musiciansdystonia.net

Psychological Risk Factors

Focal dystonia is a multi-factorial process that involves a combination of physical, psychological, and psycho-social issues. For many sufferers, the first symptoms they identify are physical, the tell-tail muscle spasms or contractions that may cause a finger to curl into the palm or the embouchure to tremor or pull to one side. In truth, there are several non-physical signs and symptoms that may be present well before this stage, and although there is no way of knowing at the present time exactly who will go on to develop physical symptoms, it is possible to identify associated psychological risk factors and take steps to address them pre-emptively where necessary.

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Stress

As with many illnesses and conditions, stress can be a significant contributing factor to the onset of focal dystonia. The life of a performing artist is stressful, and managing that stress is a constant challenge. Mental health difficulties are relatively common among musicians and many issues related to stress emerge prior to embarking on a professional playing career. 

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Anxiety Disorders

The link between anxiety disorders and the development of musicians' dystonia, is complex and multifaceted. Here's a basic overview of the relationship:

 

• Anxiety Responses: Chronic stress, including the kind associated with anxiety disorders, can lead to changes in the nervous system. When the body is continually in a state of heightened anxiety, it can disrupt the normal functioning of the nervous system. This continual state of stress may act as a trigger, contributing to conditions like musicians' dystonia.

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• Cortical Changes: Anxiety can lead to alterations in brain function and structure. Long-term anxiety has been associated with alterations in the brain's basal ganglia and cerebellum, areas often implicated in focal dystonia.

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• Pain Perception: Anxiety can heighten the perception of pain and discomfort, potentially exacerbating the physical symptoms of musicians' dystonia and making the condition more difficult to recognize.

 

• Importantly, it's not to say that anxiety disorders directly cause dystonia, but they can contribute to its onset, severity and persistence, particularly in those already predisposed to the condition.

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Excessive Perfectionism

Perfectionism is generally regarded as a positive trait by musicians and something to be aspired to. However, excessive perfectionism can have negative effects and outcomes for the musician. Constantly searching for perfectionism may be associated with obsessive-compulsive disorders. 

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Negative Expectations or Beliefs

Negative expectations or beliefs can play a significant part in its development and continuation in the following ways:

 

• Increasing stress and anxiety: Negative expectations can cause a high level of stress and anxiety. Having a consistent fear or belief of not being able to perform optimally or making a mistake can push the nervous system into a state of hyperarousal that can interfere with the precise motor control required for musical performance.

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• Attentional Focus: In anticipation of errors or poor performance due to these negative beliefs, musicians might closely monitor their own playing technique - a phenomenon known as heightened self-focused attention. This could interfere with automatic motor control that is learned over years of practice, leading to disruptions in motor control and causing motor skills to deteriorate.

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• Sensory Processing and Perception: Negative expectations can affect perception and sensory processing as well. Musicians might become hyper-aware of minute sensations, perceive them as abnormal or harmful, and adjust their normal playing technique, possibly triggering dystonic movements.

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• Conditioned Responses: Consistent negative expectations or beliefs can lead to conditioned responses. A musician who expects pain or a cramp every time they play a certain movement may unconsciously tense up in anticipation, leading to abnormal movements characteristic of dystonia.

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• Decreased Confidence and Self-Efficacy: Negative beliefs can drive down a musician's confidence in their ability to play and lead to decreased self-efficacy (belief in their ability to achieve goals). This can negatively impact the execution of motor skills, potentially contributing to dystonia.

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• Neuroplastic Changes: Chronic stress and anxiety stemming from negative expectations can lead to long-term changes in the brain's structure and function (neuroplastic changes), particularly in areas responsible for movement control. This might contribute to the development and persistence of dystonia.

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Trauma and Abuse

Experiencing trauma or abuse can lead to a host of emotional, psychological, and physical health issues, potentially including musicians' dystonia. While the primary causes of this condition are thought to involve neurological malfunctioning in the areas of the brain related to motor control, there has been a growing body of research suggesting that trauma or abuse might contribute to the development of such movement disorders. Here's how:

 

• Chronic Stress: Trauma or abuse can lead to chronic stress, which in turn can result in detrimental psychological and physical reactions. In response to chronic stress, our body releases excess cortisol, which can result in changes to brain function and structure, particularly within areas responsible for motor control - potentially leading to conditions like dystonia.

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• Psychological Distress: Trauma or abuse often leads to significant mental health issues, such as anxiety, depression, or post-traumatic stress disorder (PTSD). Such psychological distress can add to the physical stress on the body, potentially exacerbating symptoms for individuals who develop musicians' dystonia. 

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• Dissociation: In response to trauma or abuse, some individuals may dissociate, leading to a disconnection between their mind and body. This could potentially disrupt the finely tuned mind-body connection required for precise musical performance, thus possibly contributing to movement disorders.

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• Somatic Symptom Disorder: In some cases, severe psychological trauma can manifest as physical symptoms, a condition known as somatic symptom disorder. If the trauma or abuse is directly related to the individual's musical efforts (such as abusive instruction or harsh criticism), the victim might develop physical symptoms related to music performance, potentially including dystonia.

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• Hypervigilance and Heightened Sensory Perception: Experience of trauma or abuse often makes individuals hypervigilant, with a heightened awareness of bodily sensations, which might disrupt normal motor functioning over time.

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It's important to note that the exact relationship between psychological factors and musicians' dystonia is complex and not completely understood. Psychological factors might not directly cause dystonia but may exacerbate the symptoms once the disorder begins. Understanding more about the link between mental health and dystonia can help in the development of more targeted, effective treatments for dystonia in the future.