Gegenhalten (Opposition)
Gegenhalten, or opposition, is a sign in which a patient resists all passive movement with a degree of force that matches whatever force the examiner is applying, so that gentle passive movements may meet little resistance while more forceful attempts meet correspondingly greater resistance. This matching quality often makes the sign easy to miss unless the examiner specifically attempts a firmer passive movement.
This has traditionally been distinguished from ordinary voluntary resistance by its automatically matching, proportionate quality: the resistance appears to scale directly with the force applied by the examiner, rather than being a fixed or deliberately calibrated response.
Also known as
- Opposition
- The English equivalent of Gegenhalten.
Recognition features
- Resistance to passive movement that matches the degree of force applied by the examiner
- May not be obvious when only gentle passive movement is attempted, becoming apparent only with a firmer attempt
- Distinct from negativism in that opposition is specifically about resisting passive movement with matched force, rather than a broader motiveless resistance to all interference
- Considered a milder point on the same spectrum as negativism, of which negativism can be regarded as an accentuation
Eliciting it at interview
- Attempt to passively move a limb first gently, and then with somewhat greater force, comparing the degree of resistance encountered at each level
- Note whether the resistance appears to scale automatically with the force applied, which is the specific, defining pattern of Gegenhalten
- Consider this sign alongside other catatonic examination findings, such as cooperation, Mitgehen, and negativism, to build a full picture of the patient's motor presentation
Distinguishing features
- Differs from negativism, which is a more marked, apparently motiveless resistance to interference generally, of which Gegenhalten can be considered a milder variant or precursor
- Differs from cooperation (Mitmachen) and Mitgehen, its near opposite, in which passive movement meets no resistance at all rather than matched resistance
- The force-matching quality of the resistance is the key distinguishing feature from simple, fixed muscular rigidity
Common misconceptions
- That Gegenhalten reflects deliberate, voluntary resistance on the patient's part; the matching, automatic quality of the resistance distinguishes it from a conscious choice to resist
- That a gentle examination will reliably reveal this sign; it may only become apparent when a firmer passive movement is specifically attempted
Related phenomena
Negativism · Cooperation (Mitmachen) and Mitgehen
Diagnostically relevant to
Schizophrenia (catatonic presentations) (links open the DSM-5 Learning Lab)
Practice this
On examination, gentle attempts to passively move a patient's arm meet almost no resistance, but when the examiner applies firmer pressure, the patient's arm resists with a force that closely matches whatever force is being applied, so the limb seems to actively oppose being moved. What is this? · On examination, a patient's arm resists all attempts at passive movement, gentle or firm, with a marked, apparently motiveless force that does not simply scale with the examiner's own effort, and the same pattern is seen when the examiner tries to reposition his legs and turn his head. Before revealing the answer: is this Gegenhalten? · You are examining a patient's response to passive limb movement. Before revealing the answer, decide what distinguishes Gegenhalten (opposition) from Mitmachen and Mitgehen. · A patient resists passive movement or instructions during examination. Before revealing the answer, decide what distinguishes negativism from Gegenhalten. · You want to establish whether a patient shows Gegenhalten on examination. Before revealing the answer, decide how you would assess this. · Explain why Gegenhalten, Mitmachen/Mitgehen, and negativism are best understood as points on a single spectrum rather than as entirely separate, unrelated signs.
Illustration
When an examiner gently lifts a catatonic patient's arm, it moves with almost no resistance, but when the examiner deliberately applies firmer pressure to bend the elbow further, the patient's arm resists with what feels like an equally firm, matched counter-pressure, without any change in the patient's expression or any sign of deliberate effort.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 8, 'Motor Disorders'.