What is the definition of mannerisms in psychiatry?

Definition of Mannerisms in Psychiatry

Mannerisms are non-contextual peculiarities or pathologically exaggerated forms of goal-directed activities that appear odd, stilted, or bizarre in their execution, representing one of the core psychomotor disturbances seen in catatonia and other psychiatric disorders. 1

Core Characteristics

Mannerisms differ fundamentally from stereotypies in that they involve peculiar modifications of purposeful movements rather than simple repetitive actions. 2 Key distinguishing features include:

• Contextual inappropriateness: The behavior serves a recognizable purpose but is executed in an exaggerated, overdrawn, or bizarre manner 3
• Communicative dysfunction: From an ethological perspective, mannerisms represent pathologically altered forms of ritualized behavior that fail in their communicative purpose, leading to social withdrawal and rejection 3
• Complexity: Mannerisms can manifest as complex behavioral patterns, not merely simple motor movements—examples include refusing to shake hands in peculiar ways, elaborate eating rituals, or unusual patterns of speech delivery 4, 2

Clinical Context

Mannerisms are most prominently recognized as one of the defining symptoms of catatonia, where they appear alongside other psychomotor disturbances including stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, stereotypies, psychomotor agitation, grimacing, echolalia, and echopraxia. 1, 5

Beyond catatonia, mannerisms occur in:

• Autism spectrum disorder: Described as motor mannerisms alongside restricted interests and stereotyped movements 1
• Schizophrenia: Particularly in systematic forms like manneristic catatonia, where they may develop from obsessive-compulsive ideas that lose their distress component but persist as repetitive peculiar behaviors 4
• Various psychotic disorders: Where they represent unconscious communications and deeper psychopathological processes 6

Pathophysiology and Development

Mannerisms may develop through a progression where obsessive or compulsive behaviors lose their associated distress but evolve into stereotyped peculiar patterns. 4 The underlying mechanisms involve:

• Altered brain metabolism and disturbed perceptivity of social signals 3
• Possible involvement of frontostriatal circuitry and basal ganglia dysfunction 7
• Deviations in prenatal brain maturation in some cases, particularly in manneristic catatonia 4

Clinical Recognition Framework

To properly identify mannerisms, examine three critical factors: 2

1. Normative reference: Compare the behavior against age-appropriate, culturally-appropriate, and contextually-appropriate norms
2. Behavioral context: Assess whether the activity serves a recognizable purpose but is executed peculiarly
3. Pathological process: Identify the non-contextual peculiarity that distinguishes it from normal variation

Common Pitfalls

The term "mannerism" is frequently confused with stereotypies or used interchangeably with general "bizarreness," leading to diagnostic imprecision. 3, 2 Critical distinctions:

• Stereotypies are non-contextual repetitive activities without apparent purpose 2
• Mannerisms are non-contextual peculiarities of otherwise purposeful activities 2
• Both require recognition of their complexity beyond simple motor movements 2

Mannerisms in conditions like manneristic catatonia are typically refractory to psychopharmacological treatment, including high-dose neuroleptics, making behavioral rehabilitation the treatment of choice. 4