Selective Mutism: Information, Symptoms, Treatment and More

Selective Mutism is a severe Anxiety Disorder which is characterised by an individual being unable to speak in certain social situations. While predominantly seen in children, the disorder can persist into adulthood – especially if left untreated.

The individual affected literally cannot speak in some situations, it isn’t out of choice. The situation of talking to someone may trigger feelings of panic, to the extent where talking becomes impossible. They will be able to speak regularly to some people, such as close family or friends.

Selective Mutism often co-exists with Social Anxiety Disorder. While a very difficult condition to live with, treatment is available for Selective Mutism.

What are the symptoms of Selective Mutism?

Someone with Selective Mutism is perfectly capable of speech. However, in certain situations, they are unable to talk – even when they are expected to.

Unfortunately, this can be perceived as rudeness by others. This is the key symptom of the condition. Other symptoms may include, but aren’t limited to:

• Low confidence
• Shyness
• Blank affect
• Loneliness
• Anxiety
• Lack of eye contact with others

As a result of Selective Mutism, an individual may choose to avoid social situations, which can cause several problems. In adulthood, the individual may not be unable to attend job interviews – which can cause further problems.

On a more positive note, one study found that people with Selective Mutism tend to be of above-average intelligence [1]. When not in a situation that causes their mutism, the individual is normally just like any person who doesn’t have the condition. The condition will normally appear between the ages of 2 and 5.

Selective Mutism commonly runs comorbidly with Social Anxiety Disorder [2]. It can also, if left untreated, lead to Depression.

What are the causes of Selective Mutism?

The exact cause of Selective Mutism isn’t entirely known. It is believed that many different factors are involved in the onset of the condition.

Genetics appears to be a very important factor, with Selective Mutism having the ability to run in families. Personality traits like shyness and anxiety can be inherited – suggesting that some people may be predisposed to developing the condition.

A traumatic experience in youth can lead to social withdrawal and distress – which may feasibly result in Selective Mutism. It has also been hypothesised that Social Anxiety Disorder may actually cause Selective Mutism – owing to its high comorbidity rates.

Selective Mutism may become a coping method for those with Social Anxiety Disorder. Struggling to detach from a parent may also lead to an individual being unable to have enough confidence to speak alone.

The condition is also common in those who are speaking in a second language. Sometimes, there simply isn’t a cause that can be identified.

It seems that little can be done to prevent the condition. It is incredibly rare for the condition to appear after childhood.

Diagnosis of Selective Mutism

It is important for an individual to see a Doctor or mental health professional if they believe they are suffering from Selective Mutism. While Selective Mutism is normally treated in childhood, it is never too late to receive a diagnosis and instigate treatment.

This is particularly important if an individual finds their symptoms cause disruption in their day-to-day life.

A doctor will aim to make a diagnosis based on a meeting with the patient. If deemed appropriate, the doctor will typically refer the individual to a mental health professional.

At an appointment, the mental health professional will conduct an assessment on the individual. They will normally ask questions about a family history of anxiety disorders, potential causes, and anything else relevant.

It will also be important for the individual to remember when their symptoms first appeared – as this can normally rule out other conditions. Selective Mutism can normally be diagnosed in adulthood relatively clearly.

For Selective Mutism to be diagnosed, the following criteria should be met:

• The individual is unable to speak in specific social situations
• They will be able to speak in other situations, such as conversations with parents or close friends
• This will typically be a long-standing problem
• This problem leads an individual to feel distressed
• The lack of speech cannot be attributed to a lack of knowledge of the language in question
• The symptoms aren’t better suited to another mental health condition
• The symptoms aren’t better explained by Autism Spectrum Disorder

This criteria features all of the main symptoms of selective mutism. Once a diagnosis has been made, treatment can proceed.

How is Selective Mutism treated?

Treatment is available for Selective Mutism. Selective Mutism is best treated at an early age, but it can still be treated in adulthood.

While the aim is always recovery, at the very least an individual should see a reduction in the severity of their symptoms.

Treatment is normally based around attempting to reduce the anxiety that is associated with speaking.

Talking Therapy

Some form of talking therapy is normally a first line of treatment for adults. Exposure Therapy, also known as desensitisation, may be helpful.

This works on the idea that the individual can be slowly exposed to speaking. This involves a gradual process which involves emailing or texting, before voicemail, then a voice call, video call, and finally face-to-face speech.

Cognitive-Behavioural Therapy is another type of talking therapy that may be used. Therapy can also help individuals learn how to cope better with problems.

Exposure Therapy: Exposure Therapy – also known as Desensitisation – is commonly used for cases that involve either traumas or phobias. This type of therapy involves an individual being gradually exposed to their fear/trauma. A therapist can help set up a program for this. Over time, the individual will gradually become accustomed to their problem – though this takes time. The eventual aim is to overcome the problem. Relaxation methods may also be taught as part of this therapy.

Cognitive Behavioural Therapy (CBT): CBT is a type of therapy that is used to treat a range of mental health conditions. CBT involves an individual talking face-to-face with a therapist, although sometimes CBT can be conducted in a group setting. CBT attempts to improve an individual’s wellbeing and mood. The therapy focuses on the link between thoughts, feelings and actions. This can be useful for those with low self-esteem, anxiety, unhelpful personality traits or intrusive thoughts. CBT can help an individual understand their feelings more, and in the long run should lead to an improvement in quality of life.

If required, there are a range of other types of talking therapies that exist. Talking therapy can help in many ways. We have more information on our Therapy section.

Medication

It is common for cases of Selective Mutism to cause feelings of low mood. In this case, a course of antidepressants may be recommended.

Antidepressants: Antidepressants can help to improve and regulate mood. They should improve motivation and restore energy. SSRI Antidepressants are the most commonly prescribed. They act on the brain chemical serotonin – which is thought to help in regulating mood and emotion. They may include side-effects such as a dry mouth, sexual problems and nausea, though these should hopefully be short-term. Other classes of antidepressants are available in the event of an inadequate reaction.

Summary

Selective mutism is a very difficult condition to live with. It impacts not only the person with the condition, but those around them too.

Seeking help is important and can hopefully result in an improvement in overall wellbeing. Our website has a lot of information to support you.

See Also

• Anxiety Section
• What Is The Prognosis for Anxiety?
• Therapy Homepage
• Medicine Homepage