Psychosocial and body image alterations associated with focal dystonia

Focal dystonia is a movement disorder characterized by involuntary muscle contractions resulting in abnormal postures and repetitive movements. Beyond motor impairment and physical disfigurement, dystonia is increasingly recognized as a network disorder with intrinsic non-motor symptoms, including body image concerns and psychological distress, which significantly affects quality of life (QoL). This study examined the psychosocial correlates of different forms of focal dystonia, focusing on altered body image, severity of anxiety and depression, and QoL in 19 patients with focal dystonia, 18 patients with hyperhidrosis (HH), and 13 patients with hemifacial spasm (HFS) as clinical control groups. Participants completed standardized tests including the Beck Depression Inventory-II for depression, the State-Trait Anxiety Inventory-Y2 for anxiety, the Body Uneasiness Test (BUT) for body image perception, and the 36-item Short Form Health Survey (SF-36) for QoL. Post-hoc comparisons revealed significant differences in both BUT and SF-36 scores between groups. Cervical dystonia (CD) patients had higher depersonalization symptoms than HH patients (BUT-D: 0.5 ± 0.7 vs. 0.1 ± 0.1; p =.027). CD patients also reported lower SF-36 Physical Role scores (55.6 ± 44.7) compared to blepharospasm (BPS) (87.5 ± 31.7), HH (95.8 ± 17.7), and HFS (65.4 ± 43.9) (p <.001). In contrast, BPS patients scored higher on SF-36 Emotional Role (90.0 ± 31.6) and SF-36 Social Functioning (89.9 ± 14.3) than CD (SF-36-ER: 70.2 ± 39.0, p <.001; SF-36-SF: 80.4 ± 25.1, p <.001). Depression and anxiety scores were below clinical thresholds and did not differ significantly between groups. These results support the view that non-motor symptoms are core features of focal dystonia, particularly in CD, and emphasize the need to address psychological and body image-related aspects in clinical management and future models of the disorder.