Psychogenic voice disorders in performers: a psychodynamic model

Psychogenic voice disorders are not infrequently encountered in the busy voice clinic. A clinician-friendly psychodynamic model and a multidisciplinary management approach are presented which have proven helpful for our voice team and our patients. In essence the formulation revolves around an "event" occurring, which may be either organic or psychological in nature. The ensuing dysphonia then leads to emotional consequences which in turn have physical consequences on the vocal tract. The situation can become reinforcing and illness behaviors develop. Elucidating this event/process to the patient improves the likelihood of a successful long-term outcome. The diagnostic and management roles of the various team members are discussed.