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Clinician and patient perceptions of free will in movement disorders: mind the gap
  1. Sandra MA van der Salm1,
  2. Daniëlle C Cath2,3,
  3. Anne-Fleur van Rootselaar1,
  4. Johannes HTM Koelman1,
  5. Rob J de Haan4,
  6. Marina AJ Tijssen5,
  7. Gerben Meynen6,7,8
  1. 1 Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Clinical Psychology, University of Utrecht, Utrecht, The Netherlands
  3. 3 GGZDrenthe, Department of Psychiatry, University Medical Center Groningen, The Netherlands
  4. 4 Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
  5. 5 Department of Neurology, University Medical Center Groningen, University of Groningen, The Netherlands
  6. 6 Department of Philosophy, Faculty of Humanities, VU University, Amsterdam, The Netherlands
  7. 7 Department of Criminal Law, Tilburg Law School, Tilburg University, Tilburg, The Netherlands
  8. 8 GGZ inGeest, Amsterdam, The Netherlands
  1. Correspondence to Sandra MA van der Salm, Academic Medical Center, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, Netherlands; smvandersalm{at}

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Most people perceive that their actions arise from their own ‘free will’, commonly defined as the ability to choose how to act.1 Neurological disorders, such as epileptic seizures and movement disorders, are often regarded as conditions in which free will is undermined.2 Clinically, an action is considered involuntary when it is automatically performed and cannot be controlled. Our study aim was to explore patients’ views as well as clinicians’ views on ‘free will’ and voluntariness in three hyperkinetic disorders: tics, functional movement disorders (FMD, previously ‘psychogenic’ movement disorder) and myoclonus. We developed a questionnaire to determine to what extent patients in these three groups consider their ‘free will’ to be undermined by the movements induced by their disorder. We compared these findings with clinicians’ views of voluntariness in each of these movement disorders.


The current study was part of a larger study on FMD, myoclonus and tics, encompassing a clinical and Bereitschaftspotential study (approved by the local ethics committee).3 4 Thirty-nine expert clinicians participated in a diagnostic study of 60 patients with FMD (n=28), myoclonus (n=15) or tics (n=17). Furthermore, 22 healthy control subjects were included.

Clinicians were provided with a 4-item questionnaire. Clinicians were asked to rate the degree of voluntariness on a 100 mm Visual Analogue Scale (VAS) ranging from 0 (completely involuntary) to 100 (completely voluntary) for different movements: (1) raising one’s hand to vote, (2) myoclonus, (3) …

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  • Contributors SvdS, DC and GM initiated and designed the study with RdH. SvdS collected the data. Data analysis was performed by SvdS, RdH and GM. SvdS drafted the first version of the manuscript. Data interpretation and writing of the manuscript was performed by all authors.

  • Funding Academic Medical Center Graduate School PhD stipend for SvdSalm.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.