Selective Mutism in Adults (A comprehensive guide)

In this brief guide, we will discuss selective mutism in adults, causes of selective mutism in adults, and other related concepts.

Selective Mutism in Adults

Selective mutism in adults is usually a result of untreated selective mutism during childhood, or a part of social anxiety that the individual is suffering from, which may render them incapable of talking.

Selective mutism is a severe anxiety disorder that keeps the individual from being able to talk to other people in certain situations, and the classic feature of this condition is that the individual is able to talk perfectly normally to some people in their life, which means that there is nothing wrong with the ability to talk, and the person is physically alright.

The DSM 5 criteria for selective mutism applies to adults as well, as the same conditions usually prevail even in adults, and these criteria is given as such:

  • “Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better explained by a communication disorder (e.g. childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.)”

These criteria make it clear that this disorder should not be a part of other disorders, which means that aside from the anxiety that is obviously related to talking to certain people and in certain situations, the individual should not have other symptoms that may make other disorders likely.

For example, mutism may also be present in catatonic schizophrenia, and while it is unlikely to be selective, the person may still talk and have the ability to talk.

The reason for mutism in schizophrenia tends to be the thought process being disorganized and there are psychotic phenomena underlying that issue, which is not the case in selective mutism, which is why this disorder is so open to psychotherapy.

Selective mutism in adults is also thought to be maintained through the behavior of the person with mutism, and also through the expectations and behaviors of others which leads to extreme feelings of isolation for people with mutism, and this in turn keeps them away from any opportunities to speak and get over their condition.

According to one study, it was also seen that most adults suffering from selective mutism experience it as a very separate thing from their overall sense of identity, and it is almost like a separate entity that doesn’t quite belong in their personality but is there anyway.

Causes of Selective Mutism in Adults

Common causes of selective mutism in adults may include:

  • Shock/Trauma
  • Childhood selective mutism
  • Autism
  • Social Anxiety
  • Embarrassment or shame

Any causes of selective mutism that may be derived from other disorders like schizophrenia or depression, do not count as selective mutism and may come under mutism or other kinds of speech pathologies.

For example, people suffering from depression may speak in low tones, their speech productivity may be quite scant, their speed of speaking be quite slow, and sometimes, in very severe cases, the person may not speak at all, which would technically be classified as Mutism, but it is not the same as selective mutism.

There are some psychiatric symptoms that make up an entire disorder because they are so well encapsulated in the personality of an individual, and selective mutism is one of these.

There are few causes of selective mutism in adults because for mutism to be classified as selective, it needs to be a singular symptom and everything about it needs to be concerned with just the problems with speaking in particular situations, and any other cause of mutism in adulthood will come with other symptoms as well.

Another example of a disorder like this is Persistent Delusional Disorder, which is characterized by the presence of just the one delusion and apart from that one issue, the rest of the personality is completely normal, and when the person is not talking about the delusion, they are actually relatively normal.

Similarly, an adult with selective mutism might be able to text, or post things on the internet, or otherwise communicate with strangers and people in situations where they can’t speak aloud, and apart from the problem of not being able to talk, they usually do not display any other symptoms.

Selective Mutism in Adults: Trauma

Selective mutism in adults caused by trauma is usually much more short-lived compared to the selective mutism that develops from the time the person is a child, and often it is a result of shock from a major catastrophe.

It needs to be ensured, however, that it is selective mutism and not a problem with the brain or post-traumatic stress disorder or an acute stress reaction, all of which can shock the person into not talking.

Another possibility for selective mutism in adults to be caused by trauma may be undergoing some sort of severe humiliation in a certain setting and developing anxiety toward communicating in that situation anymore, which may be fairly common in students or working people.

Selective Mutism in Adults: Autism

Selective mutism in adults that is because of autism is not classified as selective mutism, but a symptom of autism.

The criteria for the communication problems in Autism reads as the following:

“Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):

  • Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions. 
  • Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures: to a total lack of facial expressions and nonverbal communication.
  • Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.”

As might be seen from the aforementioned criteria, autism can cause significant impairments in the speech of an individual, which means that communication patterns in an individual with autism may often look like selective mutism when they are not.

Therefore, it is important to first talk to a clinician about the diagnosis because elective mutism and autism might seem like they overlap, but they are distinct conditions, as in autism one might see an inability to understand or engage in non-verbal communication as well, whereas it may not be present in the case of selective mutism.

Selective Mutism in Adults: Reddit 

As mentioned in the previous section, selective mutism does not hamper the person from typing or reaching out a little bit, which is what makes it so different from the other types of mutism and speech issues that are seen in the other major psychiatric disorders.

Therefore, here are some experiences of real people from reddit who suffer from, or think they suffer from, selective mutism:

“I’ve always been a quiet and shy person. Every single report I’ve had since nursery has been about how I’m quiet and that I need to speak more at school. Up until somewhere in yr7 I could speak to people at school without y’know feeling as if I couldn’t physically speak to them. There is nothing physically stopping me from speaking but whenever I try to like when I get asked a question in a lesson it feels as if I can’t like, I have no voice.

I don’t really have any friends, and my social skills are just poor. The people that I really only talk to are my family.

I don’t really understand why I’m like this or why I can’t speak to people. A few teachers at school (I’m currently in yr10) have tried to get me to speak to them because y’know they’re worried about me because my mum mentioned that I get real angry super easily.”

“I feel pretty similar, I was always very shy and didn’t speak in certain situations but always had a couple of friends. It got way worse for me in high school, to the point of me not speaking much of the time and having no friends. I feel very alone because it seems that not many people understand this, it’s nice to have someone feel the same but also sad because I wouldn’t wish anyone to go through this. I would suggest you get help as soon as you can, I know it can be really difficult when you don’t speak so much because you might be afraid to try to speak to an adult because it may be awkward.”

“Yesterday I went for an eye test and I spoke to the optician in a normal voice – the only people I can usually speak to are my family members, people around my own age or younger and the lunchtime staff/school bus driver, so speaking out loud to someone I’d never even seen before, let alone spoken to is a huge step :)”

Conclusion

In this brief guide, we discussed selective mutism in adults, causes of selective mutism in adults, and other related concepts.

Selective mutism in adults can mean a lot of different things, and in most cases it may be a manifestation of social anxiety or even obsessive compulsive disorder, but in some rare cases it can be selective mutism that was left untreated since the person was a child.

We know a great deal about selective mutism in childhood but not nearly enough about selective mutism in adults, but research is still happening and hopefully in the next decade we will have more answers about this condition.

If you have any more questions or comments about selective mutism in adults, please feel free to reach out to us at any time.

Frequently Asked Questions (FAQs): Selective Mutism in Adults

How is selective mutism treated in adults?

Selective mutism may be treated by the following methods in adults:

Positive and negative reinforcement. 
Desensitisation. 
Cognitive behavioural therapy (CBT) 
Medication for selective mutism.
Shaping.
Family therapy. 

Does selective mutism occur in adults?

Yes, selective mutism can occur in adults as well, though it is certainly more common in children.

Selective mutism is a severe anxiety disorder that falls under the type of social anxiety, and it is believed that one in 150 or so children are affected by selective mutism, and sometimes the children may grow up to adulthood and not be able to get the mutism treated.

What causes mutism in adults?

Mutism in adults is often caused by either shock or neurological problems, and most commonly it may occur in the older populations.

When mutism in adults is a psychological phenomena it may usually occur as a result of psychotic illness as well, and it is fairly common in caatatonic schizophrenia or other types of mental illnesses that can cause so-called negative symptoms.

It is also important to not mistake mutism in adults with aphasia, as aphasia is a purely neurological condition which is a result of changes in the brain structure which leave the individual incapable of talking.

Citations

https://www.nhs.uk/conditions/selective-mutism/#:~:text=A%20child%20or%20adult%20with,fright%2C%20and%20talking%20is%20impossible.

https://www.nami.org/Blogs/NAMI-Blog/January-2017/Selective-Mutism-Frozen-in-Silence

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