Definition: Selective Mutism (SM) is an anxiety disorder which often appears in early childhood, characterized by the PERSISTENT failure to engage in speech in specific social situations where speech is typically expected, despite technically possessing the full capability (the necessary physical structures and speech motor processes) to being able to speak and hear. 

Selective Mutism often co-exists with Social Anxiety Disorder (SAD). 

The DSM-IV-TR criteria for Selective Mutism specifies that this persistent failure to speak should not be attributed to these following reasons: 

1) An organic inability rooted in the individual's language capability (e.g. comprehension, in-fluency in language, etc) 
2) Another communication disorder (e.g. stuttering) 
3) A diagnosis of another psychotic disorder (e.g. Pervasive Development Disorder, Schizophrenia, etc) 

Please note that a comprehensive and uniform theory about the etiology, assessment, and treatment of SM does not exist; Historically, varying definitions and criteria have been applied to individuals with SM, and so this provided definition and diagnostic criteria may not be yet as inclusive as it can be. 

Image citation: Journal of American Academy of Psychology. Factors That May Influence Speech and Social Inhibition., 17 Feb. 1995, www.sciencedirect.com/science/article/abs/pii/S0890856709635930. Accessed 22 June 2023.

Definition and Diagnostic Criteria of Selective Mutism 

Reference for An Overview on Selective Mutism

The risk factors for children to develop selective mutism include:

* Experiencing peer victimization.  
* Family history of selective mutism.
* Abuse or trauma.
* Moving to a country with a foreign native language.
* Family conflicts.

Risk Factors for Selective Mutism

These are possible treatments for selective mutism, these treatments include:

* Shaping.
* Medications.
* Stimulus fading.
* Desensitisation.
* Graded exposure.
* Speech Therapy.
* Behavioural therapy.
* Cognitive Behavioral Therapy.
* Positive and negative reinforcement.


Treatment for Selective Mutism

Selective mutism is relatively rare. It develops in fewer than 1% of the population of all age groups. Selective mutism starts most of the time at age 5. It begins to be noticed by people when the child starts school or kindergarten. It is less common for this disorder to occur in Adolescence or adulthood, but there is a possibility. It develops in females double the times of males.

The Prevalence of Selective Mutism 

Selective mutism in adults is not well-known but it is a serious communication anxiety disorder. It can affect people of different ages, impeding their capability to speak in some social situations despite being completely able to speak in other situations. Most of the time, this disorder is diagnosed in childhood, but it may persist into adulthood, affecting the patient’s quality of life and resulting in many social problems.

Selective Mutism in Adults


Some circumstances or situations might trigger selective mutism. These triggers might cause a person with selective mutism to refuse to speak. Some people might have specific triggers. Triggers may vary over time. Some of these triggers are:

* Going to noisy or overcrowded places.
* Meeting strangers.
* Being around people who stand too close or invade personal space.
* Going to Novel places.
* Facing novel or unsuccessful situations.
* Being around others who behave aggressively or speak loudly.
* Going to places that remind the patient of upsetting events.
* Meeting people with certain physical characteristics, such as being very tall.
* Facing negative nonverbal cues or gestures.


Selective Mutism Triggers

The following psychological disorders co-occur with selective mutism the most:

* Social anxiety disorder. 
* Separation anxiety.
* Phobias.
* Post-traumatic stress disorder (PTSD).
* Autism spectrum disorder.
* Other anxiety disorders.


Psychological Disorders that Most Commonly Co-occur with Selective Mutism

A severe anxiety disorder, where a person is unable to speak in certain social situations, for example with classmates or distant relatives. Usually, selective mutism starts during childhood, if left untreated, it can continue to adulthood. Individuals with selective mutism are not choosing to not speak but are unable to speak. The expectation to talk to certain people triggers a freeze response with feelings of panic making talking impossible. 



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The DSM-5-TR separates anxiety disorders into the following specific disorders:
-	Separation Anxiety Disorder
-	Selective Mutism
-	Specific Phobia
-	Social Anxiety Disorder
-	Panic Disorder
-	Panic Attack Specifier
-	Agoraphobia
-	Generalized Anxiety Disorder (GAD)
-	Substance / Medication-Induced Anxiety Disorder
-	Anxiety Disorder Due to Another Medical Condition
-	Other Specified Anxiety Disorder
-	Unspecified Anxiety Disorder


[DSM-5-TR] List of Anxiety Disorders

NHS. (2022). NHS. NHS choices. Retrieved March 18, 2022, from https://www.nhs.uk/ 

Separation anxiety in children seems intense or prolonged and interferes with school or other daily activities. It can also includes panic attacks. Most frequently separation anxiety disorder is linked to the child's anxiety about his or her parents, but it could relate to another close caregiver.

Less common separation anxiety disorder can occur in teenagers and adults, causing significant problems leaving home or going to work.

Separation Anxiety Disorder

Selective Mutism 

Social anxiety disorder (SAD) affects about 4% of the worldwide population and is slightly more common in women. Also known as social phobia, it is defined as a persistent,and potentially debilitating fear of meeting new people, being watched, or criticized by others. Some with social anxiety may attempt to avoid anxiety-triggering situations by self-isolating or cancelling plans. It is a profound fear of the judgement of peers, particularly public humiliation. It is NOT shyness or introversion but can sprout from childhood shyness. In a social sense, social anxiety is not just feeling nervous or shy in certain social situations like starting a new job or the first day of school. Social anxiety disorder is a disorder that interferes with everyday life and relationships due to fearing situations where you can be embarrassed or viewed negatively and intense fear of situations where a person with SAD expects the worst. 

Social Anxiety Disorder (Social Phobia)

This disorder is hallmarked by the experience of multiple, unexpected panic attacks. These attacks are often associated with intense fear that occurs quickly. Generally, this diagnosis is applied if you have had four or more panic attacks, and fear their reocurrence. Having one panic attack, is not a panic disorder. Worry over panic attacks and avoidance of situations, places, etc. that are associated with panic attacks can lead to further problems. 

Recurrent panic attacks may show temporal lobe abnormalities. Those who suffer from panic disorder typically have lower temporal lobe volumes. These attacks can occur unexpectedly or by a trigger. 



Panic Disorder

Derived from the Greek for 'fear of the marketplace,' agoraphobia is an anxiety disorder defined by intense fear and avoidance of situations where escape might be difficult or help unavailable if panic symptoms arise. Such situations often include using public transportation, being in open areas like parking lots, enclosed spaces like stores, crowded places, or being outside the home alone.

Agoraphobia

Generalized Anxiety Disorder (GAD) is characterized by a persistent and relatively continuous state of excessive, uncontrollable, and often pointless worry and apprehension. Individuals with this disorder typically worry about routine, everyday matters, such as health, finances, or the safety of family members, without any justified reason. For a diagnosis, this diffuse worrying must occur more days than not for a period of at least six months, not be attributable to another disorder, and be accompanied by at least three of the following symptoms: restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep difficulties.

Generalized Anxiety Disorder

Very Well Mind. Retrieved June 30th, 2023 from https://www.verywellmind.com/

Very Well Mind

This disorder refers to an increased amount of anxiety that stems from alcohol, drug, or medication usage. This diagnosis would go beyond the anxiousness or panic during intoxication/withdrawal. The anxiety causes distress and impariment.

Substance / Medication-Induced Anxiety Disorder

When someone's physical health condition is the direct cause for symptoms of anxiety or panic.

Anxiety Disorder Due to Another Medical Condition

MSD Manual, Professional Version. Retrieved July 2nd, 2023 from https://www.msdmanuals.com/professional

MSD Manual, Professional Version

A specific phobia, formerly known as a simple phobia, is an anxiety disorder characterized by excessive, distressing, and persistent fear or anxiety centered on a specific object or situation. Individuals with a specific phobia often recognize that their level of fear is irrational, yet they may go to great lengths to avoid the phobic stimulus. The anxiety and avoidance behaviors associated with the phobia are typically disruptive to the person's daily life and functioning.

Specific Phobia

For the past eight months, David has experienced a near-constant state of worry. He feels anxious about his performance at work, the health of his parents, and his financial situation, despite there being no specific or immediate threats in these areas. He reports feeling restless, easily fatigued, and has significant muscle tension in his neck and shoulders. His condition is best described by which of the following?

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