Betrayed by the nervous system: a comparison group study to investigate the ‘unsafe world’ model of selective mutism

Abstract

The study presented in the following verifies some assumptions of the novel ‘unsafe world’ model of selective mutism (SM). According to this model, SM is a stress reaction to situations erroneously experienced via cognition without awareness as ‘unsafe’. It assumes a high sensitivity to unsafety, whereby the nervous system triggers dissociation or freeze mode at relatively low thresholds. We examine whether there is a correlation between SM, sensory-processing sensitivity and dissociation. We compared a sample of 28 children and adolescents with SM (mean age 12.66 years; 18 females) to 33 controls without SM (mean age 12.45 years; 21 females). Both groups were compared using a medical history sheet, the ‘Selective Mutism Questionnaire’ (SMQ), a ‘Checklist for Speaking Behaviour’ (CheckS), the ‘Highly Sensitive Person Scale’ (HSPS), the ‘Child Dissociative Checklist’ (CDC), the ‘Adolescent Dissociative Experience Scale’ (A-DES) and the ‘Social Phobia and Anxiety Inventory for Children’ (SPAIK). Appropriate parametric and non-parametric tests were conducted to examine differences between groups. The results indicate that sensory-processing sensitivity was significantly higher in the group of children and adolescents with SM [X2(1) = 7.224, p = 0.0007; d = 1.092]. Furthermore, dissociative symptoms were more common in children and adolescents with SM than in controls [F(1, 33) = 13.004, p = 0.001; d = 0.986]. The results indicate that sensory-processing sensitivity and dissociation are important factors of SM that may hold important implications for the treatment. Trial Registration This study is registered with the ClinicalTrials.gov number NCT04233905.

Family Relationships in Selective Mutism—A Comparison Group Study of Children and Adolescents

“…The results clearly showed that the SMQ total value differed significantly between the group with SM (M = 19.08; SD = 7.49) and the group without SM (M = 42.39; SD = 8.71; t(0.95; 169) = 18.88; p < 0.001; d = 2.90). In addition, the structure of the English version with three factors has been confirmed for the German version (Melfsen & Walitza, in preparation) [ 31 , 32 ].…”

“…The present clinical observation study compares a sample of children and adolescents with SM (MG) to a group of children and adolescents without SM (CG) regarding various aspects like emotion regulation [ 31 ], sensory-processing sensitivity and dissociation [ 32 ] as well as family relationships. Participants were recruited at the Mutism Special Outpatient Clinic of the University of Dortmund, the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the University of Wuerzburg and Department of Child and Adolescent Psychiatry and Psychotherapy of the University Hospital Zurich as well as in cooperation with two non-profit advocacy groups ( , accessed on 18 October 2022 and , accessed on 18 October 2022), and psychotherapeutic outpatient practices.…”

“…The control group was recruited through leaflets at sports clubs and youth facilities. A small compensation for participation were offered to all controls [ 31 , 32 ].…”

“…The average duration to complete the questionnaire was one hour each for the child and the mother. After that, the questionnaires were sent back to the investigators [ 31 , 32 ].…”

“…Participants were excluded if they reported pervasive developmental disorders or communication disorders that could better account for the child’s symptoms. All participants lived in Germany or Switzerland [ 31 , 32 ].…”