When fear takes you away – Panic Attacks.

By David Joel Miller.

What is a panic attack?

Panic Disorder.

Panic Disorder.
Photo courtesy of Pixabay.com

Panic attacks are sudden, unexpected increases or surges of intense fear. These waves of fear rise rapidly like the waves of the ocean. They normally reach maximum intensity within a few minutes. Panic attacks are levels of fear which far exceed the actual level of danger.

Having a single panic attack or mild levels of anxiety recurrently don’t meet the threshold to be diagnosed with a mental illness. Milder forms are often referred to as anxiety attacks. Severe forms of panic attacks are overwhelming. If your panic attacks become frequent and disabling, then you may be suffering from the more serious condition called Panic Disorder.

16 types of panic attacks.

Panic attacks are technically classified as one of the following 16 types. People who meet the criteria for a diagnosis of panic disorder are expected to have 4 or more of these symptoms. (The DSM-5, by the APA, combines several of these and lists them as 13 criteria.)

  1. Fear of dying. Not because the danger is real but because you are so scared you think you will die.
  2. Fear of going crazy.
  3. Fear of losing control.
  4. This can’t be real. Technically this is called Derealization.
  5. Is this me doing this? (Depersonalization.)
  6. Numb all over.
  7. Tingling – when your electrical system shorts out.
  8. Hot and cold flashes and you’re not menopausal.
  9. I think I will faint.
  10. My tummy hurts, and I may throw up.
  11. Is this the big one? – Heart pain.
  12. Choking again.
  13. I can’t breathe.
  14. Why am I shaking?
  15. Is it hot in the refrigerator? Why you may sweat in the snow.
  16. Your heart is trying to leave your body.

Many common reactions to intense fear are considered culturally approved and do not get counted to make up the definition of either panic attacks or Panic Disorder. These symptoms which may be an acceptable reaction to intense fear include pains in the neck, ringing in the ears, headaches, uncontrollable screaming, or uncontrollable crying.

If you experience panic attacks occasionally or because of particular stressors you may benefit from counseling or stress management training. If these panic attacks are recurrent, or interfere with work, relationships, upset you, or prevent you from enjoying other parts of your life you may have Panic Disorder. Untreated these conditions almost never get better on their own. With professional help, it is possible to overcome panic attacks or panic disorder.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions, please consult the DSM or other appropriate references.                      See Recommended Books.         More “What is” posts will be found at “What is.”

Two David Joel Miller Books are available now!

Bumps on the Road of Life.

Bumps on the Road of Life.
By David Joel Miller

Bumps on the Road of Life is now available in both Kindle and paperback format.

Bumps on the Road of Life.

Your cruising along the road of life and then wham, something knocks you in the ditch.

Sometimes you get your life going again quickly. Other times you may stay off track and in the ditch for a considerable time. If you have gone through a divorce, break up or lost a job you may have found your life off track. Professionals call those problems caused by life-altering events “Adjustment Disorders.” Bumps on the Road of Life is the story of Adjustment Disorders, how they get people off track and how to get your life out of the ditch.

Bumps on the Road of Life

Please visit my Amazon Author Page – David Joel Miller

Casino Robbery.

Photo of Casino Robbery book

Casino Robbery.

The robbers wanted more than money; they planned to kill Arthur’s fiancé and her boss.

Arthur Mitchell was trying to start his life over with a fiancé and a new job. That all ends when the casino robbers shoot Arthur, kill his fiancée, and her boss. Arthur would like to forget that horrible day, but the traumatic nightmares and constant reminders won’t let him, and someone is still out to get him. When he tries to start over by running a rural thrift store, someone knocks him unconscious, vandalize the store, and finally tries to kill him. His only chance to find peace is to figure out what the killers want from him and why.

Casino Robbery is a novel that explores the world of a man with PTSD who has to cope with his symptoms to solve the mystery and create a new life.

Casino Robbery is available now in both Kindle and paperback editions.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

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What are Somatic Symptom and Related Disorders?

By David Joel Miller.

Your mind and your body are connected.

The Somatic Symptom and Related Disorders chapter in the DSM 5 covers a group of disorders in which both the body and the emotions play a role. A lot of people think of the mind and the body as two separate things. They would like to believe that if you are sick, that means there was something wrong in your body. Otherwise – your pain is all in your head. The truth is emotional problems can make you physically ill, and illnesses that originated the body can significantly impact your emotional health.

People with Somatic Symptom and Related Disorder are primarily seen medical settings, often by primary care physicians. They are less often seen in mental health settings, and then primarily because their doctor referred them. Some of these conditions are quite rare in the general population. If a condition affects one in 300 people, then there would be over 1,000,000 people in the U.S. with that condition.

Many emotional and mental disorders create physical symptoms in the body. Depression characteristically causes changes in sleep and appetite as well as loss of energy and motivation. Anxiety disorders can cause dizziness, sweating, light-headedness, shortness of breath and many other physical symptoms. Panic Disorder manifests with symptoms similar to a heart attack or respiratory failure.

This group of disorders displays significant physical or somatic symptoms. The pain and suffering of the body are readily apparent. In these conditions, there is also significant distress and impairment in your ability to work, create and maintain relationships, or enjoy other important areas of your life. People with Somatic Symptoms Disorders are very upset by their symptoms.

This family of diagnoses should not be used simply because the doctor has been unable to find a medical explanation for the condition. Somatic Symptoms Disorders also require a change in the way the patient sees their symptoms. What the doctor or therapist is looking for is the way in which the patient’s thoughts, feelings, and behaviors, are being altered because of the physical symptoms. Somatic Symptom Disorder, the most common among this family of disorders, is often present in combination with another diagnosed physical illness. When both conditions are present, it becomes more difficult to treat and may require the services of both a medical doctor and a therapist.

Risk factors for developing a Somatic Symptom Disorder.

Having a history of traumatic experiences in early life increases the risk for a Somatic Symptom Disorder. Stress is more than just a feeling. When under stress, hormones and neurotransmitters change. Living with high levels of stress hormones alters the functioning of the nervous system. Other risk factors include an increased sensitivity to pain, chronic pain, or living in an environment where no one listens to your needs unless your report physical pain.

Other disorders related to somatic symptoms.

Here is a short list of other disorders related to Somatic Symptom Disorder.

Illness Anxiety Disorder.

Conversion Disorder.

Facetious Disorder.

False Pregnancy (Pseudocyests)

Brief forms of Somatic Symptom Disorders.

As with the other things we are calling a mental illness, these conditions need to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues, but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when under the influence of drugs or medicines, or because of some other physical or medical problem, this problem needs to be more severe than your situation would warrant. These other issues need treating first; then if you still have symptoms, you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions, please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Bumps on the Road of Life.

Your cruising along the road of life and then wham, something knocks you in the ditch.

Sometimes you get your life going again quickly. Other times you may stay off track and

Bumps on the Road of Life.

Bumps on the Road of Life.
By David Joel Miller

in the ditch for a considerable time. If you have gone through a divorce, break up or lost a job you may have found your life off track. Professionals call those problems caused by life-altering events “Adjustment Disorders.” Bumps on the Road of Life is the story of Adjustment Disorders, how they get people off track and how to get your life out of the ditch.

Bumps on the Road of life

Amazon Author Page – David Joel Miller

More to come as other books are completed.

Thanks to all my readers for all your support.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What is an Adjustment Like Disorder? (F43.9)

By David Joel Miller.

When is an adjustment disorder not an adjustment disorder?

What is? Series

What is an Adjustment Like Disorder?
Photo courtesy of Pixabay.com

Sometimes people have symptoms as a result of experiencing trauma or stress.  These difficulties are sufficiently severe that we think this person needs treatment but the exact group of symptoms they have doesn’t quite fit a listed disorder.  The new DSM – 5 solves this problem by creating another name for adjustment like disorders.

Other Specified Trauma- and Stressor-Related Disorders (F43.9)

This designation gives us five more ways to categorize problems of everyday living which were caused by stressors or trauma but do not quite neatly fit the defined adjustment disorders.  Below are the five reasons you might get an adjustment like disorder diagnosis.

1. You had a stressor but your problems did not begin until more than three months after the stressor.

2. The problems continue for more than six months even though the stressor has ended but your symptoms have not turned into another diagnosis.

3. You were having an “ataque de nervious.” This particular condition is listed in the back of the DSM – 5 under cultural concepts of distress. While not recognized in the United States as a mental disorder, this particular group of symptoms is widely recognized in Spanish-speaking countries.

4. Another cultural syndrome. There are a number of cultural syndromes that are recognized in a particular geographic or ethnic area.  The cultural syndromes are understood as an inability to cope with a particular stressor.

5. Persistent Complex Bereavement Disorder. This condition is listed in an appendix to the DSM under conditions for further study.  Since it didn’t make the list of official diagnoses, researchers needed a way to code it.  The result is this condition ended up here under adjustment like disorders.

I don’t think I’ve ever seen an adjustment like disorder listed in the person’s chart nor have I ever use this particular diagnoses myself.  But when I saw it was right there in the DSM-5 I just couldn’t resist letting you all know about this.  Maybe this illustrates how learning to diagnose mental illnesses is both an imprecise science and an area for continuing learning.

As with the other things we are calling a mental illness this adjustment like disorder needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem this issue needs to be more severe than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

For more on this topic see Adjustment Disorders in the Trauma- and Stressor-Related Disorders category.

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What are the six types of Adjustment Disorders?

By David Joel Miller.

Adjustment Disorders include six types or specifiers.

What is? Series

What is an adjustment disorder specifier?
Photo courtesy of Pixabay.com

In another post, I wrote about adjustment disorders. You might want to take a look at that post.  You will find it in the trauma- and stressor-related disorders category. But to briefly recap, an adjustment disorder is a time when you experience stress and that amount of stress is more than you can handle.

The kind of things that you might find stressful, and how that stress might affect you, can vary a great deal from one person to another.  Adjustment Disorder can be very chameleon like, changing from person to person and from time to time. As a result of this variation and in order to help find the correct treatment for each person, professionals use six different specifiers for various presentations of adjustment disorder.  Listed below are the six specifiers or sub-types of adjustment disorder that are listed in the new DSM – 5.

Adjustment Disorder with Depressed Mood (F43.21).

Sometimes in addition to having difficulty coping with a stressor, as a result of this life problem, people develop depression.  If this goes on long enough or is severe enough they might eventually get a diagnosis of Major Depressive Disorder.  But until that happens treatment will mainly focus on the stressor and the depression that stressors is causing.

Adjustment Disorder with Anxiety (F43.22).

Sometimes the primary symptom that people experience when they are going through stress is an increase in their anxiety.  If this increase in anxiety is related to a specific stressor, is more severe than we expect or goes on too long, Adjustment Disorder with Anxiety is the likely problem.

Adjustment Disorder with both Depression and Anxiety (F43.23).

Anxiety and depression frequently happen to people at the same time.  If this stressor has produced both depression and anxiety, then this specifier should be added.

Adjustment Disorder with Conduct Problems (F43.24).

Sometimes the principle way we know that stress has affected somebody is that they begin to act in inappropriate ways.  This diagnosis with this specifier is most commonly seen in children who rather than show their symptoms as anxiety or depression, begin to act out.

Adjustment Disorder with Disturbance of Emotions and Conduct (F43.25).

When stress overcomes a person’s ability to cope, we may see changes both in their behavior and in their feelings.  This is often the case in children and adolescents but may also be seen in adults with poor emotional regulation.

Adjustment Disorder Unspecified (F43.20).

When the counselor knows that the problem the client has is caused by their reaction to stress but none of the other sub-types quite seem to fit, this category may be used.

As with the other things we are calling a mental illness this problem needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise you may have the issues but you will not get the diagnoses if this is not causing you a problem. If the only time this happens is when you are under the influence of drugs or medicines or because of some other physical or medical problem, this problem needs to be more than your situation would warrant. These other issue needs treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What are Adjustment Disorders?

By David Joel Miller.

You don’t have to be “crazy” to have a mental illness.

What is? Series

What is an adjustment disorder?
Photo courtesy of Pixabay.com

Sometimes bad things happen, and those difficulties in life can overwhelm you. When these things happen, often people get right back up, but if something bad has happened to you and you find that you can’t get back on track you might well have an Adjustment Disorder. Adjustment Disorders are the result of bad things happening to you.

Professionals need to be careful not to turn everything that could possibly happen to someone into some sort of mental disorder.  Beginning professionals are cautioned to avoid pathologizing their clients by being so sure everyone who comes to their office must have some kind of extreme mental disorder.

Stress affects everyone differently.

A particular stress, divorce, for example, can have very different meaning for different people.  One person may become very depressed.  Another might become quite angry.  Some people may even be happy and throw a party.

We know that stress can be quite difficult to handle.  But if someone’s response is far beyond what we expect, then that excessive response gets diagnosed as an adjustment disorder. To be diagnosed with an adjustment disorder your distress as a result of what happened has to be in excess of what we would normally expect.

Because of the large number of possible ways stress might affect someone there are six specifiers or some types of adjustment disorder.

This inability to adjust can result in suicide.

Adjustment disorders have come to be recognized as serious mental health issues because of the high rate of suicide, homicide or other negative behavior that can occur in the aftermath of the stressor.  Things like a divorce, loss of the job, business failure or other negative events can overwhelm a person and exceed their ability to cope.

Adjustment disorder requires an identifiable trauma or stressor.

Just any difficulty coping with life does not get diagnosed as an adjustment disorder. In this condition, we know clearly that something specific happened in your life.  We call this the identified stressor. We expect to see the results of that experience start happening within three months of the original incident.  We also believe that adjustment disorder normally stops all by itself within six months of the time it began.

If you have a strong reaction to a stressor in the first month after the incident, we call that Acute Stress Disorder, a condition that usually resolves very shortly.

An Adjustment Disorder results in a change in your feelings or behavior.

As a result of this stressor, people find their feelings overwhelming them.  That may become depressed, anxious or angry.  Not only are these feelings negative but they’re far beyond what would be useful.

People with Adjustment Disorders may begin behaving in ways that are just not normal for them.  That may be constantly angry, become violent or begin abusing drugs and alcohol.  Some develop other addictions.

People with an adjustment disorder are at high risk to become violent towards those they blame for their misfortune.

Bereavement is not the same as Adjustment Disorder.

Having someone close to you die is something everyone experiences sooner or later.  Mental health professionals see this loss of a loved one as quite different from Adjustment Disorder. While everyone needs to grieve in their own way, most people eventually get past the loss of a loved one.

In an Adjustment Disorder not being able to adjust damages your life.

As with the other things we are calling a mental illness this needs to interfere with your ability to work or go to school, your relationships, your enjoyable activities or cause you personal distress. Otherwise, you may have the issues but you will not get the diagnoses if this is not interfering with your everyday life.  If the only time this happens is when under the influence of drugs or medicines or because of some other physical or medical problem this adjustment difficulty needs to be more than your situation would warrant. These other issues may need treating first, then if you still have symptoms you could get this diagnosis.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What is Separation Anxiety Disorder (F93.0)?

By David Joel Miller.

Separation Anxiety Disorder used to be strictly a children’s condition.

What is? Series

Separation Anxiety Disorder
Photo courtesy of Pixabay.com

In the past Separation Anxiety Disorder was listed in the section of the Diagnostic and Statistical Manual (DSM) under the category of Disorders First Diagnosed in Infancy, Childhood, and Adolescence.  Recently in the reorganization of the DSM, this disorder was moved to the chapter on anxiety disorders.

Increasingly we recognize that there are adults who suffer from Separation Anxiety Disorder.  In children, if they have the symptoms for four weeks or more, that meets criteria.  But when we see this disorder in adults we expected it to last at least six months.  This is a disorder which may come and go throughout the lifespan.  It is likely to begin after, or to be triggered by, stressful events.

Separation Anxiety Disorder is about a fear of losing the major attachment figure.

In Separation Anxiety Disorder there is a fear of leaving home or being separated from a major attachment figure.  This is very different from people who are simply afraid of going out of the house, being around crowds, or meeting strangers.  In Separation Anxiety Disorder it is the fear of losing that significant person which causes them extreme distress.

This fear is clearly far more than life circumstances would warrant.  People with this disorder need to know where that important person is it all times.  And they may have an excessive need to stay in constant contact with their major attachment figure.  These people may be given to constantly texting, and may become quite upset if they’re communications are not immediately responded to.

You may also fear being taken away.

Separation Anxiety Disorder is also the fear that something will take you away from that major attachment feature.  People with this disorder worry about an illness, kidnapping or being forcibly taken from a major attachment figure. Some people with this disorder are unable to be in a room by themselves.

Separation Anxiety Disorder can make you refuse to leave home.

The classic example of this is the child who is terrified of leaving their mother to go to kindergarten on the first day of school.  In normal children, if we expect them to get over this fear after a few days.  But in those with Separation Anxiety Disorder that fear continues for long periods of time. We may continue to see this behavior as children get older.  They may have frequent illnesses which keep them at home with their important attachment figure.

Like most other anxiety disorders, Separation Anxiety Disorder typically begins in childhood, but it may well continue throughout adult life.  In diagnosing this disorder the professional looks at the developmental stage of a person to see if what they are going through is appropriate.

Some adults are so afraid of leaving their significant family member that they are unable to venture out into society alone.  They will only be willing to go outside the house, to the store or an appointment, if that major attachment figure accompanies them.

That huge fear of being alone maybe Separation Anxiety Disorder.

An abiding characteristic of Separation Anxiety Disorder is the extreme level of fear of being alone.  Any time this person is separated from their major attachment figure, they become anxious and may even become terrified.

In children, the attachment figure is likely to be their parents or caregiver.  In adulthood people with this disorder are likely to become very anxious when separated from their spouse, partner or their children.

If that important person is not home, then you can’t sleep.

People with Separation Anxiety Disorder find that they are unable to sleep when the major attachment figure is not in the house.  They may stay up all night on those occasions when that person they’re attached to needs to be gone overnight.

The person with Separation Anxiety Disorder will have a constant need for reassurance.  This need may result in frequent phone calls or other efforts to contact the attachment figure who is not there.  This constant need for reassurance may begin to interfere with their partner’s ability to work.

Separation Anxiety Disorder causes nightmares about being separated.

In this disorder, the content of the nightmare is that the important person will be taken from you or you from them and that you will never ever be able to see them again. These nightmares can be recurrent and play a role in maintaining the other symptoms.

Separation Anxiety Disorder can make your physically ill.

Symptoms of this disorder can look just like a physical illness.  These symptoms may include headaches, inability to eat, nausea, or even vomiting if there’s a chance that you’ll be separated from this major attachment figure in your life.

People with Separation Anxiety Disorder are likely to be described by others as needy and insecure.

There is help for Separation Anxiety Disorder.

While this condition often begins in childhood and may continue well into adulthood, someone with this issue does not have to continue to suffer.  There are treatments available.  If you or someone you love suffers from this condition, consider getting professional help.

More on this and other anxiety disorders see:  Anxiety

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

See Recommended Books.     More “What is” posts will be found at “What is.”

Want to sign up for my mailing list?

Get the latest updates on my books, due out later this year by signing up for my newsletter. Newsletter subscribers will also be notified about live training opportunities and free or discounted books. Sign up here – Newsletter. I promise not to share your email or to send you spam and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books

What is Selective Mutism (F94.0)?

By David Joel Miller.

Selective Mutism is the failure to speak at times when speech is necessary.

Can't talk

No speech. Selective Mutism.
Photo courtesy of Pixabay.com

Selective Mutism is an interesting disorder. It is one of the less common anxiety disorders and one which commonly first appears in childhood.  This disorder often co-occurs with Social Anxiety Disorder.  As with all the anxiety disorders, Selective Mutism may continue well into adulthood.

Selective Mutism is not the inability to speak or the willful refusal to speak.  Selective Mutism occurs when someone chooses not to speak in a particular situation even when not speaking may cause them difficult.  Children with this condition will avoid starting a conversation with other children.  When spoken to they will fail to respond.

Selective Mutism gets noticed when children begin to attend school.

Children with Selective Mutism do poorly in school because they do not respond verbally to the teacher and do not read out loud.  Those with this disorder may use other ways of communicating rather than speaking.  Sometimes they will point, grunt or used personally significant gestures.  They may also be willing to engage in social activities when speech is not required.

Children with Selective Mutism are able to speak normally at home with their parents or primary caregivers.  They may be unwilling to speak in the presence of close relatives including cousins, aunts and uncles, and grandparents.

Risk factors for Selective Mutism.

Children who are shy are at extra risk to develop this disorder.  Having parents who are withdrawn or growing up in a socially isolated environment may also be risk factors.  It is possible that having overprotective or controlling parents increases this risk.  There’s some evidence that children with this disorder have difficulty understanding the things that are said to them.  Having Social Anxiety Disorder or a family history of it may also increase the risks.

Other problems may accompany Selective Mutism.

People was Selective Mutism also frequently are shy and experience social embarrassment.  They may be isolated and withdrawn.  Children with Selective Mutism may be clingy and become easily upset.  They many also exhibit temper tantrums and oppositional behavior.

Having this disorder early in life and not getting treatment for it puts the child at extra risk for poor development and failure to learn needed social skills.

Things that are excluded from a Selective Mutism diagnosis.

To get this diagnosis, this condition of not speaking even when you need to speak must go on for at a month or more.  If the thing keeping you from speaking is the result of not knowing the English language or being bilingual in some way, this is not a case of Selective Mutism.

Also excluded from the definition of Selective Mutism are things related to speech fluency.  If the person involved is experiencing an episode of hearing voices, if being psychotic, or a schizophrenia-like condition, this also is outside the definition of Selective Mutism.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

More “What is” posts will be found at What is.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at counselorfresno.com. A list of books I have read and can recommend is over at Recommended Books