Autistic Catatonia a thing?

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Just when you think you’ve read it all, here comes another condition that is said to be related to autism: catatonia. If you haven’t heard yet, autism and catatonia have been closely studied to understand their comorbid occurrence and, from what we currently know, unfortunately, it does appear to be true that there’s some crossover.

Catatonia is an underrecognized debilitating syndrome with long-lasting effects. Its symptoms are diverse and quite challenging

Catatonia is a complex neuro psychological disorder characterized by psychomotor disturbances and global symptoms including stupor, waxy flexibility, and mutism lasting more than one hour (Quilliam, et al., 2020). And recently, there’s been more and more research linking catatonia to autism.
The experience of autistic catatonia is ill-understood and not easily diagnosed despite it dating back 20 years (Burns, et al. 2021). The reason being that it is difficult to recognize and its symptoms vary. This is in part due to fluctuations in severity and the features of both autism disorder and catatonia.
Classic (stupor) and excited catatonia are two common forms of the condition:
Excited or malignant catatonia is identified by motor restlessness and severe psychomotor agitation, potentially leading to life-threatening complications such as hyperthermia, altered consciousness, and autonomic dysfunction, including some symptoms of classic catatonia (Rasmussen, Mazurek, & Rosebush, 2016)
Classic (stupor) catatonia is characterized by immobility, staring, mutism, rigidity, withdrawal, and refusal to eat, along with more unusual features such as posturing, grimacing, negativism, waxy flexibility, echolalia or echopraxia, stereotypy, verbigeration, and automatic obedience (Rasmussen, Mazurek, & Rosebush, 2016)
It is advised that excited catatonia be considered a medical emergency and a condition called neuroleptic malignant syndrome (NMS) could be considered a form of malignant catatonia. NMS is a life-threatening neurological condition that is linked to the use of antipsychotic agents. Its symptoms are “characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia (disorders of the autonomic nervous system)”. (Wijdicks, E.F.M., 2021)

The risk factors of developing autistic catatonia are still under investigation. Some hypotheses suggest it could be linked to a “reaction to extreme fear, interpersonal conflict, a tragic event, or following a significant loss” but the direct cause or pathophysiology is unknown (Quilliam, et al., 2020). Some may be predisposed to genes on chromosomes 15 and 22 (Quilliam, et al., 2020).

What does autistic catatonia look like?
Symptoms of autistic catatonia can easily be missed because they’re so similar to symptoms of standard autistic behavior such as repetitive and restrictive behavior, fixation, difficulty making eye contact, to name a few.
While catatonia is found to be related to autism and is termed “autistic catatonia”, the symptoms of autistic catatonia are much more severe. Individuals with autistic catatonia experience symptoms such as obsessive compulsions, repetitive purposeless behaviors, and unresponsiveness to the external world.
Clinicians can detect signs of catatonia by observing symptoms such as psychomotor delay and weight loss, plus many patients show signs of stupor alternating with excitement. Additionally, psychosis is observed in about 75% of patients with catatonia.
When there’s comorbidity with autism, catatonia, and psychosis, this combination is called the “Iron Triangle” and, according to Shorter & Wachtel, (2013), psychosis is strongly linked to autistic catatonia.

The link between catatonia and autism
Currently, the prevalence rate of catatonia in psychiatric units is estimated at five to 20% and the rate of comorbid catatonia in autism or autistic catatonia is 12 to 20% (Burns, et al. 2021).
Unfortunately, it is difficult to recognize catatonic symptoms in individuals with ASD because, firstly, there are 40 different symptoms of catatonia, secondly, the overlap between autism and catatonia creates difficulty for obtaining a diagnosis.

Yes it's a thing. For sure it is!

I haven't had an episode in quite a while but I've had it from trauma as well as sensory burnout and BFRB.

Body-Focussed Repetitive Behaviours