Psychogenic mutism as a reaction to psychological trauma, stress and anxiety

Mutism is like a dog: I understand everything, but I can’t answer.
The condition is characterized by loss of the ability to speak while maintaining hearing and the functionality of the speech-motor apparatus. The term owes its name to the Latin word mutus, which means “silence.” The pathology occurs in both children and adults, but more often it develops in childhood.

Symptoms of mutism

The main symptoms of mutism include the absence or cessation of speech while the functions of the speech apparatus and brain structures responsible for understanding and reproducing speech structures are preserved. In addition, the following data is collected to make a diagnosis:

• duration of absence of speech, movements, answers to questions;
• the presence of strong emotional turmoil;
• social isolation in behavior;
• expressing your needs and desires with gestures;
• loss of consciousness;
• head injuries;
• facial asymmetry;
• mental retardation and speech disorders;
• strabismus and impaired movements of the eyeballs.

One person does not necessarily have all the symptoms; more often it is a combination of a couple of disorders characteristic of a certain type of mutism.

Complex of therapeutic measures

There is no universal method for treating psychogenic mutism; in each case, methods are selected individually, depending on the patient’s condition and the causes of the disorder. The main goal of treatment is to eliminate the consequences of injury and normalize the patient’s mental state.

As part of therapy, medications from the group of nootropics and antipsychotics are prescribed, and antidepressants may be recommended.

The patient also needs psychotherapeutic treatment, help in getting rid of anxiety and overcoming stress. In addition, additional activities may be prescribed, for example, massage, therapeutic and breathing exercises, etc.

In most cases, mutism of psychogenic origin is treatable, and patients have a good chance of a full recovery and a full life in the future.

Types and causes of mutism

Variants of mutism differ not only in their manifestation, but also in the cause that caused this disorder. The following types of mutism are distinguished:

• Psychogenic – occurs as a result of a traumatic situation or in specific social conditions that cause a child to feel fear or severe anxiety.
• Catatonic – characteristic of catatonic syndrome, represents an unmotivated refusal to communicate (in schizophrenia spectrum disorders).
• Hysterical - a person’s subconscious desire to attract the attention of others, using the loss of speech (with dissociations).
• Akinetic - occurs due to violations of the integrity of brain structures, organic, traumatic or infectious lesions of the brain, tumors, etc.

Separately, selective mutism should be highlighted, when a person is able to communicate with a certain circle of people. This disorder is most common in adults. It occurs in children from the age of three years, when speech is considered formed.

Clinical manifestations and symptoms

Psychogenic mutism can be diagnosed by the presence of certain signs; the main symptoms include:

• refusal of verbal (speech) communication;
• absence of diseases as a result of which speech functions are impaired;
• clarity of consciousness;
• maintaining the ability to express one's thoughts in writing;
• use of non-verbal methods of communication.

If muteness persists for more than 1 month, this indicates mutism. In some cases, a person is unable to communicate only in a state of excitement or loses speech when in contact with a certain circle of people.

Mutism in children

Childhood mutism is initially divided into situational, permanent and total. Typically, the provoking factor for the occurrence of this disorder in childhood is traumatic psychogenic influence and the general psychological climate in the family. Selective childhood mutism occurs between the ages of three and is often first diagnosed at the beginning of school. There are cases when it goes away on its own by the age of ten, but if it is not corrected, the child will develop secondary speech and psycho-emotional disorders: logophobia, logoneurosis, social phobia, low self-esteem, anxiety and other neurotic disorders. Children with mutism, which has not been corrected, have pronounced schizoid and inhibited features, and have difficulties in intellectual development and verbal and logical thinking.

There are no physiological disturbances in this case, so mutism can be perceived as a passive form of protest against new social norms or changes in social conditions.

Psychogenic mutism, which occurs in children as a result of psychological trauma, has a different specificity. This state arises due to the unpreparedness of the psyche to transform the acquired life experience and establish contact with others in the current situation. War events, psychological violence in the family, sexual violence, presence at the death of loved ones, etc. – all this violates the stability of the psyche. This form of mutism is accompanied by an increased level of anxiety, depression, impressionability, and infantilism. There may be disturbances in appetite and sleep, lethargy, and frequent moods of protest.

In the most common forms of childhood mutism, there are no physiological disturbances, so the condition is corrected exclusively by psychotherapeutic methods.

Getting rid of the disorder

Recognizing the symptoms of childhood mutism and treating it poses some challenges. To establish a diagnosis, it is necessary to clearly differentiate the phenomenon from other disorders.

There is no generally accepted treatment regimen for mutism in children. An individual approach is used in each specific case. Possible methods used:

• psychotic drugs to relieve tension, relieve fear;
• physiotherapy to relax the muscles of the neck and speech-motor apparatus, which the child strains in the situation of planned communication;
• psychotherapy. Initially, individual therapy is recommended to establish contact with the little silent one. But in the future, you should still switch to the group form. Being in a team helps to establish social contact and emancipation. Group therapy may take the form of drama. Family psychotherapy is required.

But it is worth understanding that the main step to restoring a child’s speech activity is treating the underlying disease or eliminating a traumatic psychological factor. Therapy must be started as early as possible. The following situations may be indications for contacting a doctor:

• if the baby does not communicate for more than 1 month;
• the presence of speech problems under certain circumstances;
• the child hears and understands what is said to him, his intelligence is preserved. Tries to communicate with gestures and writing;
• absence of speech motor defects.

Children suffering from mutism are a special category. Despite their silence, they understand everything, are distinguished by observation and simply donkey stubbornness. The inability to speak creates tension and unrest in their inner world. They are able to swim in different guises. For example, cases of pronounced cruelty in children have been observed. The boy could come up to his mother and bite her for no reason. Other patients showed cruelty to animals.

The inability to express one's thoughts directly requires treating silent people with increased attention. Early diagnosis and assistance to the child will help to avoid social vacuum and psychosis.

Treatment and correction of mutism

To correct mutism, an integrated approach is used, which involves the coordinated work of several specialists:

• First of all, it is recommended to contact a neuropsychiatrist or child psychotherapist, who will make an accurate diagnosis and, if necessary, prescribe medication.
• Neurologist - prescribes medications and physical procedures that correct the functioning of the brain, and also conducts periodic diagnostics of changes in condition.
• Child psychologist - carries out basic psychotherapeutic work, where communication itself is a stimulating and supportive method for speech and writing, and provides advice on changing the situation in the family. Children benefit greatly from the sand therapy method used by psychologists.
• Speech therapist - conducts classes on the development of the articulatory apparatus in order to prevent or correct speech disorders that arise as a result of long silence.
• The Tomatis hardware method can also be used to reduce anxiety levels. It prevents logophobia and logoneurosis as common consequences of mutism.

All actions of specialists must be coordinated for each specific case. Only one recommendation remains the same - start correction as early as possible.

Diagnostic criteria and methods

In the diagnostic process, in order to most fully assess the patient’s condition, specialists will need information about how long ago the person stopped communicating through speech and as a result of what events this happened. The following examinations are also prescribed:

• magnetic resonance imaging (MRI);
• computed tomography of the brain ();
• electroencephalography (EEG).

In addition, it is necessary to conduct a neurological examination, as well as consult with a psychiatrist and speech therapist.

Selective mutism in simple schizophrenia

The reason for the appearance of this pathology may be not only an increased level of intellectual capabilities and the desire to manipulate adults in their own interests. When diagnosing this type of pathology, doctors first check the patient for the presence of schizophrenia. Such a manifestation may be a sign of the onset of one of the most complex types of catatonic schizophrenia. In the absence of proper therapy, a patient with this form of severe mental disorder is able to completely withdraw from the world, retreating into his own shell.

Preventive measures

There are no specific preventive measures to prevent psychogenic disorders. The reason is that in most cases it is impossible to predict and prevent the emotional shocks and psychological trauma that can trigger the disease.

The only thing that can be done is to monitor your health, which will to some extent increase your mental stability in stressful situations, namely:

• observe a rest regime and avoid emotional and physical overload;
• lead a healthy lifestyle;
• sleep at least 8 hours a day;
• If possible, avoid stressful situations and nervous tension;
• promptly seek medical help for health problems.

When it comes to a child, it is necessary to take care of a calm and comfortable environment in the family, avoid stormy showdowns and not use violence against the child. And if any deviations or behavioral disorders appear, immediately contact a specialist.

List of sources

• Osipova A.A. General psychocorrection: textbook. allowance. M.: Sfera, 2002;
• Sidorov P.I., Parnyakov A.V. Introduction to clinical psychology: A textbook for medical students. Volume 1. M. Ekaterinburg: Academic project-Business book; 2000;
• Yakhno N. N., Shtulman D. R. Diseases of the nervous system: A guide for doctors in 2 volumes. - M.: “Medicine”, 2005;
• Konovalova A. N., Skvortsova V. I., Gekht A. B. Neurology: National Guide / Ed. E. I. Guseva. - M.: GEOTAR-Media, 2009.

“Like a lump in the throat”: how children with selective mutism explain the inability to speak

To further study selective mutism, children with the disorder are often asked what prevents them from speaking in a given situation.

The answers are very different. “I can’t start talking, because then everyone will immediately pay attention to what I’m doing,” this is how a teenage girl explained her condition at an appointment with an American psychologist who was treating her.

Some older children describe the feeling of a large lump in their throat that prevents them from speaking.

Article:

Selective mutism, also known as psychogenic mutism, causes people to remain silent, particularly in social and stressful situations.
The causes of this condition are unknown, and although it can affect anyone, selective mutism is most common in young children. What is Selective Mutism?

Mutism can be caused by a number of conditions, including deafness, speech delay and developmental disabilities.

But selective mutism occurs when someone—usually a child—who is able to speak stops doing so. Most adults have witnessed an intermittent example, selective mutism, where a child who can speak does not react to an unfamiliar adult. Typically, selective mutism is much more pervasive and interferes with daily activities. Some children with selective mutism do not speak in social situations, at school, or during times of extreme stress.

There is a strong correlation between selective mutism and shyness; parents whose children selectively "switch off" sometimes interpret the child's behavior as rudeness and believe that he or she is simply refusing to talk. In fact, the child is truly unable to speak in these cases. Most children with selective mutism also experience some kind of phobia, such as social anxiety.

Symptoms of Selective Mutism

Children and adults with selective mutism may talk in their own homes or other familiar places, they may be shy in everyday situations and show fear and anxiety when around people. To be diagnosed, the behavior must have continued for one month and it must not be due to cultural issues. Selective mutism may also be accompanied by a characteristically blank facial expression.

What Causes Selective Mutism?

Selective mutism has no known cause, although those who have experienced it often have a history of anxiety, anxiety, extreme shyness, social phobia, and/or inhibited temperament, which is believed to be due to decreased levels of excitability in amygdala. This condition is almost always accompanied by a certain degree of shyness or inhibition.

Selective mutism is different from traumatic mutism and mutism. People who experience selective mutism are able to speak but are unable to do so due to shyness, anxiety or pressure. However, if left untreated, selective mutism can progress to mutism, resulting in a complete inability to speak in any environment.

How is Selective Mutism Treated?

Selective mutism can affect a child's ability to learn in school, as well as their social status. Treatment of selective mutism, first of all, takes place in therapy, reducing the person’s anxiety level, sometimes together with a psychiatrist (medication). Trying to force someone with selective mutism to speak may actually make the condition worse.

The key to treating selective mutism lies in behavioral changes. Parents of children with selective mutism can help their children by making lifestyle changes, gradually introducing them to new people, choosing small schools, helping children work on social skills, praising the child for their efforts rather than trying to force them to talk or simply not accepting them. state. Anti-anxiety medications may be helpful for people with this condition, especially those whose anxiety is very severe.

When selective mutism accompanies another condition, such as generalized anxiety or social phobia, treatment begins by focusing on the underlying anxiety.

Selective Mutism in popular culture.

In popular culture, traumatic mutism is often confused with selective mutism, since the two conditions can produce similar results. Traumatic mutism, which can result from a traumatic event, is often depicted in books and films such as Maya Angelou - I Know Why the Caged Bird Sings and Laurie Halse Anderson - Speak. The main characters in these books became mute after experiencing rape.

The portrayal of selective mutism in popular culture can be seen in such famous sitcoms as The Big Bang Theory. One of the characters, Rajesh Koothrappali, plays an adult scientist who has selective mutism with anxiety (it occurs selectively to him, namely when talking to women). Silent Bob, a character who appears in many of Kevin Smith's films, also appears to experience selective mutism.

The most striking illustration of childhood selective mutism is presented in the Paul McCartney song “She Refused to Talk.” It is about a girl who is constantly silent at school, experiencing anxiety and loneliness, but when she comes home, her voice returns and her words move freely.

Dear parents, if your child shows what is described in this article, then try to contact a specialist, and do not forcefully try to adapt the child to the social environment.

After all, your child is the miracle that makes your life happy, and you are the miracle that, in children’s eyes, will always come and protect you from any misfortune.