Psychogenic stuttering in adults with and without neurologic disease

This retrospective study examined the demographic, speech, neurologic, and psychiatric characteristics of 49 people without and 20 people with neurologic disease who, as adults, developed stuttering-like dysfluencies attributable to psychological factors. In both groups, men and women were equally represented, age of onset was usually before age 60, and educational achievement approximated the national average. The duration of stuttering at the time of assessment varied from days to years. Stuttering most often was only one of a number of presenting complaints that raised concerns about organic disease in both groups. In those with confirmed neurologic disease, closed head injury, seizure disorder, and degenerative neurologic disease were the most common neurologic diagnoses; a relatively small number of patients had a history or current evidence of aphasia, apraxia of speech, or dysarthria. Conversion reaction, anxiety or hysterical neurosis, and depression were the most frequent psychiatric diagnoses across the two groups. About 70% of treated patients in both groups improved rapidly and dramatically during behavioral therapy, providing strong evidence of psychogenic etiology. The mechanisms that may lead to psychogenic stuttering, and the characteristics that may and may not help distinguish psychogenic from neurogenic stuttering, are discussed.