Table 1. Features on Examination Supportive of the Diagnosis of Psychogenic Tremor.

Shaking with changing frequency, amplitude direction, and anatomic distribution

Movements disappear with distraction maneuver or pressing on a particular spot

Application of a tuning fork with a suggestion that vibration may increase or suppress the tremor

Non-patterned abnormal postures and spasms

Bizarre gait (astasia–abasia), knee-buckling gait, bouncing stance

Deliberate slowness (with “effort”) carrying out requested voluntary movement

Abnormal speech pattern (hesitant and slow, bursts of verbal gibberish; changing dialects and accents)

Facial grimacing, alternating facial contractions (may resemble hemifacial spasm)

Movements and postures incongruous with recognized disease patterns or with expected physiologic abnormalities

Manifesting exhaustion, excessive fatigue

Obvious psychiatric disturbances (depression, anxiety)

Multiple somatizations and undiagnosed conditions

La belle indifference

Delayed and excessive startle (bizarre movements in response to sudden, unexpected noise or threatening movement)

Presence of additional types of abnormal movements that are not known to be part of the primary or principal movement disorder pattern that the patient manifests

Convergence spasm and other dysconjugate oculomotor abnormalities