There are many causes of tremor ranging from Parkinsonism to too much caffeine. One particularly common form is called essential tremor. It may affect various body parts such as the head and the voice, but it most commonly affects the hands. It is a fine tremor that goes away during sleep and typically diminishes or goes away when at rest.
It is this feature of resolution during sleep that has made some people question whether or not it is a psychosomatic disorder. This impression is reinforced because the tremor typically gets worse when the individual is stressed. However, this disorder is not a psychosomatic condition but a neurological one. Worsening of many biological illnesses during times of stress is not unusual and does not indicate that the disorder is purely psychological.
Essential tremor usually begins during middle age or older although it can occur at a younger age. One interesting feature is that the tremor may improve when drinking small amounts of alcohol. However, this is not a recommended treatment since excess alcohol may make it worse, and, more importantly, there is the risk of developing alcoholism, which is much worse.
It is necessary to distinguish essential tremor from other causes. If you have a tremor, it is important to see your doctor to determine the cause. In some cases, you may need to see a neurologist for a definitive diagnosis since they have special expertise.
There are some psychiatric illnesses that may include tremor as a symptom. Examples include anxiety disorders, stimulant abuse, or alcohol withdrawal. In these instances the tremor occurs in conjunction with other evidence of the underlying condition.
Essential tremor does not necessarily require treatment if it does not interfere with functioning or cause excessive embarrassment. In some cases treatment is only needed at certain times such as when it is necessary to sign a large number of papers. There is no medication that cures the disorder, but a class of medications called, beta blockers may reduce the tremor. Less commonly, an anti seizure medication may be used.
The bottom line is that essential tremor is a benign, fine tremor usually of the hands, which may begin on just one side but affects both sides over time. It is a neurological disorder that must be distinguished from other causes of tremor. There is no cure, but there are medications that can reduce the symptoms.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
