambulatory – from 1 to 2 months.