In the DSM-IV selective mutism is described as a rare psychological disorder in children. Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. They function normally in other areas of behaviour and learning, though appear severely withdrawn and might be unwilling to participate in group activities. It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.

The disorder is not regarded as a communication disorder, in that most children communicate through facial expressions, gestures, etc. In some cases, selective mutism is a symptom of a pervasive developmental disorder or a psychotic disorder.

In diagnosis, it can be easily confused with autistic spectrum disorder, or Aspergers, especially if the child acts particularly withdrawn around his or her psychologist. Unfortunately, this can lead to incorrect treatment.

Selective mutism is usually characterised by the following:

The person does not speak in specific places such as school or other social events.
The person can speak normally in at least one environment. Normally this is in the home.
The person's inability to speak interferes with his or her ability to function in educational and/or social settings.
The mutism has persisted for at least a month and is not related to change in the environment.
The mutism is not caused by another communication disorder and does not occur as part of other mental disorders.

The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak they just cannot make any voice. To reflect the involuntary nature of this disorder, its name has been changed to selective mutism in 1994. However, misconceptions still prevail; for instance, the ABC News erroneously attributed the cause of selective mutism to trauma and described it as willful in a report dated May 26, 2005.

The incidence of selective mutism is not certain. Owing to the poor understanding of the general public on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.

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Ask Dr. E: answers to your questions about dishonesty, dreams, selective mutism and more - Q&A
From Psychology Today, 3/1/03 by Robert Epstein

Dear Dr. E,

I recently met a married man who says he's getting a divorce, so we started having fun physically. My friends say he's probably lying, but my intuition tells me he's honest and that patience will pay off. Can you give me some direction?

PBZ, via e-mail

Dear PBZ,

My intuition says he's probably lying. Perhaps, though, we should each put intuition aside and think. Is what you're doing right? Might your behavior have negative consequences? If your relationship with him is meant to be, couldn't it wait until after the divorce?

Dear Dr. E,

I can't remember my dreams. Am I trying to flee from my desires?

G, New York, NY

Dear G,

Research suggests that the main purpose of dreams is to help us resolve our conflicts. Fortunately, we don't need to remember them to reap their benefits. If, however, you want to learn how to remember your dreams, books like Teach Yourself to Dream, by David Fontana, Ph.D., can help. Pleasant dreams.

Dear Dr. E,

I'm 23, and I recently ended a three-year relationship with my boyfriend. So many hurtful things were said and done while we were together that I just couldn't continue. How can I get over my hurt so that I can have a healthy relationship with another guy?

D, Los Angeles

Dear D,

Time will probably help, and so will an understanding new partner. If you don't seem to be making progress, consider consulting a therapist. You can find skilled therapists through the associations listed at right or through online directories, such as the new one at www.psychologytoday.com.

Dear Dr. E,

My child suffers from a condition called "selective mutism," which means she only talks when she wants to. Where can I get more information about this condition, and how can I help her?

EH, via e-mail

Dear EH,

Selective mutism is an anxiety disorder that is usually specific to certain settings, such as a school classroom. For more information, see www.selectivemutism.org, or check out books such as Easing School Jitters for the Selectively Mute Child, by Elisa Shipon-Blum, D.O. Lessening a child's anxiety is the key to treatment.

Dear Dr. E,

I'm straight, but I enjoy it more when a man performs oral sex on me than when a woman does. I don't reciprocate. Does this mean I'm actually gay?

E, via e-mail

Dear E,

The "gay" and "straight" labels sometimes cause more problems than they solve. You were probably doing fine until you felt the need to classify yourself. Nature gives us black and white, but it also gives us an infinite array of colors. Stop trying to fit yourself into a box.

PLEASE SEND YOUR QUESTIONS to askthedr@psychologytoday.com, or call our 24-hour hotline: (877) PSYCH-TODAY. We reserve the right to edit all submitted material.

TO BE REFERRED TO A THERAPIST, CONTACT: www.psychologytoday.com | American Association for Marriage and Family Therapy: www.aamft.org | American Psychological Association: www.apa.org or (800) 964-2000 | Association for Advancement of Behavior Therapy: www.aabt.org | National Association of Social Workers: (800) 638-8799 | National Board for Certified Counselors: (336) 547-0607

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