Prolonged Catatonia and Severe Malnutrition in Adolescents Following Bullying-Triggered Stress: A Dual Case Report

Catatonia is a complex neuropsychiatric syndrome characterized by motor, behavioral, and affective disturbances. Though traditionally associated with schizophrenia, it is now recognized across a range of psychiatric and medical conditions. Catatonia is often underrecognized in the pediatric population, and bullying-induced psychological trauma is a largely overlooked trigger. This case report presents two adolescents who developed prolonged catatonia and severe malnutrition following intense bullying-triggered stress. The first case involves a 17-year-old female with developmental delay who developed severe catatonia and malnutrition following a school bullying incident. Despite initial treatment with benzodiazepines and antidepressants, her condition necessitated electroconvulsive therapy (ECT) after recurrent episodes and prolonged functional decline. The second case involves a 13-year-old female with DiGeorge syndrome who developed catatonia following emotional and physical bullying. Her symptoms partially responded to benzodiazepines, antipsychotics, and supportive care. Both patients exhibited classic catatonic features, including mutism, rigidity, and refusal to eat, and required multidisciplinary interventions. Pharmacological management with lorazepam was central, with ECT proving critical in the first case due to poor response to medication. Nutritional rehabilitation and trauma-informed psychosocial support were also essential to recovery. These cases emphasize the role of bullying-related trauma as a significant yet underrecognized trigger for pediatric catatonia. Early recognition and intervention, including using ECT, are vital to recovery. Increasing awareness, implementing preventive strategies, and conducting future research on school bullying, its effects, and its connection to catatonia may help decrease the occurrence of severe psychiatric outcomes.