Internal versus external frame of reference in functional movement disorders

Joaquin A. Vizcarra, Stephanie Hacker, Ricardo Lopez-Castellanos, Louie Ryes, Holly N. Laub, Luca Marsili, Alok K. Dwivedi, Kathrin Lafaver, Alberto J. Espay*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: The purpose of this study was to determine whether patients with functional movement disorders (FMDs) differ in their internal versus external locus of control (LOC) and whether LOC in these patients affected disease severity, quality of life, and functional impairment compared with control subjects with degenerative (Parkinson’s dis-ease) and nondegenerative (focal dystonia) neurological conditions. Methods: A total of 156 patients with FMD (N=45), Parkinson’s disease (N=64), and focal dystonia (N=47) were recruited between June 2015 and August 2017. The authors administered the general Levenson Multidimensional LOC (LOC-G) and health-specific Multidimensional Health LOC (LOC-H) scales. An internal LOC was represented similarly in both scales: the external LOC included “chance” and “powerful others” in the LOC-G measure and chance, “other people,” and “doctors” in the LOC-H measure. Quality of life, functional impairment, and FMD severity were assessed. One-way analysis of variance and adjusted logistic regressions were used, as well as ordinary least-squares between and within groups, respectively. Results: Patients with FMD had lower external chance LOC-G scores compared with patients in the Parkinson’s disease group (odds ratio=0.90, p=0.03) and higher internal (odds ratio=1.22, p=0.01) and lower external (odds ratio=0.77, p=0.02) doctors LOC-H scores compared with patients in the focal dystonia group. External powerful others LOC-G score was associated with functional impairment (regression co-efficient=-0.04, p=0.02). There were no effects of LOC on quality of life or disease severity. Conclusions: Patients with FMD exhibited high “within our control” internal general and health-specific frame of reference. LOC had no influence on quality of life or disease severity in this patient population.

Original languageEnglish (US)
Pages (from-to)67-72
Number of pages6
JournalJournal of Neuropsychiatry and Clinical Neurosciences
Issue number1
StatePublished - 2020
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health


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