Selective mutism (SM) is a rare childhood disorder characterized by a persistent failure to speak in certain social situations, such as school, despite the ability to speak in others, like at home. Although earlier theories explained SM through psychodynamic perspectives focused on trauma and family dynamics, current classifications in the DSM-5-TR place it within anxiety disorders. However, research suggests that SM is a complex and multidimensional condition that cannot be explained by anxiety alone. Using Engel’s biopsychosocial model, the essay highlights how biological, psychological, and social factors interact in the development of SM. Biological influences include genetic vulnerabilities, auditory processing differences, temperament traits such as shyness, and familial psychopathology. Psychological mechanisms involve fear of negative evaluation, behavioral inhibition, social withdrawal, and high rates of comorbid anxiety disorders, particularly social anxiety. Social factors include overprotective or controlling parenting styles, parental anxiety, family conflict, stressful life events, and environmental transitions such as starting a new school. Several theoretical frameworks, including the “unsafe world” model, polyvagal theory, and attachment theory, help explain how perceptions of safety and emotion regulation influence speech behavior. Evidence indicates that early intervention is important, with cognitive-behavioral and behavioral therapies—often combined with family and school support—showing the strongest effectiveness in improving speech and reducing anxiety in children with SM.
Bizani-Tsiliggiri et al. (Fri,) studied this question.