How common are abnormal involuntary movements in people with anxiety?

*Editor’s note: This article focuses on involuntary movements that are not associated with antipsychotic or other psychotropic medication use.

Nora Brier, PsyD, is a psychologist and a postdoctoral fellow at Penn Medicine, where she works with patients at the Center for the Treatment and Study of Anxiety. The center most often treats obsessive-compulsive disorders, PTSD, social anxiety disorders, panic, specific phobia, and other skin-picking disorders. Dr. Brier said that she sees involuntary movements quite often, but they are “usually within the normal realm of adaptive behavioral presentations of anxiety.”

Psycom Pro asked its readers how often abnormal involuntary movements present in their patients with anxiety? Their responses:

• 39% often

• 37% occasionally

• 24% rarely

Here, Dr. Brier shares a few insights on movements being voluntary, and the presentation of involuntary movements in adolescents and those with OCD.

Most commonly, Dr. Brier and her colleagues see symptoms such as shaking, trembling, or manifestations of panic, which typically present as gasping sensations or choking.

“People typically will describe them as involuntary – they’ll say that their body is just doing these motions,” Dr. Brier explains. “As we talk more about the symptom, typically people will come to describe them as more voluntary, but when the anxiety disorder is really acute, and just starting to present, they are experienced, for sure, as involuntary.”

It is less common for Dr. Brier to see involuntary movements that are categorized as Tourette syndrome (TS) or a more specific tic disorder. She says that these movements typically present as a tic or a twitch of some kind, often accompanied by a noise, and sometimes they can occur in isolation. Individuals with TS or another tic disorder are usually referred out for treatment, Dr. Brier said, but if they have a comorbid anxiety disorder, they may be treated at the center.

When distinguishing between involuntary movements based in anxiety and those caused by another medical condition, Dr. Brier recommends asking the patient about the timeline of their anxiety symptoms, what they feel like, and when the movements are happening. “There are certainly gray areas, and there is some overlap,” she noted.

For example, individuals who may feel like they need to do a repetitive motion that is associated with OCD, such as needing to touch or tap something [an object or their body] several times when they are anxious to relieve some of that anxiety, that is a repetitive behavioral motion that a lot of people will say they experience as almost involuntary. But, she says, “after we dive into it a bit more, they’ll say, ‘Well, I guess I can resist it; I guess it’s voluntary, in this moment that I’m going to do this motion or this behavior.’”

In general, Dr. Brier says that tics, Tourette’s, and other repetitive motions or behaviors that feel involuntary can start earlier on, such as in childhood. “This is not to say that they can’t onset in in adolescence or adulthood, but it’s a lot more common for these to onset in childhood,” she says.

If an adult is presenting with both a tic and symptoms of anxiety, she suggests asking about whether the tic was present during childhood or adolescence. “It’s more helpful to be able to rule out if it’s an anxiety disorder organically, if there’s a bit of both going on, or if it sounds more like a Tourette syndrome that may have started younger.”

On the subject of teens, and the rising number of adolescent girls developing tics, Dr. Brier said, that in her experience, the tics are a manifestation of their anxiety.

“What I’ve typically seen is that once we do some of the exposure and response prevention CBT therapy treatment for OCD, a lot of their tics and twitches seem to decrease, which is really wonderful. My hypothesis is that it’s a manifestation of that generalized anxiety, and once some of the underlying causes are treated, we see the reduction in those involuntary movements.”

Dr. Brier suggests clinicians take the following steps to gain a better understanding of a patient’s experience of involuntary movements and to help guide treatment:

• Take a thorough history and timeline of the patient’s anxiety levels and involuntary movements.

• Ask the patient what others have told them about their behavior when they are anxious. Sometimes talking to a partner or friend, or, if the patient is a child, a parent or caregiver, can shed light on the behaviors.

• Ask about the context in which the behaviors occur. When does this happen? What are some of the triggers for it? What makes it better?

• Help raise the patient’s awareness of the behavior by suggesting they keep a log of when the movements occur. “I find that really helpful because it’s going to raise awareness, and every time the patient is more aware of what they’re doing, it’s one more step toward getting good data to work on and treating in therapy,” she said.