Posture, Gestures and Mannerisms

The word attitude is most often used in psychiatry Opens in new window to denote a patient’s posture or position rather than his personal viewpoint.

In cases of catatonic schizophrenia, where a client’s preoccupation with overwhelming incapacitating ideas or perceptions has rendered him unresponsive, this unresponsiveness may be accompanied by prolonged, stereotyped, postures.

A.     Manneristic and Stereotyped Postures

A patient’s posture may sometimes be described as manneristic or stereotyped. Conventionally, manneristic postures differ from stereotyped postures in that the former are not rigidly maintained.

1. Catatonic posturing

The term catatonic posturing describes the voluntary assumption of an inappropriate or bizarre posture which is usually held for a long period of time. For example, a patient standing with arms out-stretched as if he were Jesus on the cross.

2. Body maintained in a semi-rigid position (“waxy rigidity”)

The terms catalepsy and catatonic waxy flexibility— and, also, the latter’s Latin variant, flexibilitas cerea— are synonymous.

They describe a physical state of sudden onset in which the muscles of the face, body and limbs are maintained by increased muscle tone in a semi-rigid position, possibly for several hours, during which time neither expression or body position changes.

Voluntary movement and sensibility are suspended, respiration and pulse are slowed, and body temperature falls. The affected person’s limbs can be moulded into any position. When moved in this way, they feel as if made of a pliable wax which enables these externally imposed postures to be maintained. Phenomena of the kind described are observed in catatonic schizophrenia Opens in new window and a number of other conditions.

3. Body maintained in a rigid position (“iron-pipe rigidity”)

Waxlike postures may also appear with rigid rather than flexible musculature. Consequently, a distinction is sometimes drawn between flexible and rigid catalepsy (catatonic or iron-pipe rigidity). In the former case, a posture is assumed at the slightest external prompting; in the latter, the patient’s self-assumed posture resists external attempts at modification and is maintained by the person against all efforts to be moved.

B.    Mannerisms, Gestures or Rituals

A person’s mannerisms, gestures or rituals may sometimes be highly distinctive and strikingly unusual.

1. Mannerisms and Gestures

A mannerism is a gesture or expression peculiar to a person, such as an odd way of walking or eating. If the mannerism involves taking up an idiosyncratic posture, rather than idiosyncratic movement, it may be referred to as a manneristic posture (supra).

Mannerisms differ from spontaneous, involuntary, movements (dyskinesias) in that they are voluntary, if idiosyncratic, movements. They differ from stereotyped behavior in that the latter is carried out in an unvarying, repetitive, manner and is not goal-directed.

2. Repetitive or imitative behavior

While manneristic behavior is directed towards some goal (i.e., eating), stereotypy is not. Stereotyped behavior, or stereotypy, is the constant, almost mechanical repetition of an action. For example, pacing the same circle each day, head-banging, rocking or repetitive hand movements, or repeating some phrase over many weeks or months.

Stereotyped movements are often rhythmic. Echopraxia, which is sometimes a feature of catatonic schizophrenia, refers to the imitative repetitive copying of the movements of another person.

3. Negativism (contrary behavior) and catatonic negativism

Negativism is opposition or resistance, whether covert or overt, to outside suggestions or advice. For example, a person drops his arm when asked to raise it.

Catatonic negativism is a resistance to all instructions or attempts to be moved. The person may do the opposite of what is asked, firmly clenching the jaws in response to being asked to open his mouth.

4. Automatic obedience (command automatism)

The opposite of negativism is automatic compliance which may be so marked that the individual does more than is required to comply with any instructions.

For example, a person who is asked to raise an arm raises both of them in an exaggerated manner. Such undue or automatic compliance is associated with catatonic syndromes and hypnotic states.

5. Compulsive or ritualistic behavior

A compulsion is an irresistible impulse to perform an irrational act. The individual experiences a powerful urge to act or behave in a way he recognizes is irrational or senseless and which he attributes to subjective necessity rather than to external influences. Performing the particular act may relieve tension.

Compulsive behavior may be attributable to obsessional ideas. For example, a young adult may become obsessed with the idea that his shoelaces must be perfectly tied, continually retying them for twenty minutes, and unable to move on to the next stage of dressing until this objective has been achieved; or he may continually close the refrigerator door until it eventually makes the “right” sound.

6. Compulsive acts and obsessive thoughts

It can be seen that the terms “obsession” and “compulsion” are not synonymous. The former refers to a thought and the latter to an act. Obsessions are recurrent, persistent ideas, thoughts, images, or impulses that are not experienced as voluntarily produced but as ideas, urges or representations which invade consciousness.

A thought may properly be described as “obssessional” if a person cannot prevent himself from repeatedly, insistently, having that thought albeit that the content of the thought is not delusional in nature. Obsessive thoughts lie behind compulsive acts, and stereotyped or manneristic behavior, but they may exist without being externally manifested in the form of an observable repetitive action.