Asked if they feel nervous, some people respond by holding up their unshaking hands, watching them a few seconds and saying, "I don't think so. They look steady to me!" This unexpected answer illustrates confusion many people have about anxiety, tremors, and what they have to do with each other.

A psychiatrist friend proposed a useful labeling system. He refers to internal states of anxiety, worry and upset as "inner nerves." By contrast, when outward, visible tremulousness is present, he calls that "outer nerves." The distinction is important because causes and treatments of "inner nerves" and "outer nerves" are almost entirely different from each other.

It's not hard to see where confusion arises. Most people with tremulousness experience worsening of their shaking in states of high emotion, like anger, fear—-or even joy. They notice improvement in tremor when they are feeling unstressed, and their companions see their tremoring disappear completely when they sleep. Yet, it's not emotional states that caused tremor. Instead, emotions just increased or decreased a tremor that was already there for another reason.

Although tremor can occur in almost any part of body, shaking of hands is most common and can be caused by a variety of conditions. Tremors can also vary in their appearance, and appearance of tremor can narrow down list of possibilities.

Here are three basic tremor patterns:

#1. Tremors most evident while hands are at rest. A typical situation is that hands shake worse while in person's lap than while in air or when put to use. This pattern is seen most often with Parkinson's disease or with medications that can produce a Parkinson-like condition, including most antipsychotic and anti-nausea drugs.