Spasmodic torticollis: a behavioral perspective

The literature on spasmodic torticollis is critically reviewed. The currently most popular etiological hypothesis characterizes torticollis as an extrapyramidal disorder, the symptoms of which are aggravated by stress, but there is no unequivocal evidence available to support this view. Psychological mechanisms have been suggested but not elaborated or tested in any detail. A wide range of treatments has been advocated but controlled studies have not been reported, and the problems of assessing outcome have never been tackled adequately. Behavioral treatments have been evaluated more rigorously than other approaches (particularly EMG feedback training), and the literature suggests that they benefit some patients. It is argued that psychologists have the potential for making a very significant contribution to the understanding and management of torticollis. In discussing outcome measures, the more promising techniques that have been used are summarized and a list is presented of the factors which must be considered when assessing torticollis symptoms. Directions for future research are outlined and priorities suggested.