What Is Echopraxia? Definition, Causes, & Treatments

What Is Echopraxia?

Echopraxia is the repetition or direct imitation of someone else’s movements, gestures, or facial expressions. Sometimes, it can coincide with echolalia, which refers to speech repetition.² It’s notably associated with schizophrenia but can be present in various behavior, mood, cognitive, and psychotic disorders. It’s also common amongst gestalt language processors.

Echopraxia often appears in individuals with:

• Schizophrenia
• Autism
• Tourette’s Syndrome
• Autoimmune disorders
• Epilepsy
• Major neurocognitive disorder (dementia)

Signs of Echopraxia

Everyone occasionally mirrors movements and actions to socialize with others. It’s also part of social learning in childhood. Children often copy others as a way of understanding the world. However, involuntary actions that persist into adolescence or adulthood may indicate the presence of echopraxia. Echopraxia happens automatically, and it exists independently of the individual’s insight.³

Signs of echopraxia include:

• Mimicking actions from TV shows and/or movies
• Copying authoritative figures in school or the workplace
• Imitating others’ actions during the same conversation

The Connection Between Echopraxia & Other Disorders

Echopraxia is considered more of a symptom than a condition. It’s relatively rare, and it can be affected by a number of factors and stressors. Researchers are still examining the specific nature of how echopraxia correlates with other disorders. Therefore, the link between echopraxia and its associated disorders is not yet well understood.

Schizophrenia & Echopraxia

People with schizophrenia often exhibit poor social skills and disorganized thoughts and speech. With that, there is a high correlation between schizophrenia and echopraxia, with one study suggesting that nearly 30% of people with schizophrenia have echopraxia.⁴ This symptom may be more common when someone with schizophrenia experiences difficulties with communication.

Tourettes & Echopraxia

The average onset of Tourette syndrome is 7 years, and motor tics generally occur before vocal tics. Echopraxia is a core feature of Tourette syndrome, and its presence may be one of the first indicators of the condition. Echopraxia may be the representation of a cluster of tics where the brain’s frontal lobe becomes interfered.¹

Autism & Echopraxia

Echopraxia can be a feature of autism, although it’s less common than echolalia. An autistic person with echolalia will copy specific accents, dialects, and language verbatim. Autism may coincide with having fewer mirror neurons or structural changes within the mirror neurons, which may contribute to communication differences.¹

Echolalia & Echopraxia

Echolalia and echopraxia are both symptoms that can occur together or independently in several different conditions. They may also be a part of neurodivergence. When present together, one of the symptoms may be more dominant than the other. In each case, either echolalia or echopraxia can be repetitive, delayed, or contextual (related to the current situation).

Catatonia & Echopraxia

Catatonia refers to little to no reaction to outside surroundings. People with catatonia may have a distorted range of movement, and their behavior presents as abnormal. They may be highly excited/hyperkinetic or highly withdrawn/hypokinetic. It can occur in both psychiatric and neurological conditions, and echopraxia is one of the twelve symptoms of catatonia.⁵

Echopraxia Diagnosis

There isn’t a specific, comprehensive test that assesses for echopraxia. It is not diagnosed in young children (because imitation is highly common among babies and toddlers). But, in older children, teenagers, or adults, the urges feel uncontrollable and automatic. A doctor may diagnose echopraxia by observing symptoms and taking a thorough medical history.

The diagnosis process for echopraxia may include:

• Medical history analysis: It’s important to assess an individual’s medical history to determine if echopraxia is a result of other underlying (or unknown) health conditions.
• Psychological evaluation:  Because echopraxia is associated with different neurological and psychiatric conditions, this evaluation helps get a clearer picture of the symptom presentation.
• Family interviews: Parents may be asked to discuss their observations with a medical professional on behalf of their child or adolescent.

Treatment Options for Echopraxia

Echopraxia is not inherently problematic and should never be shamed. That said, there are no specific treatments aimed at treating echopraxia on its own. Instead, treatment is focused on the disorders that are associated with this particular symptom. Treatment methods will vary based on the type of condition, its severity, and any other co-occurring conditions.

Therapy options for echopraxia include:

• Cognitive behavioral therapy: CBT alone may not stop echopraxia, but it may help reduce stress or other associated problems, such as anxiety, depression, or low self-esteem.
• Habit reversal training: Habit reversal training is a type of behavioral therapy for people who want to eliminate certain behaviors or habits, such as echopraxia.

Medication options for echopraxia include:⁶

• Antipsychotic medications: Antipsychotic medications may be prescribed as a way to help reduce or eliminate the tics associated with Tourette syndrome.
• Benzodiazepines: Some research suggests that benzodiazepines may be helpful for managing tics, behavioral symptoms, or anxiety underlying impulse control issues. That said, benzodiazepines are recommended only as a short-term treatment, as they can be habit-forming.⁶
• Antidepressants: Antidepressants, such as SSRIs, may be recommended for people experiencing depression or anxiety that coincides with or exacerbates their echopraxia.

Medical procedures for echopraxia symptoms in severe psychotic disorders include:

• Electroconvulsive therapy: Electroconvulsive therapy is a medical treatment that induces small, brief seizures to help rewire the brain safely.
• Transcranial magnetic stimulation: Transcranial magnetic stimulation uses magnets to stimulate nerve cells in the brain. It’s highly targeted but non-invasive, and the magnetic pulses can teach neurons how to fire effectively together.

When to Seek Professional Support

Echopraxia is not inherently dangerous. However, it can coincide with social challenges, especially if other people don’t understand the symptoms or feel offended by someone imitating them. People with echopraxia may feel insecure or depressed as a result. If you or a loved one is struggling, it may be beneficial to seek professional support.

It’s important to work with a skilled therapist specializing in the specific condition (i.e. schizophrenia or autism). You can look for a provider using an online therapist directory or online therapy platform. Consider consulting with a psychiatrist to discuss medication options- online psychiatrist options are also available for ongoing medication management.