Elective mutism

Last updated

Elective mutism is a now outdated term which was defined as a refusal to speak in almost all social situations (despite normal ability to do so), while selective mutism was considered to be a failure to speak in specific situations and is strongly associated with social anxiety disorder. In contrast to selective mutism, it was thought someone who was electively mute may not speak in any situation, as is usually shown in books and movies. Elective mutism was often attributed to defiance or the effect of trauma. Those who are able to speak freely in some situations but not in others are now better described by selective mutism. [1]

Contents

History

In 1877, a German physician named the disorder aphasia voluntaria to describe children who were able to speak normally but often "refused" to. [2]

In 1980, a study by Torey Hayden identified four "subtypes" of Elective Mutism: [3]

The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, first included Elective Mutism in its third edition, published in 1980. Elective mutism was described as "a continuous refusal to speak in almost all social situations" despite normal ability to speak. While "excessive shyness" and other anxiety-related traits were listed as associated features, predisposing factors included "maternal overprotection", mental retardation, and trauma. Elective mutism in the third edition revised (DSM III-R) is described similarly as in the third edition except for specifying that the disorder is not related to social anxiety disorder.

In 1994, the fourth edition of the DSM reflected the name change to selective mutism and redefined the disorder.

Cultural references

Though elective mutism is no longer recognized by most psychiatrists, it is a popular character element or plot point in stories and movies. Many characters choose to stop speaking, for various reasons. Even more commonly, there are also characters who stop speaking after a traumatic incident. In both these cases, often, and almost always in the second, the character is silent in all situations. This is therefore not selective mutism, and anxiety is very rarely involved. Selective mutism itself is almost nonexistent in pop culture.

The following are a few references to stories including a character who does not speak despite being physically able to.

Related Research Articles

Phobia Anxiety disorder defined by a persistent and excessive fear of an object or situation

A phobia is a type of anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are present for more than six months. Those affected will go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, which are often found in agoraphobia. Around 75% of those with phobias have multiple phobias.

Anxiety disorder Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant feelings of anxiety and fear. Anxiety is a worry about future events, while fear is a reaction to current events. These feelings may cause physical symptoms, such as increased heart rate and shakiness. There are several anxiety disorders, including generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism. The disorder differs by what results in the symptoms. An individual may have more than one anxiety disorder.

Specific phobia is an anxiety disorder, characterized by an unreasonable fear associated with a specific object or situation. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear.

Post-traumatic stress disorder mental disorder that can develop after experiencing or witnessing a terrifying or life-threatening event

Post-traumatic stress disorder (PTSD) is a mental disorder that can develop after a person is exposed to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, or other threats on a person's life. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in how a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Reactive attachment disorder Psychological disorder that can affect children

Reactive attachment disorder (RAD) is described in clinical literature as a severe and relatively uncommon disorder that can affect children. RAD is characterized by markedly disturbed and developmentally inappropriate ways of relating socially in most contexts. It can take the form of a persistent failure to initiate or respond to most social interactions in a developmentally appropriate way—known as the "inhibited form". Due to recent revision in the DSM-5 the "disinhibited form" is now considered a separate diagnosis named "disinhibited attachment disorder".

Selective mutism (SM) is an anxiety disorder in which a person normally cannot speak in specific situations, specific places, or to specific people if triggered. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.

DSM-IV codes are the classification found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, a manual published by the American Psychiatric Association (APA) that includes almost all currently recognized mental health disorders. The DSM-IV codes are thus used by mental health professionals to describe the features of a given mental disorder and indicate how the disorder can be distinguished from other, similar problems.

In psychology, emotional detachment, also known as emotional blunting, has two meanings: one is the inability to connect to others on an emotional level; the other is as a positive means of coping with anxiety. This coping strategy, also known as emotion focused-coping, is used by avoiding certain situations that might trigger anxiety. It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting as reduced affect display is one of the negative symptoms of schizophrenia.

<i>One Child</i>

One Child is a memoir by American author and psychologist Torey Hayden. It was first published in the United States in 1980, becoming a best seller in the 00s. This book has been translated into 27 languages and dramatized as an interactive opera. It was also loosely adapted as the 1994 Lifetime television film Untamed Love, starring Ashlee Lauren, Lois Foraker and Cathy Lee Crosby. Goodreads rated the book 4.26 out of 5. The book has inspired people to move into Special Educational Need careers.

Muteness or mutism is defined as an absence of speech while conserving or maintaining the ability to understand the speech of others. Mutism is typically understood as an inability to speak on the part of a child or an adult due to an observed lack of speech from the point of view of others who know them. Such observers commonly include a mute person's family members, caregivers, teachers, and health professionals like doctors or speech and language pathologists. Muteness may not be a permanent condition, depending upon etiology (cause). In general, someone who is mute may be mute for one of several different reasons: organic, psychological, developmental/ neurological. For children, a lack of speech may be developmental, neurological, psychological, or due to a physical disability or a communication disorder. For adults who previously had speech and then became unable to speak, loss of speech may be due to injury, disease, termed aphasia, or surgery affecting areas of the brain needed for speech. Loss of speech in adults may occur rarely for psychological reasons.

DSM-5 2013 fifth and current edition of the Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, the taxonomic and diagnostic tool published by the American Psychiatric Association (APA). In the United States, the DSM serves as the principal authority for psychiatric diagnoses. Treatment recommendations, as well as payment by health care providers, are often determined by DSM classifications, so the appearance of a new version has significant practical importance. The DSM-5 is the first DSM to use an Arabic numeral instead of a Roman numeral in its title, as well as the first "living document" version of a DSM.

Traumatic stress is a common term for reactive anxiety and depression, although it is not a medical term and is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The experience of traumatic stress include subtypes of anxiety, depression and disturbance of conduct along with combinations of these symptoms. This may result from events that are less threatening and distressing than those that lead to post-traumatic stress disorder. The fifth edition of the DSM describes in a section titled "Trauma and Stress-Related Disorders" disinhibited social engagement disorder, reactive attachment disorder, acute stress disorder, adjustment disorder, and post-traumatic stress disorder.

Social anxiety is nervousness in social situations. Some disorders associated with the social anxiety spectrum include anxiety disorders, mood disorders, autistic spectrum disorders, eating disorders, and substance use disorders. Individuals higher in social anxiety avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Trait social anxiety, the stable tendency to experience this nervousness, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Nearly 90% of individuals, more of whom are women, report feeling symptoms of social anxiety at some point in their lives. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Raj Koothrappali Fictional character on the television series The Big Bang Theory

Rajesh Ramayan Koothrappali, Ph.D. is a fictional character on the CBS television series The Big Bang Theory, portrayed by Indian actor Kunal Nayyar. He is one of the four characters, along with Howard Wolowitz, Sheldon Cooper, and Leonard Hofstadter, to appear in every episode of The Big Bang Theory. Raj is based on a computer programmer that the show's co-creator, Bill Prady, knew back when he himself was a programmer.

Mental disorders diagnosed in childhood are divided into two categories: childhood disorders and learning disorders. These disorders are usually first diagnosed in infancy, childhood, or adolescence, as laid out in the DSM-IV-TR and in the ICD-10. The DSM-IV-TR includes ten subcategories of disorders including mental retardation, Learning Disorders, Motor Skills Disorders, Communication Disorders, Pervasive Developmental Disorders, Attention-Deficit and Disruptive Behavior Disorders, Feeding and Eating Disorders, Tic Disorders, Elimination Disorders, and Other Disorders of Infancy, Childhood, or Adolescence.

Social anxiety disorder (SAD), also known as social phobia, is an anxiety disorder characterized by sentiments of fear and anxiety in social situations, causing considerable distress and impaired ability to function in at least some aspects of daily life. These fears can be triggered by perceived or actual scrutiny from others. Individuals with social anxiety disorder fear negative evaluation from other people.

Trapped in Silence is a 1986 American made-for-television drama film starring Kiefer Sutherland and Marsha Mason, produced by Dick Atkins and Jeff Grant for Reader's Digest Entertainment Inc. It is based on the book Murphy's Boy by Torey Hayden.

Thought blocking is a medical or psychological phenomenon in which a person is talking about a particular subject and then abruptly changes to another subject. Thought blocking is a type of thought disorder associated with disrupted speech processes.

Social Phobia and Anxiety Inventory Brief, abbreviated as (SPAI-B), is a Spanish version of the Social Phobia and Anxiety Inventory. It evaluates the same psychological factors as SPAI related to cognition, behavior and somatic symptoms usually exhibited by persons with social anxiety. Although the psychometrics have been found to be sound, its utility as a screening measure is limited by its length. As an attempt to resolve this situation, Dr. Beidel from University of Central Florida (USA), along with an international team led by Dr. Garcia-Lopez at the University of Jaen (Spain) developed this form in 2008.

References

  1. Selective Mutism Resource Manual, Second Edition, Routledge, 2016.
  2. http://www.brighttots.com/Selective_Mutism.html Bright Tots: Selective Mutism
  3. Torey Hayden. Classification of elective mutism