Catatonia: The Ultimate yet Treatable Motor Reaction to Fear in Autism

Abstract

Background: Catatonia is a unique syndrome characterized by specific motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, yet treatable if recognized early. Catatonia occurs in patients with various disorders including autism and related developmental disorders. Sometimes catatonia develops after severe psychological trauma, supporting the view that it is an extreme motor reaction to fear. Methods: Review of literature on the role of fear in the development of catatonia in autism, and its treatment. Results: There are no empirical studies in the literature addressing the role of fear in the development of catatonia in autism. Case-reports support that stressful events often precede the development of catatonia in autistic people and that catatonia in autism is a treatable syndrome, often requiring psychosocial interventions to reduce anxiety, and the use of benzodiazepines, electroconvulsive therapy, and maintenance electroconvulsive therapy for safe reversal. Autistic people may be particularly vulnerable to catatonia due to social, cognitive, and sensory deficits. Conclusion: Further studies are warranted in autistic people, measuring states of anxiety in response to various stressors, and assessing their relationship to catatonia, and applying various treatments including benzodiazepines, electroconvulsive therapy, and psychosocial interventions, in those with catatonia.