Selective mutism – an overview of the condition and etiology: is the absence of speech just the tip of the iceberg?

The inability to speak in certain situations, as one may briefly characterize selective mutism (SM), according to the most recent classifications (DSM-5, ICD-11) belongs to the anxiety disorder spectrum. The onset of mutism in early childhood may impair further development and adversely affect educational achievements. It is essential that psychiatrists, as well as other physicians, speech therapists, nurses and teachers are familiar with this disorder, since the early start of treatment is associated with better prognosis. This literature review aims to present the contemporary view of this relatively rare psychopathological syndrome. In light of most recent studies on the etiology of SM, the sole symptom of mutism appears to represent an underlying heterogenic group of disorders. Based on the developmental psychopathology, the interrelations between overlapping abnormalities favor SM manifestation in some crucial moment in an individual's life. The etiologic complexity strongly suggests multimodal approach in the diagnostic and treatment process, which has been postulated by many authors.