Unifying Concepts

Diagnostic Criteria for Catatonia

Catatonia has a complex presentation that is composed of multiple signs and symptoms, of which only three need to be present for diagnosis. It may be thought of as occurring with schizophrenia or with mania; however, patients in other settings with various general medical health conditions may develop an episode of catatonia. It is essential to identify catatonia early on for treatment to protect the patient from developing any further complications. A number of medical conditions can mask catatonia, delaying its treatment.

The diagnostic criteria for catatonia in the current DSM-5 require three or more of the following symptoms: stupor, waxy flexibility, catalepsy, mutism, posturing, negativism, stereotypes, mannerisms, grimacing, agitation, echopraxia, and echolalia. These diagnostic criteria apply to both adults and children, but in children, catatonia often presents as a result of somatic conditions or substance use.


Diagnostic Criteria for Catatonia
1 Stupor No psychomotor activity; not actively relating to environment
2 Catalepsy Passive induction of a posture held against gravity
3 Waxy flexibility Slight, even resistance to positioning by examiner
4 Mutism No, or very little, verbal response not related to an aphasia
5 Negativism Opposition or no response to instructions or external stimuli
6 Posturing Spontaneous and active maintenance of a posture against gravity
7 Mannerism Odd, circumstantial caricature of normal actions
8 Stereotypy Repetitive, abnormally frequent, non–goal-directed movements
9 Agitation Agitation not influenced by external stimuli
10 Grimacing Painful or aggressive facial expression
11 Echolalia Mimicking another’s speech
12 Echopraxia Mimicking another’s movements


  1. Edinoff AN, Kaufman SE, Hollier JW, Virgen CG, Karam CA, Malone GW, Cornett EM, Kaye AM, Kaye AD. Catatonia: Clinical Overview of the Diagnosis, Treatment, and Clinical Challenges. Neurol Int. 2021 Nov 8;13(4):570-586. [Medline]
  2. Heckers S, Walther S. Catatonia. N Engl J Med. 2023 Nov 9;389(19):1797-1802. [Medline]
Created Mar 13, 2024.
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