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Forum Name: Psychiatric Topics

Question: Selective mutism


 scaredy_phoebe - Thu Jan 15, 2009 6:44 pm

I'm almost 21 and I've had social anxiety for the past several years (I was properly diagnosed with it this year). I've had problems with anxiety, shyness and speaking since I was about 8.

I've only recently found out about selective mutism- I had counselling last week and she mentioned that she'd read an article on it and that it sounded very similar to what I'm like around doctors, tutors, etc (and her sometimes!). I remember reading a book with a kid who had it- so I thought it was something that you only got in childhood.

When I get really anxious I sometimes find that I physically cannot speak- it's like my voice has just disappeared and no matter how much I want to say something I just can't. Even when I can speak, my voice comes out really quietly or I stutter and then people ask me to repeat what I said which makes me more anxious!

I often get told off for not smiling and find it really difficult to smile when I'm not happy. I find it really hard to maintain eye contact with anyone (even family) and end up staring into space or at the floor to avoid it.

I'm very sensitive to noises- I can't concentrate if there's any kind of background noise distracting me like a radiator, someone breathing heavily or people talking outside the window. I had to get extra time in my exams because it would take me much longer to write anything because I would be distracted by the sound of everyone else writing and then would start panicking. Nowadays, if I'm going anywhere I have to take my iPod to drown out all the noises or I start panicking. I also have a tendency to jump at loud or sudden noises!

When I was younger I often got told off in class for not talking loud enough, not taking part in class discussions and being really slow to respond to questions- which was because I would get really nervous about what to say and start over thinking it, so it would take me ages to actually say anything. (I think I still have a tendency to do that). I was the 'quiet' child who always got overlooked because adults had a tendency to forget I was there. I was also bullied throughout my school career for not being outgoing and talkative like everyone else. I can read really well in my head, but pronounce things wrongly when I try to say them out loud. I used to get told off in school because I would get bored and read ahead in the story, then when it was my turn to read I wouldn't know where I was meant to be reading from and get all anxious and start stuttering or missing out words.


If I get really anxious my whole body kind of seizes up and I get all tense. I've got really bad back pain from being all stiff and tense so often! My counsellor actually tries to make me sit more relaxed, but whenever I try I panic and get even more tense.

I went back to my counsellor this afternoon and she decided to 'test' what things make me lose my voice. I can normally answer a specific question from her, so she asked me to read out an article from a magazine. I sat there for 10 mins just staring at it, completely unable to start reading it out. My head was yelling 'just read it for god sake!' Then she asked me to copy noises she was making, but I couldn't do that either!

I'm currently getting counselling for my social anxiety and have had CBT and been on anti-depressants for it. I'm really struggling though, because counselling and therapy require that you actually have to talk, and that's my main problem! One therapist I worked with got so annoyed she told me I just had to 'get over it and start talking' before giving up and saying that I 'wasn't ready to change'.

Wondering if it's possible I have selective mutism as well as social anxiety or if it's just part of my social anxiety?
 Faye Lang, RN, MSW - Fri Jan 23, 2009 5:20 pm

Hello, Scaredy_Phoebe,

It's clear that you are in real distress. If you have selective mutism, it is connected to your anxiety disorder or social phobia. It's really not surprising that you would have such symptoms, based on what you have described about the events of your childhood. I recommend that if you are not receiving treatment at a community mental health agency, you need to do so. Such agencies have providers who have different specialties (psychologists, MSWs, or counselors), so that the best type of treatment provider for your situaion would be available. A psychiatrist would oversee your treatment, including any medications that you may need. Behavioral treatment is indicated, with the recognition that you can't just stop it if someone tells you to. I suggest that for your first visit, you go prepared with a written description of your difficulties (such as the one you did for this forum), so that the pressure to speak is reduced. If you are already in treatment with a mental health agency, request further evaluation by a psychologist (you have the legal right to do so), to firmly establish your diagnosis.

I urge you to make the appointment as soon as possible. Good luck to you!

Faye, RN, MSW
 scaredy_phoebe - Sat Jan 24, 2009 6:28 pm

Thanks for your reply.

I'm actually in the UK, so we have to access mental health services through the NHS. The CBT treatment I recieved as a day patient in a private hospital, (where I also saw the psychiatrist who diagnosed me) but my insurance has now ran out and won't pay for any more treatment. My doctor referred me to my local Community Mental Health Team (CMHT) which is made up of community psychiatric nurses (CPNs), psychologists, psychiatrists and social workers. I was assessed by a CPN a month ago, but she told me I didn't 'look anxious' (even though I was almost having a panic attack) and when she looked at my arm where I cut it (I self harm) she said the cuts 'weren't that bad'. Basically she made out I was wasting her time. She kept suggesting groups I could go to, but couldn't seem to grasp that I can't cope with groups!

I'm currently seeing a different psychiatrist through my university, but she doesn't seem to understand social anxiety. I also see my university counselor every week. The CPN finally contacted me this week to say she'd 'closed my case' and wanted me to go to a group. Clearly she didn't listen to a thing I said when she assessed me. Unless she changes her mind, my chances of seeing a psychologist are virtually nill. Basically unless you're depressed (which I'm not), self harming so much you're damaging tendons and arteries, have some sort of psychosis, or have an addiction it's almost impossible to get any sort of support from the NHS!

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