Selective mutism is a rare mental health disorder that primarily affects children, with prevalence estimates varying from 0.2% to 1.6%.
However, if left untreated, it can continue into adulthood. It is often associated with social anxiety, but it is a different mental health condition with its own unique features.
This article will discuss all the ins and outs of selective mutism in adults and how someone can overcome this problem.
What is Selective Mutism?
Selective mutism is a psychological condition in which a person loses their ability to speak up in specific situations. It could happen in the classroom, work environment, or a family gathering where a person is supposed to participate in the conversation but fails to do so. In all other settings, a person has no difficulty talking and speaks freely without hesitation.
What are the Signs and Symptoms of Selective Mutism in Adults?
An adult with selective mutism can present with the following signs and symptoms:
- Inability to talk in specific situations
- Changes in facial expressions in uncomfortable settings
- Excessive shyness
- Fear of social embarrassment and rejection
- The use of nonverbal communication methods (pointing, nodding, writing, etc.) in conversations
- Asking a friend or a family member to speak on their behalf in public
- Difficulty in making new personal and professional relationships
- Rude and compulsive behavior
- Unexpected temper tantrums
- Stiffness and tension
- Negative and distorted perceptions
- Excessive anxiety
What are the Causes of Selective Mutism in Adults?
Selective mutism develops in the early years, so most of the time, the causes of selective mutism in adults are linked to childhood factors. Its exact cause is unclear; however, the following common triggers are associated with it.
- Genes. Genetics plays a critical role in the development of many mental health problems; selective mutism is also not an exception to this rule. Maternal anxiety, depression, and attachment disorders are commonly seen in the families of sufferers. Moreover, due to the close resemblance of selective mutism with social anxiety, the
same genetic factors [1*] might be responsible for both conditions. - Childhood environment. The environment plays a key role in the upbringing of children, and its impact can last lifelong in their lives. Overprotection of parents for their children is a risk factor for selective mutism. Similarly, if any of the parents are dealing with anxiety disorders, it can result in a lack of communication with their children, increasing the probability of this disorder. Childhood trauma is also frequently associated with this disorder, and some clinicians refer to it as traumatic mutism.
- Speech and language difficulties. Speech delay is common in people with selective mutism. Adults with this disorder may likely suffer from auditory problems in childhood, leading to speech delays. However, these difficulties are subtle in nature and do not warrant a diagnosis of their own.
Besides these risk factors, there are specific
- Psychodynamic theory: unresolved childhood conflicts may cause a person to use mute behavior as a defense mechanism.
- Behavioral theory: specific social triggers cause adaptive behavior changes that result in failure to speak in different situations.
- Dissociative identity theory: past traumatic experiences may cause mute behavior as a part of multiple personalities exhibited in
dissociative identity disorder [3*] . - Family systems theory: unhealthy intense attachments and detachments with parents may be the primary cause of this disorder.
- Social anxiety and social phobia: selective mutism is a part of the social phobia spectrum marked by exaggerated social anxiety.
- Posttraumatic stress theory: dissociative features of post-traumatic stress disorder (PTSD) are linked to selective mutism.
How is Selective Mutism in Adults Diagnosed?
In the previous iterations of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), selective mutism was included in the list of “Disorders of childhood and adolescence.” In the latest edition of DSM (5), selective mutism was moved to the list of anxiety disorders because of its anxious nature. The limitations of its diagnosis in children only were removed, too; adults can also be evaluated and
To be considered selectively mute, the following characteristic features must be present in an adult:
- Repeated failure to speak in some situations and an ability to speak freely in other scenarios.
- The inability to speak is not caused by the language barrier.
- The disturbance in communication is not better explained by other mental health disorders.
- The symptoms have been present for more than a month.
Adults with selective mutism do not initiate conversation or respond to others in specific social situations. It is highly probable that doctors also diagnose an anxiety disorder, commonly social anxiety disorder, when assessing for selective mutism.
The following questions may be asked by mental health professionals from the patient or relatives to assess for selective mutism:
- Who are you comfortable and uncomfortable speaking with?
- What driving factors make you remain silent in some situations?
- Where do you consistently fail to talk?
- When do you fail to communicate effectively?
- How do you communicate in such situations?
Selective Mutism Test for Adults
There are no standardized tests to check for selective mutism in adults. Only a mental health professional can assess and diagnose selective mutism based on DSM criteria after a comprehensive interview with the patient or their relatives. You can have a general idea of your mental state by completing our short assessment via the SmartCare symptom checker.
How is Selective Mutism Different from Other Conditions?
It is tough for health professionals to distinguish selective mutism from other psychological conditions with similar characteristics. Therefore, receiving a dual diagnosis of selective mutism and another psychiatric condition is common. However, subtle differences make selective mutism unique from other conditions:
Characteristic Behavior | Selective Mutism | |
|---|---|---|
Elective mutism | Can speak but chooses to remain silent in certain situations. | Wants to speak but is unable to do so in some public settings. |
Neurogenic mutism | Caused by underlying brain injury. | Caused by psychological issues without an organic etiology and is categorized as psychogenic mutism. |
Traumatic mutism | Temporary silence after a traumatic event. | Permanent silence in specific situations may or may not be due to past trauma. |
Social Anxiety | Is the avoidance of social situations due to fear. | Is mute behavior in certain situations due to anxiety. |
Shyness | Is relieved after adjustment to a particular social setting. | Is not relieved even after the initial adjustment time. |
Communication Disorders | Speaking problems are consistent across all social gatherings. | Failure to speak is limited to a few social paradigms. |
Autism | Is characterized by behavioral issues along with communication deficits. | Behavioral problems are not a part of the diagnosis. |
What is the Treatment of Selective Mutism in Adults?
The treatment of selective mutism in adults is multimodal. Like most anxiety disorders, therapy and medication are the primary forms of treatment for this mental health problem.
Therapy for Selective Mutism
Different therapies are in play to combat speaking issues in specific settings. The most effective ones include:
Cognitive Behavioral Therapy (CBT)
Adults can learn various coping techniques to manage stress for situations that trigger selective mutism under the guidance of a qualified therapist. Some of the behavioral techniques used to improve speaking skills in specific situations include:
- Self-modeling involves making video and audio recordings modeled on appropriate behaviors to show adults speaking in situations they previously kept silent. The recordings are played regularly during the therapy sessions to make patients accustomed to hearing themself talking in various circumstances.
- Systematic Desensitization is a technique that gradually exposes patients to anxiety-provoking events, moving from less to more severe triggers. The therapy consists of image sequences and real-life exposures to problematic situations. In this way, an interventional hierarchy is built for feared speaking events.
- Shaping of Behavior is achieved by interacting with a group of strangers in a controlled environment. It employs activities such as reading out loud or participating in interactive board games. It is then superseded by one-on-one communications with other people to overcome selective mutism.
- Social Skills Training involves equipping yourself with necessary social skills with the help of a therapist. It helps reduce social anxiety and participate in difficult conversations for adults with selective mutism. The training helps people develop skills such as starting and carrying a conversation, understanding nonverbal cues and managing eye contact, among others.
- Contingency Management is a behavioral technique that involves identifying and rewarding positive verbal behavior and not reinforcing mute behavior in adults.
Psychodynamic Therapy
Psychodynamic therapy primarily focuses on deep analyses of individual factors that drive and affect behaviors. The goal is to help the patient understand the influence of past memories on present behavior. It helps resolve internal conflicts that might have stemmed from a troubled childhood. In the case of selective mutism, psychodynamic therapy helps to reveal the embedded childhood influences that might be the primary cause of mute behavior in adults.
Family Therapy
Family therapy is particularly useful in selective mutism cases where internal family factors play a critical role in developing and reinforcing selective mutism. Cooperation and understanding from parents and siblings help the child overcome anxiety and avoidance. Anxious and avoidant behavior can be treated more effectively with the cooperation of family and friends.
Speech-Language Therapy
Speech-language therapy is often recommended alongside behavioral therapy for people with selective mutism. It helps them feel more comfortable talking in uncomfortable situations.
Medications
Pharmacological treatment of selective mutism in adults commonly consists of antidepressants, such as selective serotonin inhibitors (SSRIs). These medications improve mood and cognition by balancing neurochemical levels in the brain, which helps overcome the speaking barrier in specific situations. They are more beneficial when aided with therapy and counseling.
Self-Help Tips
There are certain self-help tips that you can implement to ease symptoms of mute behavior.
- Gradually expose yourself to social situations. Some social situations can be tough to handle for people with selective mutism. However, keeping yourself away from these situations will only reinforce the problematic behavior. Therefore, it is important to participate in some form of social activity, however small it may be, and then gradually progress to more challenging social scenarios. It will help lower the sensitivity to potential triggers that cause mute behavior.
- Talk to familiar faces in social situations. The next step would be to talk to someone you are comfortable with in a social setting. It could be your friend or a family member. It will help build up your confidence to talk to strangers or in front of an audience.
- Learn nonverbal gestures. Communicating in any way possible is better than remaining completely silent in problematic situations. Here, effective communication tools come into play and help carry out a conversation without actively speaking. Gestures that may come in handy are pointing, nodding, smiling, miming, eye contact, etc. With time, when you become more comfortable, you can try to make small talk along with gestures.
- Reward yourself for achieving small milestones. Rewarding yourself is a positive reinforcement that can help change and maintain your positive behavior. So, whenever you speak in a public setting, it’s better to make it more rewarding by attaching a prize to it.
End Note
Selective mutism is a rare anxiety disorder that is observed in children but can also be diagnosed in adults as per the DSM-V. The inability to hold a conversation in a specific situation is its characteristic feature. Untreated selective mutism can result in social and academic loss and emotional repercussions and need medical help. If you are experiencing such a phenomenon, reach out to expert anxiety health professionals at MEDvidi for a proper diagnosis and personalized treatment plan.
