The impact of botulinum toxin injection on psychological function was assessed in 26 patients with idiopathic torticollis. Eighty five per cent of the patients and 88% of the relatives considered torticollis to be better following the injections. Symptomatic improvement with the injections was associated with significant reduction of depression and disability, but non-significant improvement in body concept, and self-esteem. This concordant pattern of change in symptoms and psychological function with the injections supports the proposal that in torticollis depression and disability are consequences of the postural abnormality of the head.