Impact of psychic traumatization on the development of musicians' dystonia six exploratory case studies

OBJECTIVE: Musician's dystonia represents a special case of focal dystonia. It is described as a task-specific movement disorder which presents itself as muscular incoordination or loss of voluntary fine-motor control of extensively trained movements while a musician is playing the instrument. Several triggering factors have been identified, such as overuse, chronic pain, perfectionism, and anxiety disorders. As a common feature, dysfunctional self-management and stress-coping mechanisms are at the root of the aforementioned behaviors. Based on long-term experience from our musicians' medicine outpatient clinic, we hypothesized that early psychic or somatic traumatization may be an underlying mechanism and therefore contribute essentially to focal dystonia. METHODS: In a qualitative study, we investigated the role of early traumatization as a potential cause of motor failures, such as musician's dystonia, employing an episodic interview on a sample of six professional musicians (age 30-57 yrs, 5:1 M:F) suffering from musician's dystonia. RESULTS: Using grounded theory methodology, we were able to derive one generalized etiological model describing contributing factors in the etiological understanding of focal dystonia from the six case studies. The qualitative interviews clearly revealed that all patients experienced early psychic traumatizations, including violence and parents' substance abuse. CONCLUSIONS: In this small sample, we theorize that in-depth, early traumatization most probably led to a dysfunctional stress-coping mechanism. We therefore propose in our model that there are two types of motor failures, one linked to stressful experiences, dysfunctional coping behaviors, and increased muscle tone, and one linked to genetic susceptibility of the motor-system without psychological triggering factors.