symptoms, causes and how it is treated in therapy

Selective mutism is an anxiety disorder in which an affected person is unable to speak in specific social situations; instead, in others, that person is able to speak and communicate normally, being fully functional.

This disorder usually develops during childhood and tends to disappear during adolescence or adulthood; however, some cases have been detected in adulthood. Selective mutism in adults has similar diagnostic criteria to those given 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 adultsand for this it is important to see what are the main diagnostic criteria and also the symptoms, as well as their etiology or the possible causes of their development.

What is selective mutism in adults?

Selective mutism in adults he has diagnostic criteria quite similar to those given in childhoodsince in the international diagnostic manuals the classification of this disorder is not contemplated of independent form to which it develops in the childhood, that when it usually develops in the majority of the cases.

Selective mutism, according to the DSM-5 Diagnostic and Statistical Manual of Mental Disorders, includes the criteria which we will discuss below.

The basic criterion would be that it occurred a consistent failure to speak in those specific social situations in which speaking is expected (for example, talking to a group of people who have just introduced themselves to this person), even though in other situations that person may be able to do so (for example, talking with friends or family).

Another criterion that a case must meet to make the diagnosis of selective mutism is that the alteration interfere with academic and/or professional achievements (more frequent in cases of selective mutism in adults) or in social communication.

In addition, the duration of the above criteria must be at least 1 month in order to 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 the contexts that we had mentioned in the first criterion cannot be attributed to the lack of knowledge of the spoken language required in the social environment in which the person evolves.

It should be noted that such an alteration could not be better explained by the existence of a communication disorder and does not occur exclusively during schizophrenia or other psychotic disorder, nor autism spectrum disorder.

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 are the main symptoms to consider when detecting, evaluating and/or diagnosing a possible case of selective mutism. selective mutism in adults.

A part of the main symptoms or warning signs of selective mutism in adults are the ones we will list below:

  • They do not initiate conversation and/or respond to each other when talking to other people.
  • They have poor or poor language in social interactions with other people.
  • They usually talk normally at home with close relatives but do not when they are with other relatives.
  • Due to the difficulties caused by mutism, they had poor academic and/or professional performance.
  • They tend to be extremely shy.
  • Remarkable fear of social humiliation.
  • Retreats are often shown at the social level.
  • They may have compulsive traits.
  • Negativism.
  • controlling behavior.
  • Their lack of expression makes their social communication difficult.
  • They usually have a preference for participating in those activities in which it is not necessary to speak.

Possible causes of selective mutism in adults

As for the possible causes of selective mutism in adults, it should be mentioned that they could exist a number of hereditary or genetic factors shared with other conditions such as social anxiety disorder or social phobia. In addition, certain environmental and temperamental risk factors that may influence the development of selective mutism in adults have been observed in some studies. Some of these possible causes are what we will see below:

  • Traits 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.
  • Social inhibition by one or both parents; could have served as a model.
  • Having parents who were overprotective and controlling when the person was younger.

Treatment in psychotherapy

When managing 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 proven to be more beneficial compared to the use of psychotropics by showing better long-term results, as well as a lower relapse rate and the absence of side effects. This is why we will explain below the most used techniques in psychological therapy to treat anxiety disorders.

Before explaining the different psychological techniques most used in selective mutism therapy, it should be mentioned that it is important to start by identifying the specific symptoms presented by the patient who is going to work in therapy in order to know what the symptoms and signs showing. Psychoeducation should also be used explain to the patient which techniques will be applied during the therapy sessions, as well as the factors that influence the maintenance of selective mutism and what are the causes.

1. Relaxation training

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

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

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 framed genes in the cognitive-behavioral therapy model to improve the patient’s quality of communication, interpersonal and relational relationships, as well as increase the repertoire of behaviors appropriate to each social situation.

Social skills training includes techniques such as reinforced testing of useful behaviors for various situations to enhance the patient’s repertoire of behaviors, modeling by the psychotherapist, and also homework so that the patient reinforces the learnings developed in therapy. This can also be complemented by other techniques such as as cognitive restructuring, successive approach, behavior analysis and vicarious learning, among others; being very useful for both selective mutism and social phobia.

3. Living and/or imaginative exhibition

Among the main techniques used in the psychological treatment of selective mutism in adulthood is also exposure, which can be both vivid and imaginary, by which the patient must come into contact with the situations that cause him anxiety until this associated anxiety is noticeably reduced or eventually disappears.

In this case, the dreaded stimulus to which the person should be exposed would be the social situations in which it is impossible for him to speak. This exposure is usually done gradually (for example, starting with imaginary exposure during therapy sessions and/or with homework) until, eventually, you are able to expose yourself to the feared stimulus or real situation (for example, exposing yourself to those situations in which it is very difficult or impossible to talk to other people).

It should be noted that when applying exposure training, the person can use a relaxation technique beforehand, such as progressive muscle relaxation, before being exposed to the feared situation. In this case, we would be using a widely used psychological technique known as Systematic Desensitization.

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