Selective mutism in adults: symptoms, causes, and how it is treated in therapy

Selective mutism is an anxiety disorder in which a person who suffers from it is unable to speak in specific social situations; On the other hand, in others, these people are able to speak and communicate with total normality, being fully functional.

This disorder usually develops during childhood and tends to disappear in adolescence or adulthood; however, some cases have been detected in the adult stage. Selective mutism in adults presents diagnostic criteria similar to those that occur in childhood, so in this article we will include those that appear in the DSM-5.

In this article we will explain what is selective mutism in adults, and for this it is important that we see what are the main diagnostic criteria and also the symptoms, as well as its etiology or the possible causes of its development.

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What is selective mutism in adults?

selective mutism in adults presents diagnostic criteria quite similar to those found in childhood

, since the international diagnostic manuals do not contemplate the classification of this disorder of independently from the one that develops in childhood, which when it usually develops in most cases.

Selective mutism, according to the Diagnostic and Statistical Manual of Mental Disorders DSM-5, is made up of the criteria that we are going to comment on below.

The basic criterion would be that there had been a consistent failure to speak in those concrete social situations in which there is an expectation to speak (p. when speaking to a group of people who have just been introduced to that person), even though in other situations that person is capable of doing so (eg. g., when talking to friends or relatives).

Another of the criteria that a case should meet to make the diagnosis of selective mutism is that the alteration interferes with academic and/or work achievements (more common in the case of selective mutism in adults) or in social communication.

In addition, the duration of the above criteria should be at least 1 month so that we can consider the diagnosis of selective mutism in adults and, of course, in children and adolescents.

On the other hand, the fact of not being able to speak in those contexts that we had mentioned in the first criterion cannot be attribute to the lack of knowledge of the spoken language required in the social environment in which the person.

Notably said alteration could not be better explained by the existence of a communication disorder and does not occur exclusively during the course of schizophrenia or another psychotic disorder, nor does it occur exclusively during the course of an autism spectrum disorder.

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What are the main symptoms of selective mutism in adults?

Now that we have seen what the main diagnostic criteria for selective mutism are, it is time to explain what the main symptoms that should be taken into account when detecting, evaluating and/or diagnosing a possible case of selective mutism in Adults.

Some of the main symptoms or warning signs of selective mutism in adults They are the ones that we are going to list below:

• They do not initiate a conversation and/or do not respond in a reciprocal way when they are talking to other people.
• They present a poor or little speech in social interactions with other people.
• They usually speak normally at home with close relatives but do not do so when they are with other relatives.
• Due to the difficulties caused by mutism, they have had poor academic and/or work performance.
• They tend to be extremely shy.
• Remarkable fear of social humiliation.
• They tend to be withdrawn on a social level.
• They may have compulsive traits.
• Negativism.
• controlling behavior.
• His lack of expression hinders his social communication.
• They tend to have a preference for participating in those activities in which it is not necessary to speak.

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Possible causes of selective mutism in adults

As for the possible causes of selective mutism in adults, it is worth mentioning that there could be a series of hereditary or genetic factors shared with other affections such as social anxiety disorder or social phobia. In addition, in some studies in this regard, it has been possible to observe some environmental and temperamental risk factors that could influence the development of selective mutism in adults. Some of these possible causes are the ones we are going to see below:

• Characteristics of neuroticism in his personality (negative affectivity).
• Existence of a family history of shyness, social phobia and/or selective mutism.
• Possibility of isolation and social anxiety.
• Behavioral inhibition.
• Inhibition at the social level by one or both parents; may have served as a model.
• Having parents who were overprotective and controlling when the person was younger.

Treatment in psychotherapy

When dealing with anxiety disorders in therapy, including selective mutism in adults, the most common is to opt for psychological therapy and also psychopharmacological treatment because both treatment modalities have been effective in this type of disorder.

However, psychological therapy has shown to be more advantageous with respect to the use of psychotropic drugs when present better long-term results, as well as a lower rate of relapse and the absence of side effects secondary. That is why we will now explain the most used techniques in psychological therapy for dealing with anxiety disorders.

Before explaining the different psychological techniques most used in therapy for selective mutism, it should be mentioned that it is important to start with the identification of that specific symptomatology presented by the patient with whom we are going to work in therapy in order to know what the symptoms and signs are shows. Psychoeducation should also be used to explain to the patient what the techniques that are going to be applied during the therapy sessions consist of, as well as those factors that influence the maintenance of selective mutism and what are its Causes.

1. relaxation training

One of the most used techniques for the treatment of selective mutism in adults is relaxation training, which could include breathing exercises, attention management and/or muscle relaxation training exercises progressive. The latter is the most popular and basically consists of performing a series of tension-distension exercises of various thick muscles gradually, in order to achieve greater control and perception of muscle sensations, as well as a relaxation of the different muscle groups in a volunteer.

It should be noted that progressive relaxation training has turned out to be a very valid option for the treatment of a large part of the anxiety disorders, both when used individually and when applied in conjunction with other techniques and/or therapies psychological.

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2. Social skills training

Another of the most commonly used psychological techniques for the treatment of selective mutism in adults is social skills training. This technique can be used individually or in conjunction with other genes framed within the cognitive-behavioral therapy model in order to improve the quality of communication of the patient, of their interpersonal and relational relationships, as well as to increase the repertoire of behaviors that are suitable depending on each situation Social.

Within the training of social skills, techniques such as the reinforced rehearsal of useful behaviors for the various situations are included in order to improve the repertoire of behaviors of the patient, modeling by the psychotherapist and also homework so that the patient reinforces the learning developed in therapy. This can also be complemented with other techniques such as cognitive restructuring, the successive approach, behavior analysis and vicarious learning, among others; being very useful for both selective mutism and social phobia.

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3. Exposure live and/or in imagination

Among the main techniques used in psychological treatment for selective mutism in adult we can also find exposure, which can be both live and in imagination, through the which the patient should come into contact with those situations that produce anxiety until that associated anxiety is significantly reduced or ends up disappearing.

In this case, the feared stimulus to which the person should be exposed would be those social situations in which it is impossible for him to speak. Such exposure is usually carried out gradually (p. beginning with imaginative exposure during therapy sessions and/or through homework) until finally being exposed to the feared stimulus or real situation (eg. g., exposing yourself to those situations in which it is very difficult or even impossible for you to talk to other people).

Notably When applying exposure training, the person can previously resort to some relaxation technique, such as progressive muscle relaxation, before exposing yourself to the feared situation. In this case we would be using a widely used psychological technique known as systematic desensitization.