Do you talk freely with family or close friends, but find it impossible to speak around people you don’t know? You may have a type of anxiety called selective mutism.
Selective mutism is a fairly uncommon anxiety disorder that usually develops in children before they reach age 5, according to the “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).”
While this mental health condition typically shows up during childhood and improves with age, it may, in some cases, persist into adulthood.
This generally happens if you never get a diagnosis or treatment in childhood, explains Lindsay Scharfstein, a licensed psychologist and founder of the private practice Rockville Therapy Center in Rockville, Maryland.
If you have selective mutism, you’ll most likely:
- feel unable to speak at school, work, or in other specific social contexts, even though you can talk with family, friends, and romantic partners
- have difficulties at school or work due to your inability to speak
- experience this inability to speak for more than 1 month at a time
Here’s what to know about the potential causes of selective mutism, how to handle it, and when to get support.
Selective mutism may begin as a coping mechanism for anxiety and other distress, but experts have yet to identify a clear cause.
Factors that may play a part include:
- having another anxiety condition, like separation anxiety or social anxiety
- experiencing physical, emotional, or sexual abuse
- having a family history of selective mutism or social anxiety
- having fewer opportunities for social contact
- having an extremely shy personality
- having a speech or language disorder, learning disability, or sensory processing disorder
- parent-child enmeshment, or lack of clear boundaries in the relationship
Traumatic experiences, like witnessing a shooting or experiencing relationship abuse, can also contribute to selective mutism in adulthood, Scharfstein says.
Traumatic mutism vs. trauma-induced selective mutism
There’s a slight distinction between these two conditions.
If you have traumatic mutism, you may be unable to talk in all situations following a trauma.
On the other hand, with trauma-induced selective mutism, you may find it impossible to talk only in certain situations — say, in front of the person who hurt you or in a setting that resembles the circumstances of your trauma.
According to some evidence, up to
While these two conditions do have similarities, they also have a few notable differences.
Both of these conditions can involve social difficulties and unease in public settings. But if you have selective mutism, you may not feel anxious at all when talking with people you know well. If you have social anxiety, however, even talking with familiar people may feel uncomfortable and difficult.
Here’s a chart to help contrast the two conditions:
| Social anxiety symptoms | Selective mutism symptoms |
|---|---|
| avoiding social situations and not speaking or making eye contact when you do have to participate | speaking easily in certain situations with familiar people, but not being able to speak around people you don’t know well |
| intense fear about social situations — specifically, embarrassing yourself or being judged by others | difficulty moving, speaking, or making facial expressions during anxiety-inducing social situations |
| experiencing nausea, shaking, sweating, and a racing heart during social situations or while preparing for them | using nonverbal communication like nodding and pointing to express your needs |
Some experts consider selective mutism an extreme form of social anxiety.
A small
However, this research is older, so future studies may help shed more light on any links between the two conditions.
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Still, children with selective mutism scored higher on several measures of verbal and nonverbal inhibition — like hesitancy or inability to talk or make eye contact — than children with social anxiety.
Not all experts support the theory of selective mutism developing as an extreme version of social anxiety. In fact, in a small
Other key differences between the two conditions are:
- Social anxiety can show up in social situations where you don’t have to speak, Scharfstein says — for example, eating in front of strangers, using public restrooms, or walking through a hallway at school. Selective mutism, however, tends to happen only in situations where you have to speak in front of others.
- Selective mutism tends to involve greater anxiety and fear in verbal social situations than social anxiety, per a
2020 study . - Selective mutism tends to cause greater anxiety in specific social contexts, like school, than social anxiety, the same 2020 study notes.
- Though selective mutism tends to develop when a child starts school, generally around age 5, social anxiety tends to show up during the adolescent and teen years. What’s more,
evidence from 2021 suggests a link between language and communication issues and selective mutism, but not social anxiety. - Most children with selective mutism tend to grow out of the condition as they get older, but many people with social anxiety do not.
Selective mutism generally doesn’t go away on its own, Scharfstein says, and this makes it important to address your symptoms in a way that feels right for you.
These techniques may help you feel more comfortable talking with people you don’t know:
Stimulus fading
This tactic involves starting a one-on-one conversation with someone you already know. Then, someone you don’t know or feel less comfortable with joins your conversation.
It’s OK if you freeze up at first. Just try to focus your attention on the person you know and keep your eyes focused on them while you speak.
Once you’re able to say something, the person you know will leave, and you can then try to continue the conversation with the new person.
Desensitization
This exercise helps you to get used to hearing your own speaking voice out loud without the pressure of talking with someone else. Here’s how to do it:
- Find a private, comfortable place where you can talk about your day out loud.
- Record yourself talking on your phone, a video camera, or another device, then listen to or watch the recordings.
- When you feel ready, play the recording for someone else or send it to them.
- Alternatively, you can try reading a piece of text out loud to yourself and then reading it to someone else. You can start facing away from that person if necessary, then gradually turn to face them.
It can help to give yourself some positive affirmations or even a reward every time you’re able to confront your fear of speaking in front of people you do not know.
Texting and email
When getting acquainted with new people, you can always ask if it’s OK to communicate via text or email until you feel more comfortable talking face-to-face.
You might let them know you find it tough to speak with people you’ve just met and ask if they’re open to communicating digitally until you feel more comfortable.
According to Kathryn Boger, a child and adolescent clinical psychologist and co-founder of InStride Health, you might want to connect with a therapist for additional support if:
- Selective mutism gets in the way of your ability to do your work, maintain friendships and other relationships, or complete essential daily tasks.
- Your symptoms contribute to feelings of depression, worthlessness, or hopelessness.
- You’ve tried coping mechanisms on your own but your symptoms fail to improve or get worse.
According to Scharfstein, treatment can significantly improve your symptoms and quality of life, often within a matter of months.
Holly Schiff, PsyD, a licensed clinical psychologist at Jewish Family Services of Greenwich, says treatment for selective mutism usually involves one or more of the following:
- cognitive behavioral therapy (CBT), an approach that focuses on changing negative thought patterns about yourself, other people, and the world around you.
- speech therapy, an approach that your care team may recommend when a speech disorder or other communication difficulties play a part in selective mutism
- exposure therapy, an approach that uses a gradual step-by-step process to help you conquer fears in a safe environment
If you also experience mental health symptoms like anxiety and depression, a therapist can also offer guidance with:
- untangling any connections between your symptoms
- unpacking any thoughts or feelings contributing to your distress
- developing new coping strategies to navigate uncomfortable emotions.
Your care team may also recommend anti-anxiety or antidepressant medications as a supplement to therapy if you receive a co-diagnosis of anxiety or depression, Boger says.
Support groups can also make a difference
A support group typically consists of other people who experience the same or similar symptoms as you. For instance, you might consider a support group for people with selective mutism and other anxiety conditions
Not only can people in these groups relate to and empathize with your experiences, but you can also learn from each other.
A therapist can recommend helpful support groups in your area or online, but you can also try searching for an in-person or virtual group on your own.
Our guide to the best anxiety support groups can get you started.
While selective mutism usually shows up in childhood, this condition can also affect adults.
Selective mutism goes beyond shyness or a dislike of public speaking. If you live with this condition, you don’t make a choice not to talk. Rather, you may find it impossible to speak around people you don’t know.
It’s possible to feel more comfortable speaking by gradually exposing yourself to talking in social situations. If this feels challenging to do on your own, a therapist can offer more support by helping you address the root causes and triggers of selective mutism and explore strategies that can make a difference.
Rebecca Strong is a Boston-based freelance writer covering health and wellness, fitness, food, lifestyle, and beauty. Her work has also appeared in Insider, Bustle, StyleCaster, Eat This Not That, AskMen, and Elite Daily.