Abstract
Tremors in post‐traumatic stress disorders have not been previously well characterized. A 67‐year‐old man has a 46‐year history of a noiseinduced exaggerated startle reflex followed by a large amplitude rest, postural and kinetic tremor that may persist for up to 3 days. This tremor is superimposed on a continuous mild organic postural/kinetic tremor whose electrophysiological characteristics are different from those of the overlying tremor. We attribute the exaggerated startle reflex and the noise‐induced tremor to Post‐Traumatic Stress Disorder (PTSD) and postulate a psychogenic origin for the noise‐induced tremor. The patient alos believes the noise‐induced tremor to be psychologically based and to be produced by the fear and anxiety he experiences when he hears loud, unexpected noises. The sudden onset of the noise‐induced tremor, its intermittent character, its temporary disappearance on distraction despite the patient's inability to suppress it, inconsistencies in handwriting and figure drawing, and the fact that the noise‐induced tremor is stimulus specific and persists long after the offending stimulus (noise) is no longer present all suggest a tremor of psychogenic origin.