With waxy flexibility, a person’s limbs respond like a warm candlestick being moved and positioned.

Waxy flexibility is a relatively rare symptom typically seen in catatonia, a condition that disrupts a person’s awareness of the world and their ability to move and communicate.

Waxy flexibility is not a diagnosis in itself, but rather it indicates the presence of an underlying mental health condition or neurological disorder.

Learn more about what causes waxy flexibility and treatments available below.

Waxy flexibility is a psychomotor symptom that’s typically seen in catatonia, a condition in which individuals appear mostly unresponsive to their environment even though they’re awake.

Waxy flexibility is so named because if you were to move the limbs of a person with this condition, you’d be met with slight resistance, but their limbs would quickly give way and bend as if they were a malleable wax figure.

The individual would then stay in that position until you moved them again — a symptom known as catalepsy.

Waxy flexibility and catatonia

Catatonia — and thus, waxy flexibility — is typically seen in people with mental health conditions such as schizophrenia and mood disorders. Catatonia may also appear in neurological disorders such as Huntington’s disease, Parkinson’s disease, or encephalitis.

When a person has waxy flexibility, other catatonic symptoms are usually present, such as:

  • stupor (lower response to external behavior)
  • mutism (inability to speak)
  • immobility

Waxy flexibility is just one symptom of catatonia.

While waxy flexibility specifically refers to slight resistance to being moved, it’s very often seen with other symptoms of catatonia, including the following:

  • Mutism: being verbally unresponsive
  • Staring: having a fixed gaze
  • Catalepsy: experiencing a marked loss of voluntary motion in which limbs remain in whatever position they’re placed
  • Stupor: having a reduced response to the environment
  • Immobility: experiencing the inability ability to move muscles; resistance to being moved
  • Posturing: maintaining a position for a long time
  • Grimacing: having distorted facial expressions

The exact cause of waxy flexibility is not fully understood. It may be linked to dysfunction in the central nervous system, particularly in areas of the brain that control movement and behavior.

Waxy flexibility is a symptom of catatonia, which is also not well understood. However, abnormalities in certain neurotransmitters, particularly GABA (gamma-aminobutyric acid), appear to play a role.

For instance, researchers theorize that there is decreased GABA activity in the brains of people with catatonia. Researchers have also found that catatonia sometimes occurs due to withdrawal from benzodiazepines and alcohol, both of which act on GABA receptors.

In addition, research from 2014 reveals that benzodiazepines (drugs that act on GABA receptors) are the most effective medications for treating catatonia.

Having a medical condition, mental health condition, or neurological disorder can put you at greater risk for catatonia.

Some evidence shows that about 20% of people with catatonia have schizophrenia, while 45% have symptoms of a mood disorder (such as bipolar disorder) or medical condition.

Up to 25% of people with catatonia have a significant medical or neurological condition that contributes to their catatonic state.

This may include the following conditions:

Catatonia has also been reported in association with substance use, antipsychotics (medications used to treat schizophrenia), and opiates. It may also occur from withdrawal from benzodiazepines and dopaminergic drugs.

Similar to other mental health conditions, environment and genetics may also contribute to the development of catatonia.

In particular, genes appear to play a role in the development of catatonia in schizophrenia. For example, a 2019 case study reveals that two biological brothers developed similar signs and symptoms of catatonic schizophrenia.

Treatment for waxy flexibility requires treating the underlying illness, which is typically catatonia.

First, if a person with catatonia has been taking antipsychotic medications, a doctor may recommend that that person stop taking them temporarily, as the medication may be making symptoms worse.

Catatonia is usually treated first with benzodiazepines. In a 2012 study of 107 people, 2 in 3 of the participants with catatonia responded sufficiently to lorazepam.

Another common treatment is electroconvulsive therapy (ECT). It appears that catatonia in mood disorders is more responsive to ECT than catatonia in schizophrenia.

The largest review of catatonia in schizophrenia and ECT as treatment to date was conducted in 1974. It showed that about 53% of people with catatonic schizophrenia responded well to ECT.

Some evidence from 2011 suggests that the presence of waxy flexibility in catatonia may represent a faster response to ECT.

Waxy flexibility is a symptom typically seen in catatonia — a psychomotor syndrome that may occur in people with a mental health condition or neurological disorder, including bipolar disorder, schizophrenia, or Parkinson’s disease.

If you try to move the arms of a person with waxy flexibility, you’ll be met with slight resistance, but their arms will eventually bend as if they were made of soft wax. Their limbs stay in that position until you move them again.

If your loved one shows any symptoms of waxy flexibility or catatonia, be sure to bring it to a doctor’s attention immediately. Catatonia is typically treated with benzodiazepines, ECT, or a combination of the two.