Which features are characteristic of psychogenic tremor?

• A. Abrupt onset, spontaneous remission, changing characteristics, and extinction with distraction
• B. Even, fixed, and worsened with intention
• C. Only occurs during sleep
• D. Progressively worsening with age

Answer: (A)

Psychogenic tremor is a functional movement disorder, so its hallmark is variability and non-structural features rather than a fixed organic pattern. The best description includes an abrupt onset, often tied to stress, followed by waxing and waning with changes in frequency and amplitude. A striking clue is that the tremor can be extinguished or markedly reduced when the patient is distracted or engaged in another task, showing the non-organic nature of the phenomenon. It may also shift its characteristics across examinations, which further argues against a true neurodegenerative tremor.

In contrast, tremors that are even and fixed in rhythm and worsen with deliberate movement—or occur only during sleep—or steadily worsen with age point to organic or other non-psychogenic processes. Thus, the combination of abrupt onset, spontaneous remission, changing features, and extinction with distraction is characteristic of psychogenic tremor.