Selective Mutism vs. Social Anxiety Disorder: What Are the Differences?

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Selective mutismandsocial anxiety disordershare similar symptoms but are distinct conditions. However, researchers believe that the conditions are interrelated and they often occur together at the same time.

While they are classified as different disorders, some researchers have characterized selective mutism as a more severe form of social anxiety disorder.

Around 9.1% of adolescents experience social anxiety disorder at some point before the age of 18.Selective mutism is less common, affecting around 1% of children. Studies suggest that nearly 40% of children with selective mutism also have social anxiety disorder.

Learn more about the differences between selective mutism and social anxiety disorder. Talk to your child’s doctor if you think your child might have one or both conditions.

Social mutism causes children to stop speaking in specific social situations. While they speak in other settings, such as at home or around people they are familiar with, they will often become completely nonverbal in others. Symptoms of the condition affect a child’s social life, ability to maintain friendships, and educational achievement.

Selective MutismNonverbal at school or around strangersInability to speak in front of othersRigidity, fidgeting, lack of eye contactRelying on nonverbal signals to communicateShynessSpeaking at home or with familiar peopleSocial AnxietyAnxiety in social situationsFear of new thingsFear of talking to othersFear of public speakingIrritability, crying, tantrumsQuiet and passiveFear of negative evaluations

Selective MutismNonverbal at school or around strangersInability to speak in front of othersRigidity, fidgeting, lack of eye contactRelying on nonverbal signals to communicateShynessSpeaking at home or with familiar people

Nonverbal at school or around strangers

Inability to speak in front of others

Rigidity, fidgeting, lack of eye contact

Relying on nonverbal signals to communicate

Shyness

Speaking at home or with familiar people

Social AnxietyAnxiety in social situationsFear of new thingsFear of talking to othersFear of public speakingIrritability, crying, tantrumsQuiet and passiveFear of negative evaluations

Anxiety in social situations

Fear of new things

Fear of talking to others

Fear of public speaking

Irritability, crying, tantrums

Quiet and passive

Fear of negative evaluations

The exact causes of selective mutism andsocial anxiety disorderare not completely understood. Various factors—including genetics, environmental variables, and social influences—are believed to play a role.

Selective Mutism

Selective mutism appears to have some genetic influences. According to the National Organization for Rare Diseases (NORD), some children may have a genetic vulnerability that interacts with environmental factors to increase the risk of developing the condition.

Children with the condition tend to have family members who also haveanxiety disorders. Temperament factors and family influences may increase a child’s risk. For example, a child with a shy, inhibited temperament who grows up around adults who model anxious behaviors might be more likely to develop selective mutism.

Children who arevery shy, have an anxiety disorder, and fear embarrassing themselves are more likely to experience selective mutism.

Social Anxiety Disorder

Like selective mutism, social anxiety disorder is believed to stem from a mix of genetic, environmental, and social variables. Some evidence shows that social anxiety tends to run in families. Certain temperaments, which are associated with genetic influences, are linked to a higher risk for social anxiety.

Structural differences in the brain may also play a part. For example, anoveractive amygdala, the part of the brain associated with fear, may cause people to interpret social situations as threatening and fear-inducing.

Environmental influences, including observing anxious behaviors in others, can also contribute to the condition’s onset.

In order to make a diagnosis, a healthcare practitioner will ask questions about a child’s symptoms. They will want to know more about the type of symptoms a child experiences, when they have them, and how severe they are. In addition to observing a child’s behavior, they may also talk to other people who interact with the child, such as teachers and other family members.

While the two conditions share similarities, there are symptom patterns that can help distinguish between the two. Kids with social anxiety disorder are more likely to have physical symptoms, such as frequent headaches and stomach aches.

Children with selective mutism are more likely to exhibit other speech difficulties, including problems understanding speech and speech delays. Symptoms of the condition usually begin earlier and occur in specific settings.

Children with selective mutism may also be higher in behavioral inhibition and exhibit greater fear of unfamiliar people and situations than kids with social anxiety.

Treatments for selective mutism and social anxiety disorder are very similar.Cognitive-behavioral therapy(CBT) is often the first-line approach. CBT addresses the underlying thoughts that contribute to anxiety and avoidance behavior.

Specific forms of CBT that can be helpful in treating selective mutism or social anxiety include desensitization andexposure therapy. People are gradually exposed to what they fear. With prolonged and repeated exposure, they eventually become desensitized and their fear decreases.

Most importantly, seek help if you think your child needs extra assistance. Treating social anxiety early on can prevent symptoms from getting worse, which may help reduce the risk of selective mutism.

Early recognition of social anxiety and behavioral inhibition can help improve outcomes.

Summary

Selective mutism and social anxiety disorder are separate conditions, but they share similar symptoms and may share a connection. Some experts believe that selective mutism may represent a more severe form of social anxiety disorder.

A Word From Verywell

Selective mutism and social anxiety disorder share common features and appear to be related, but are separate conditions. If your child is struggling to engage socially and experiences significant anxiety in social situations, talk to their doctor for further evaluation. With diagnosis and treatment, both are highly treatable conditions. By working with a therapist and supporting your child, you can help them manage their anxiety and build social confidence.

7 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hassan GAM, Taha GRA, Mahmoud A, Azzam H.Selective mutism and social anxiety disorders: are they two faces of the same coin?Middle East Current Psychiatry. 2013;20(3):156. doi:10.1097/01.XME.0000430430.64966.65Poole KL, Cunningham CE, McHolm AE, Schmidt LA.Distinguishing selective mutism and social anxiety in children: a multi-method study.Eur Child Adolesc Psychiatry. 2021;30(7):1059-1069. doi:10.1007/s00787-020-01588-3National Institute of Mental Health.Social anxiety disorder.National Organization for Rare Diseases.Mutism, selective.American Speech-Language-Hearing Association (ASHA).Selective mutism.Hitchcock CA, Chavira DA, Stein MB.Recent findings in social phobia among children and adolescents.Isr J Psychiatry Relat Sci. 2009;46(1):34-44. PMID: 19728571; PMCID: PMC2925835.Bas-Hoogendam JM, Westenberg PM.Imaging the socially-anxious brain: recent advances and future prospects.F1000Res. 2020;9:F1000 Faculty Rev-230. doi:10.12688/f1000research.21214.1

7 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hassan GAM, Taha GRA, Mahmoud A, Azzam H.Selective mutism and social anxiety disorders: are they two faces of the same coin?Middle East Current Psychiatry. 2013;20(3):156. doi:10.1097/01.XME.0000430430.64966.65Poole KL, Cunningham CE, McHolm AE, Schmidt LA.Distinguishing selective mutism and social anxiety in children: a multi-method study.Eur Child Adolesc Psychiatry. 2021;30(7):1059-1069. doi:10.1007/s00787-020-01588-3National Institute of Mental Health.Social anxiety disorder.National Organization for Rare Diseases.Mutism, selective.American Speech-Language-Hearing Association (ASHA).Selective mutism.Hitchcock CA, Chavira DA, Stein MB.Recent findings in social phobia among children and adolescents.Isr J Psychiatry Relat Sci. 2009;46(1):34-44. PMID: 19728571; PMCID: PMC2925835.Bas-Hoogendam JM, Westenberg PM.Imaging the socially-anxious brain: recent advances and future prospects.F1000Res. 2020;9:F1000 Faculty Rev-230. doi:10.12688/f1000research.21214.1

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Hassan GAM, Taha GRA, Mahmoud A, Azzam H.Selective mutism and social anxiety disorders: are they two faces of the same coin?Middle East Current Psychiatry. 2013;20(3):156. doi:10.1097/01.XME.0000430430.64966.65Poole KL, Cunningham CE, McHolm AE, Schmidt LA.Distinguishing selective mutism and social anxiety in children: a multi-method study.Eur Child Adolesc Psychiatry. 2021;30(7):1059-1069. doi:10.1007/s00787-020-01588-3National Institute of Mental Health.Social anxiety disorder.National Organization for Rare Diseases.Mutism, selective.American Speech-Language-Hearing Association (ASHA).Selective mutism.Hitchcock CA, Chavira DA, Stein MB.Recent findings in social phobia among children and adolescents.Isr J Psychiatry Relat Sci. 2009;46(1):34-44. PMID: 19728571; PMCID: PMC2925835.Bas-Hoogendam JM, Westenberg PM.Imaging the socially-anxious brain: recent advances and future prospects.F1000Res. 2020;9:F1000 Faculty Rev-230. doi:10.12688/f1000research.21214.1

Hassan GAM, Taha GRA, Mahmoud A, Azzam H.Selective mutism and social anxiety disorders: are they two faces of the same coin?Middle East Current Psychiatry. 2013;20(3):156. doi:10.1097/01.XME.0000430430.64966.65

Poole KL, Cunningham CE, McHolm AE, Schmidt LA.Distinguishing selective mutism and social anxiety in children: a multi-method study.Eur Child Adolesc Psychiatry. 2021;30(7):1059-1069. doi:10.1007/s00787-020-01588-3

National Institute of Mental Health.Social anxiety disorder.

National Organization for Rare Diseases.Mutism, selective.

American Speech-Language-Hearing Association (ASHA).Selective mutism.

Hitchcock CA, Chavira DA, Stein MB.Recent findings in social phobia among children and adolescents.Isr J Psychiatry Relat Sci. 2009;46(1):34-44. PMID: 19728571; PMCID: PMC2925835.

Bas-Hoogendam JM, Westenberg PM.Imaging the socially-anxious brain: recent advances and future prospects.F1000Res. 2020;9:F1000 Faculty Rev-230. doi:10.12688/f1000research.21214.1

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