ETD

• autism spectrum
• autistic traits
• borderline personality disorder
• catatonia spectrum
• mood symptoms
• suicidality

Background: Catatonia was first described by Kahlbaum as a motor and behavioral dysregulation syndrome, associated with mood, cognitive and neurovegetative symptoms. Subsequently, Kraepelin included catatonia into dementia praecox and later Bleuler coined the term “schizophrenia”. In the DSM-5 and, subsequently, in the DSM-5-TR, catatonia is described in the chapter of “Spectrum of Schizophrenia and Other Psychotic Disorders” where three main categories of catatonia are identified: “catatonia associated with another mental disorder”, “catatonic disorder due to another medical condition”, and “unspecified catatonia”. In particular, catatonia can be often associated with psychotic disorders, mood disorders and ASD (autism spectrum disorder). The modern definition of catatonia in the DSM-5-TR opens the boundaries to a dimensional approach that extends from the highest levels of stupor and excitement to the subthreshold attitudes. In this regard, the Catatonia Spectrum model considers catatonia as a trans-nosographic dimension that may be found in different psychiatric conditions, eventually following the continuous distribution of autistic traits, in the framework of an autistic-catatonic continuum. In our study we aimed to investigate, in a sample of patients with BPD (Borderline Personality Disorder), a population associated with a higher presence of autistic traits, mood spectrum symptoms and greater suicidality risk, the possible correlation between catatonic features and autism spectrum, mood symptoms and suicidality.

Methods: a total of 105 participants diagnosed with BPD completed three self-report instruments: the Catatonia Spectrum (CS), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), and the Mood Spectrum Self-Report (MOODS-SR). Based on the CS cut-off score of 30, participants were divided into two groups: a Catatonia group (CAT) and a No Catatonia group (No CAT). Statistical analyses included Student’s t-tests, Chi-square, and logistic regression analyses to identify clinical predictors of catatonic features.

Results: the CAT group was composed of 81 participants, the No CAT group was composed of 24 participants. The two groups were homogeneous in age and gender. BPD patients with life-time catatonic features scored significantly higher than those without in all AdAS Spectrum domains and total score. Individuals with clinically relevant ATs (autistic traits) and individuals who meet the threshold for clinically relevant ASD symptoms were significantly more likely to be included in the CAT group. Moreover, except for Manic Cognition domain, patients with a history of catatonic symptoms scored significantly higher than those without in all MOODS-SR domains including on MOODS-SR suicidality score. Individuals in the CAT group showed also suicidal ideation and suicidal behaviors in a significantly higher proportion. A logistic regression analysis showed that the presence of globally higher autistic symptoms, but not of globally higher mood symptoms, increase the likelihood of life-time catatonic features. MOODS-SR Depressive cognition and AdAS Spectrum Non-Verbal Communication domains were significant positive predictors of the inclusion in the CAT group.

Conclusion: the present study found an association between lifetime catatonic symptoms and the presence of both autistic traits and mood symptoms. While the specific dimension of depressive cognition appears to be associated with significant catatonic symptoms, when considered as a whole, only autistic symptoms, and not mood symptoms, were statistically predictive of catatonic features. These finding may highlight a closer association between autistic and catatonic spectrum, which seems to overcome the association between mood spectrum and catatonia.