It is only 30 years ago since primary focal dystonias (PFD) such as blepharospasm and spasmodic torticollis, previously considered manifestations of psychiatric disease, were firmly reclassified as neurological disorders originating from basal ganglia dysfunction.1 Following this conceptual change, psychiatric comorbidity in patients with PFD was explained as resulting from the experience of pain and disfigurement. More recently, another conceptual change, this time in the opposite direction, has been brought about by the increased awareness of the important role of corticostriatal circuits in generating psychiatric symptoms and by the availability of well controlled studies of patients with PFD. Thus the psychiatric and …