Have you ever wondered about the connection between selective mutism & anxiety? This post explores how anxiety can prevent those with selective mutism from speaking.
Selective mutsim is an anxiety disorder, but how does anxiety cause one to go mute? This is what differentiates the disorder from many other types of mutsim, as well as types of anxiety. So, let’s examine the disorder to find how selective mutism and anxiety connect.
Read ahead to learn more about types of mutsim, selective mutsim’s connection to anxiety, the difference between selective mutsim and social anxiety, as well as how to treat selective mutism.
What is Mutism?
Mutism is a disorder that makes it difficult or impossible to speak. There are multiple different types of mutism such as:
- Selective mutsim: An anxiety disorder that makes it difficult to speak in certain circumstances, while being able to in other circumstances.
- Akinetic mutism: A rare neurological disorder that causes a lack of movement or speaking.
- Organic mutism: Mutism caused by brain injury from stroke or drug use.
- Cerebellar mutism: A type of mutism caused by the removal of a brain tumour from a part of the skull surrounding the cerebellum.
- Aphasia: When people find it challenging to speak due to stroke, brain tumour, or head injury.
- Elective mutism: When a person chooses not to speak.
- Traumatic mutsim: After experiencing a traumatic event the person becomes mute in all situations.
- Progressive mutism: Occurs when a person with selective mutism becomes mute in all situations due to stress or negative reinforcement.
- Total mutsim: Where a person does not speak under any circumstances.
Selective mutism is considered the most common type of mutsim, and one of the few caused by anxiety.
What is Selective Mutsim?
Selective mutsim is an anxiety disorder, most commonly seen in childhood, that makes it challenging to speak in certain circumstances. Often these children don’t talk at school or around people they aren’t familiar with, yet will be chatty and lively at home.
While largely being considered a childhood disorder, it can continue into adulthood as well, especially if not treated. In some cases, the disorder can turn into progressive mutsim, where they become unable to speak at all. This is why treatment is so important for this disorder.
Related: What is Selective Mutism? And Why is It So Unheard Of?
What are Anxiety Disorders?
Anxiety disorders are the most common of mental disorders, affecting nearly 30% of adults at some point in their lives.
Anxiety refers to the anticipation of a future event and is associated with avoidance and muscle tension. This avoidance can impact your daily life including work, school, and relationships.
To be diagnosed with an anxiety disorder, the anxiety must:
- Be disproportionate to the situation
- Hinder your ability to function normally
There are many types of anxiety disorders such as generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder, separation anxiety, and selective mutism.
What Causes Selective Mutism?
Although the exact cause of selective mutism is unknown, it is thought to be related to several different attributes: an anxious predisposition, an inhibited temperament, and sensory processing disorder. In some cases, speech or language abnormalities may also contribute.
Anxious Predisposition
Those with selective mutism are often predisposed towards anxiety, meaning they likely inherited anxious traits from their family. People with selective mutsim are likely to have coexisting anxiety disorders such as social anxiety, separation anxiety, or other disorders such as phobias or PTSD.
Inhibited Temperament
Those with SM are more prone to shyness. An inhibited temperament is tied to an overactive amygdala, the brain’s fear centre. This means someone with selective mutsim is likely to be more reactive to perceived threats, making them more susceptible to anxiety.
Sensory Processing Disorder
People with SM are also more likely to have Sensory Processing Disorder. This means they have difficulty processing certain sensory information, such as bright lights or loud noises. Thus, causing them to overreact or become overwhelmed more easily.
Other Factors
Some other factors that may contribute to selective mutsim are speech or language problems, poor family relationships, self-esteem problems, untreated psychological issues, and in some cases, trauma.
Related: What Causes Selective Mutsim? Misconceptions & More!
Selective Mutism & the Freeze Response
People with selective mutism experience the freeze response, one of the four stress responses: flight, flight, freeze, and fawn. The freeze response causes them to shut down in the face of stress. For someone with selective mutsim, this means going mute and often appearing with a flat emotionless expression.
Selective Mutism Vs Social Anxiety
Selective Mutism and social anxiety are two distinct disorders. Social anxiety is more common with 9.1% of adolescents experiencing it before the age of 18. Whereas, selective mutsim is less common at 1%.
However, these two disorders often occur together. Nearly 40% of children with selective mutsim also have social anxiety and 33% of children with social anxiety display speech issues such as stuttering.
Both disorders are characterized by anxiety that impacts your daily life. While being entirely separate disorders, some researchers refer to selective mutsim as an extreme form of social anxiety.
The biggest difference between the disorders is the inability to speak in certain situations seen in those with selective mutism. Their anxiety is more situational than for someone with social anxiety alone. Selective mutsim also has an earlier age of onset, often occurring once they begin school. Children with SM are also more likely to be behaviourally inhibited, meaning they experience more distress in unfamiliar situations than those with social anxiety.
On the other hand, those with social anxiety are more likely to experience somatic symptoms such as stomachaches and headaches. They may fear new situations or speaking to people, and even be more quiet or passive, but their anxiety doesn’t prevent them from talking.
Selective Mutsim Treatment
Treating selective mutsim is all about addressing the underlying anxiety. For this reason, the most common psychotherapies are Behavioural and Cognitive Behavioural Therapy (CBT), both of which are used to treat anxiety.
CBT helps address the underlying thoughts that lead to their anxiety and avoidance. Some specific types of CBT include desensitization and exposure therapy, where you’re slowly exposed to your fear until you become desensitized to it.
In some cases, medication can be used to assist treatment but it’s not always needed. SSRIs can help reduce anxiety to make beginning treatment more simple for some.
Related: Discover the Best Selective Mutism Treatment Plan for You!
As you can see, there are many ways anxiety contributes to selective mutism, such as an anxious predisposition and inhibited temperament. Many also have coexisting anxiety disorders such as social anxiety. Finally, the freeze response also contributes to why people with SM go mute due to extreme stress.
by Morgan Peters
Sources:
Kashyap, Neha. “Mutism: Learn the Symptoms, Causes, and Treatments of Selective Mutism.” Verywell Health, 13 June 2023, www.verywellhealth.com/mutism-6260925.
Muskin, Philip R. “What Are Anxiety Disorders?” Psychiatry.Org – What Are Anxiety Disorders?, June 2023, www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.
“Selective Mutism: Overcoming Anxiety to Find Your Voice.” Cleveland Clinic, 1 May 2024, my.clevelandclinic.org/health/diseases/selective-mutism.
Cherry, Kendra. “Selective Mutism vs. Social Anxiety Disorder: What Are the Differences?” Verywell Mind, Verywell Mind, 22 Dec. 2022, www.verywellmind.com/selective-mutism-vs-social-anxiety-disorder-symptoms-causes-treatment-6950775.
Shenfield, Tali. “Is It Shyness, Social Anxiety, or Selective Mutism?” Child Psychology Resources by Dr. Tali Shenfield, 3 June 2022, www.psy-ed.com/wpblog/shyness-social-anxiety-or-selective-mutism/.
“A Closer Look at the Freeze Response.” Ashley Addiction Treatment, 30 July 2024, www.ashleytreatment.org/rehab-blog/learning-about-stress-responses/.
