Ecopraxy (uncontrollable imitations): causes and associated disorders

We know that imitation is a fundamental part of human development. Humans, like other apes, imitate others during childhood as a form of social learning. However, in some people this imitation does not cease; becomes a tic impossible to avoid and they develop a symptom called ecopraxia.

The presence of ecopraxia or echokinesis may indicate the presence of a neuropsychiatric disorder. While it can often be obvious, it can manifest in more subtle ways that go unnoticed by the naked eye.

Below we briefly describe what ecophenomena are, what we know about their causes, and in which disorders they are usually most characteristic.

    What exactly is ecopraxy?

    Ecopraxy is a motor tic which is part of the so-called ecophenomena. These symptoms are characterized by imitation. While echolalia is the imitation of sounds or words, ecopraxia corresponds to automatic imitation of another person’s actions.

    Besides the imitation of gestures, it can manifest itself in different ways: ecomimic or imitation of facial expressions, ultrasound or imitation by writing auditory stimuli, ecoplasia or the act of drawing the outline of objects or people mentally. , in the air or on a certain surface. The imitation of words by sign language, called echolaliophrase, has even been described.

      Causes of ecopraxia

      Understand why people tend to imitate in the first place we must take into account the existence of mirror neurons. These neurons are activated when they see another perform an action and cause a reaction parallel to that observed, mirroring the actions of the other. Activation of these neurons does not always lead to movement, as we are able to inhibit the motor response.

      The imitative center of the brain is located in the inferior frontal gyrus, the inferior parietal lobe and the superior part of the temporal sulcus. In addition to these, the prefrontal cortex and premotor areas play a key role in imitating new stimuli. Thus, imitation passes as a process from the top (perception, coding of the external stimulus and preparation of the motor action) to the bottom (motor execution).

      Traditionally, ecopraxia is believed to occur because the patient is unable to inhibit motor performance and interrupt the process. However, not all empirical evidence agrees. According to recent studies, Ecopractic tics are strongly overestimated motor responses which, when triggered by an external stimulus, are inevitably executed. It is impossible to interfere with and interrupt these responses, hence their involuntary and automatic character.

      It is possible that ecopraxies, since they are performed very frequently and are more consolidated, are more represented in the brain than voluntary movements. In this way, people with ecopraxia have a very sensitive association between stimulus and tic and they find it impossible to control these responses.

      So, it’s not that tics are uninterrupted normal responses, it’s that they are much more entrenched stimulus-response associations that are triggered at the slightest stimulus.

      eco-friendly disorders

      There are many neuropsychiatric disorders that generally include ecopraxies and ecofenómenos in their clinical presentation. Yet there is one that stands out above all. Gilles de la Tourette disorder (TGD), strongly characterized by the presence of tics, echolalia and ecopraxia.

      1. Trouble of Gilles de la Tourette

      From its first clinical description, the presence of tics is necessary for its diagnosis. Patients with TGD have a high rate of tics, coprolalia and ecophenomenon, which is a fundamental pillar of diagnosis.

      In fact, factor analyzes they give greater importance to motor tics and ecofenómenos than in motor hyperactivity or vocal tics, more commonly known.

      In TGD, tics occur due to excessive activity in the basal ganglia. It is hypothesized that, because the prefrontal of these patients must constantly inhibit tics due to this activity, it eventually becomes exhausted and does not interrupt the imitation of the movements of others, showing ecopraxia.

      In addition, the movements they imitate are usually tics that are part of their repertoire. That means they are much more likely to imitate movements that they are already very over-learned in their brains, as we have exposed a few paragraphs back, than any other new movement.

        2. Schizophrenia

        Schizophrenia is another disorder in which ecopraxia can sometimes occur in more subtle ways than in TGD. The hypothesis is that the schizophrenic patient, due to the dysfunction of the prefrontal region, struggles to control inappropriate responses like imitation.

        These patients, unlike the others, are able to control their ecopraxia if it is prepared in advance so as not to emit them. Therefore, it is believed that the problem of schizophrenic patients has more to do with executive functions than with learning motor tics.

        3. Autism spectrum disorders

        In these disorders, we often find motor extravagance: mannerisms, wavering, tics, etc. We must therefore hope that we find the presence of ecopraxia. however, sometimes autistic ecopraxies don’t work like tics, But like behavior problems.

        This means that in people with autism, ecopraxia is not so much due to a lack of executive control or excessive learning, but because the individual does not believe that imitation should be repressed or it may be socially inappropriate.

          4. Other associated disorders

          Other disorders where one can find ecopractic symptoms include:

          • Neurocognitive disorders (dementias)
          • Transcortical aphasia
          • epilepsy
          • autoimmune diseases
          • Obsessive-compulsive disorder with tics


          Treatment for ecopraxia will depend on the underlying mechanism that causes it. In cases where neurological dysfunctions predominate, medication will be a focal point of treatment.

          however, all forms of tics and ecopraxis can be treated through behavior therapy. This is particularly important in people with autism, where ecopraxia is the result of an inability to understand social reality, and in obsessive-compulsive disorder.

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