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Resilience Mitigates the Link between Adverse Childhood Experiences and Musician’s Dystonia: A Neuroendocrine and Psychological Perspective Cover

Resilience Mitigates the Link between Adverse Childhood Experiences and Musician’s Dystonia: A Neuroendocrine and Psychological Perspective

Open Access
|Mar 2026

References

  1. Neychev VK, Gross RE, Lehéricy S, Hess EJ, Jinnah HA. The functional neuroanatomy of dystonia. Neurobiol Dis. 2011;42:185201. DOI: 10.1016/j.nbd.2011.01.026
  2. Schmidt A, Jabusch H-C, Altenmüller E, Hagenah J, Brüggemann N, Hedrich K, Saunders-Pullman R, Bressman SB, Kramer PL, Klein C. Dominantly transmitted focal dystonia in families of patients with musician’s cramp. Neurology. 2006;67:6913. DOI: 10.1212/01.wnl.0000230148.00035.f9
  3. Schmidt A, Jabusch H-C, Altenmüller E, Kasten M, Klein C. Challenges of Making Music: What Causes Musician’s Dystonia? JAMA Neurol. 2013;70:1456. DOI: 10.1001/jamaneurol.2013.3931
  4. Altenmüller E, Jabusch H-C. Focal dystonia in musicians: phenomenology, pathophysiology and triggering factors. Eur J Neurol. 2010;17:316. DOI: 10.1111/j.1468-1331.2010.03048.x
  5. Enders L, Spector JT, Altenmüller E, Schmidt A, Klein C, Jabusch H. Musician’s dystonia and comorbid anxiety: Two sides of one coin? Mov Disord. 2011;26:53942. DOI: 10.1002/mds.23607
  6. Jabusch H, Müller SV, Altenmüller E. Anxiety in musicians with focal dystonia and those with chronic pain. Mov Disord. 2004;19:116975. DOI: 10.1002/mds.20110
  7. Babić R, Babić M, Rastović P, Ćurlin M, Šimić J, Mandić K, Pavlović K. Resilience in Health and Illness. Psychiatr Danub. 2020;32:22632.
  8. VanMeter F, Cicchetti D. Resilience. Handb. Clin. Neurol. 173, Elsevier; 2020, pp. 6773. DOI: 10.1016/B978-0-444-64150-2.00008-3
  9. Fergus S, Zimmerman MA. ADOLESCENT RESILIENCE: A Framework for Understanding Healthy Development in the Face of Risk. Annu Rev Public Health. 2005;26:399419. DOI: 10.1146/annurev.publhealth.26.021304.144357
  10. Sisto A, Vicinanza F, Campanozzi LL, Ricci G, Tartaglini D, Tambone V. Towards a Transversal Definition of Psychological Resilience: A Literature Review. Medicina (Mex). 2019;55:745. DOI: 10.3390/medicina55110745
  11. Wu G, Feder A, Cohen H, Kim JJ, Calderon S, Charney DS, Mathé AA. Understanding resilience. Front Behav Neurosci. 2013;7. DOI: 10.3389/fnbeh.2013.00010
  12. Alpheis S, Altenmüller E, Scholz DS. Focal Dystonia and the Stress Network: The Role of Stress Vulnerability and Adverse Childhood Experiences in the Development of Musician’s Dystonia. In: Shaikh A, Sadnicka A, editors. Basic and Translational Applications of the Network Theory for Dystonia, vol. 31, Cham: Springer International Publishing; 2023, pp. 2344. DOI: 10.1007/978-3-031-26220-3_2
  13. Hu H, Chen C, Xu B, Wang D. Moderating and mediating effects of resilience between childhood trauma and psychotic-like experiences among college students. BMC Psychiatry. 2024;24:273. DOI: 10.1186/s12888-024-05719-x
  14. Zheng K, Chu J, Zhang X, Ding Z, Song Q, Liu Z, Peng W, Cao W, Zou T, Yi J. Psychological resilience and daily stress mediate the effect of childhood trauma on depression. Child Abuse Negl. 2022;125:105485. DOI: 10.1016/j.chiabu.2022.105485
  15. CDC. About Adverse Childhood Experiences. Adverse Child Exp ACEs 2024. https://www.cdc.gov/aces/about/index.html (accessed November 4, 2024).
  16. Murphy F, Nasa A, Cullinane D, Raajakesary K, Gazzaz A, Sooknarine V, Haines M, Roman E, Kelly L, O’Neill A, Cannon M, Roddy DW. Childhood Trauma, the HPA Axis and Psychiatric Illnesses: A Targeted Literature Synthesis. Front Psychiatry. 2022;13:748372. DOI: 10.3389/fpsyt.2022.748372
  17. Zhong X, Ming Q, Dong D, Sun X, Cheng C, Xiong G, Li C, Zhang X, Yao S. Childhood Maltreatment Experience Influences Neural Response to Psychosocial Stress in Adults: An fMRI Study. Front Psychol. 2020;10:2961. DOI: 10.3389/fpsyg.2019.02961
  18. Keller J, Gomez R, Williams G, Lembke A, Lazzeroni L, Murphy GM, Schatzberg AF. HPA axis in major depression: cortisol, clinical symptomatology and genetic variation predict cognition. Mol Psychiatry. 2017;22:52736. DOI: 10.1038/mp.2016.120
  19. Menke A. The HPA Axis as Target for Depression. Curr Neuropharmacol. 2024;22:90415. DOI: 10.2174/1570159X21666230811141557
  20. Zhou L, Wang T, Yu Y, Li M, Sun X, Song W, Wang Y, Zhang C, Fu F. The etiology of poststroke-depression: a hypothesis involving HPA axis. Biomed Pharmacother. 2022;151:113146. DOI: 10.1016/j.biopha.2022.113146
  21. Lackova Rebicova M, Dankulincova Veselska Z, Husarova D, Madarasova Geckova A, Jansen DEMC, Van Dijk JP, Reijneveld SA. Does Resilience Mediate the Association of Adverse Early Childhood Experiences With Emotional and Behavioural Problems? Int J Public Health. 2021;66:1604006. DOI: 10.3389/ijph.2021.1604006
  22. Lee SW, Bae GY, Rim H-D, Lee SJ, Chang SM, Kim B-S, Won S. Mediating Effect of Resilience on the Association between Emotional Neglect and Depressive Symptoms. Psychiatry Investig. 2018;15:629. DOI: 10.4306/pi.2018.15.1.62
  23. Mathieu J, Brunaud L, Reibel N, Moukah D, Witkowski P, Lighezzolo-Alnot J, Quilliot D, Ziegler O. Low resilience in severe obesity: marker of adverse childhood experiences and current psychological disorders. Eat Weight Disord – Stud Anorex Bulim Obes. 2022;27:350719. DOI: 10.1007/s40519-022-01488-2
  24. Ross N, Gilbert R, Torres S, Dugas K, Jefferies P, McDonald S, Savage S, Ungar M. Adverse childhood experiences: Assessing the impact on physical and psychosocial health in adulthood and the mitigating role of resilience. Child Abuse Negl. 2020;103:104440. DOI: 10.1016/j.chiabu.2020.104440
  25. Wingo AP, Wrenn G, Pelletier T, Gutman AR, Bradley B, Ressler KJ. Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. J Affect Disord. 2010;126:4114. DOI: 10.1016/j.jad.2010.04.009
  26. Comoletti S, Mercogliano C. Focal dystonia in musicians, a literature review. J Hand Ther. 2024:S0894113024000243. DOI: 10.1016/j.jht.2024.02.011
  27. Metz GA. Stress as a Modulator of Motor System Function and Pathology. Rev Neurosci. 2007;18. DOI: 10.1515/REVNEURO.2007.18.3-4.209
  28. Van Loon EM, Masters RSW, Ring C, McIntyre DB. Changes in Limb Stiffness Under Conditions of Mental Stress. J Mot Behav. 2001;33:15364. DOI: 10.1080/00222890109603147
  29. Baadjou V. Musculoskeletal complaints in musicians: epidemiology, phenomenology and prevention: proefschrift ter verkrijging van de graad van doctor aan de Universiteit van Maastricht. S.l.: Studio Michal Slawinski; 2018.
  30. Bird HA. Overuse syndrome in musicians. Clin Rheumatol. 2013;32:4759. DOI: 10.1007/s10067-013-2198-2
  31. Buma LA, Bakker FC, Oudejans RRD. Exploring the thoughts and focus of attention of elite musicians under pressure. Psychol Music. 2015;43:45972. DOI: 10.1177/0305735613517285
  32. Oudejans RRD, Spitse A, Kralt E, Bakker FC. Exploring the thoughts and attentional focus of music students under pressure. Psychol Music. 2017;45:21630. DOI: 10.1177/0305735616656790
  33. Perkins R, Reid H, Araújo LS, Clark T, Williamon A. Perceived Enablers and Barriers to Optimal Health among Music Students: A Qualitative Study in the Music Conservatoire Setting. Front Psychol. 2017;8:968. DOI: 10.3389/fpsyg.2017.00968
  34. Yoshie M, Kudo K, Ohtsuki T. Effects of Psychological Stress on State Anxiety, Electromyographic Activity, and Arpeggio Performance in Pianists. Med Probl Perform Art. 2008;23:12032. DOI: 10.21091/mppa.2008.3024
  35. Altenmüller E, Jabusch H-C. Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art. 2010;25:39. DOI: 10.21091/mppa.2010.1002
  36. Ioannou CI, Furuya S, Altenmüller E. The impact of stress on motor performance in skilled musicians suffering from focal dystonia: Physiological and psychological characteristics. Neuropsychologia. 2016;85:22636. DOI: 10.1016/j.neuropsychologia.2016.03.029
  37. Schuele S, Lederman RJ. Long-term outcome of focal dystonia in string instrumentalists. Mov Disord. 2004;19:438. DOI: 10.1002/mds.10647
  38. Munts AG, Koehler PJ. How psychogenic is dystonia? views from past to present. Brain. 2010;133:155264. DOI: 10.1093/brain/awq050
  39. Alpheis S, Sinke C, Burek J, Krüger THC, Altenmüller E, Scholz DS. Stress in Musicians with and Without Focal Dystonia Is Not Reflected in Limbic Circuit Activation. Mov Disord. 2024:mds.29941. DOI: 10.1002/mds.29941
  40. Connor KM, Davidson JR. T. Connor–Davidson Resilience Scale. 2012. DOI: 10.1037/t06346-000
  41. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:7682. DOI: 10.1002/da.10113
  42. Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L, Medrano M, Desmond D, Zule W. Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl. 2003;27:16990. DOI: 10.1016/S0145-2134(02)00541-0
  43. Wingenfeld K, Spitzer C, Mensebach C, Grabe H, Hill A, Gast U, Schlosser N, Höpp H, Beblo T, Driessen M. Die deutsche Version des Childhood Trauma Questionnaire (CTQ): Erste Befunde zu den psychometrischen Kennwerten. PPmP – Psychother. Psychosom. Med Psychol. 2010;60:44250. DOI: 10.1055/s-0030-1247564
  44. Dedovic K, Renwick R, Mahani NK, Engert V, Lupien SJ, Pruessner JC. The Montreal Imaging Stress Task: using functional imaging to investigate the effects of perceiving and processing psychosocial stress in the human brain. J Psychiatry Neurosci JPN. 2005;30:31925. DOI: 10.1139/jpn.0541
  45. Reilly EB, Gunnar MR. Neglect, HPA axis reactivity, and development. Int J Dev Neurosci. 2019;78:1008. DOI: 10.1016/j.ijdevneu.2019.07.010
  46. R Core Team (RCT). R: A Language and Environment for Statistical computing; 2020.
  47. Wasserstein RL, Lazar NA. The ASA Statement on p-Values: Context, Process, and Purpose. Am Stat. 2016;70:12933. DOI: 10.1080/00031305.2016.1154108
  48. Bürkner P-C. brms: An R Package for Bayesian Multilevel Models Using Stan. J Stat Softw. 2017;80. DOI: 10.18637/jss.v080.i01
  49. Alpheis S, Altenmüller E, Scholz DS. Influence of Adverse Childhood Experiences and Perfectionism on Musician’s Dystonia: a Case Control Study. Tremor Hyperkinetic Mov. 2022;12:8. DOI: 10.5334/tohm.687
  50. Vehtari A, Gelman A, Gabry J. Practical Bayesian model evaluation using leave-one-out cross-validation and WAIC. Stat Comput. 2017;27:141332. DOI: 10.1007/s11222-016-9696-4
  51. Ioannou CI, Altenmüller E. Psychological characteristics in musician’s dystonia: A new diagnostic classification. Neuropsychologia. 2014;61:808. DOI: 10.1016/j.neuropsychologia.2014.05.014
  52. Kranick S, Ekanayake V, Martinez V, Ameli R, Hallett M, Voon V. Psychopathology and psychogenic movement disorders. Mov Disord. 2011;26:184450. DOI: 10.1002/mds.23830
  53. Schmidt A, Jabusch H-C, Altenmüller E, Hagenah J, Brüggemann N, Lohmann K, Enders L, Kramer PL, Saunders-Pullman R, Bressman SB, Münchau A, Klein C. Etiology of musician’s dystonia: Familial or environmental? Neurology. 2009;72:124854. DOI: 10.1212/01.wnl.0000345670.63363.d1
  54. Passarotto E, Worschech F, Altenmüller E. The effects of anxiety on practice behaviors and performance quality in expert pianists. Front Psychol. 2023;14:1152900. DOI: 10.3389/fpsyg.2023.1152900
  55. Corr R, Pelletier-Baldelli A, Glier S, Bizzell J, Campbell A, Belger A. Neural mechanisms of acute stress and trait anxiety in adolescents. NeuroImage Clin. 2021;29:102543. DOI: 10.1016/j.nicl.2020.102543
  56. Koumantarou Malisiova E, Mourikis I, Darviri C, Nicolaides NC, Zervas IM, Papageorgiou C, Chrousos GP. Hair cortisol concentrations in mental disorders: A systematic review. Physiol Behav. 2021;229:113244. DOI: 10.1016/j.physbeh.2020.113244
  57. Russell G, Lightman S. The human stress response. Nat Rev Endocrinol. 2019;15:52534. DOI: 10.1038/s41574-019-0228-0
  58. Iob E, Steptoe A. Cardiovascular Disease and Hair Cortisol: a Novel Biomarker of Chronic Stress. Curr Cardiol Rep. 2019;21:116. DOI: 10.1007/s11886-019-1208-7
  59. Litteral V, Migliozzi R, Metzger D, McPherson C, Saldanha R. Engineering a Cortisol Sensing Enteric Probiotic. ACS Biomater Sci Eng. 2023;9:516375. DOI: 10.1021/acsbiomaterials.2c01300
  60. Altenmüller E. Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians. Hand Clin. 2003;19:52338. DOI: 10.1016/S0749-0712(03)00043-X
  61. Worschech F, Großbach M, Bläsing B, Altenmüller E. Elevated Forearm Coactivation Levels and Higher Temporal Variability in String Players with Musicians’ Dystonia During Demanding Playing Conditions. Med Probl Perform Art. 2020;35:1927. DOI: 10.21091/mppa.2020.1003
  62. Carpenter LL, Carvalho JP, Tyrka AR, Wier LM, Mello AF, Mello MF, Anderson GM, Wilkinson CW, Price LH. Decreased Adrenocorticotropic Hormone and Cortisol Responses to Stress in Healthy Adults Reporting Significant Childhood Maltreatment. Biol Psychiatry. 2007;62:10807. DOI: 10.1016/j.biopsych.2007.05.002
  63. Elzinga BM, Roelofs K, Tollenaar MS, Bakvis P, Van Pelt J, Spinhoven P. Diminished cortisol responses to psychosocial stress associated with lifetime adverse events. Psychoneuroendocrinology. 2008;33:22737. DOI: 10.1016/j.psyneuen.2007.11.004
  64. Hakamata Y, Suzuki Y, Kobashikawa H, Hori H. Neurobiology of early life adversity: A systematic review of meta-analyses towards an integrative account of its neurobiological trajectories to mental disorders. Front Neuroendocrinol. 2022;65:100994. DOI: 10.1016/j.yfrne.2022.100994
  65. Heim C, Ehlert U, Hellhammer DH. The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology. 2000;25:135. DOI: 10.1016/S0306-4530(99)00035-9
  66. Baldwin JR, Reuben A, Newbury JB, Danese A. Agreement Between Prospective and Retrospective Measures of Childhood Maltreatment: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2019;76:584. DOI: 10.1001/jamapsychiatry.2019.0097
DOI: https://doi.org/10.5334/tohm.1161 | Journal eISSN: 2160-8288
Language: English
Submitted on: Dec 29, 2025
|
Accepted on: Feb 19, 2026
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Published on: Mar 13, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2026 Julian Burek, Stine Alpheis, Christopher Sinke, Tillmann H. C. Krüger, Michael Großbach, Daniel S. Scholz, Florian Worschech, André Lee, Eckart Altenmüller, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.