We would like to present a unique case of the emergence of psychogenic akathisia, described as a conversion disorder, in a patient undergoing longstanding treatment for tardive akathisia. This is the case of a 54-year-old-female with generalized anxiety disorder, dysthymia, and dependent personality traits, complicated by a learning disability and prior alcoholism, with past episodes of psychosis. First hospitalized at 25, she experienced akathisia on numerous trials of typical neuroleptics. Subsequent psychotic episodes necessitated the re-addition of low-dose chlorpromazine but akathisia did not recur. However, tardive akathisia emerged twenty years later, and through joint treatment by neurology and psychiatry, she was eventually maintained on clozapine and clonazepam after several unsuccessful medication trials. These medications gave some relief but she retained a severe decline in her functioning. Eight years later, when admitted for a trial of ECT, the neurology consult team determined her symptoms were no longer consistent with tardive akathisia, but rather consistent with a psychogenic movement disorder. Clozapine was slowly discontinued and management of her anxiety became the focus of treatment. The patient was left with residual periodic akathetic-like movements and was given a new diagnosis of psychogenic akathisia. In the months since discharge, her abnormal movements have decreased while her social functioning has improved.