Significance of Cultural Beliefs in Presentation of Psychiatric Illness: A Case Report of Selective Mutism in a Man from Nepal

Abstract

A 22-year-old active duty E1 Nepalese male who recently emigrated from Nepal suddenly exhibited strange behaviors and mutism during Advanced Individual Training. After receiving care from a hospital near his unit, he was transferred to Walter Reed Army Medical Center Inpatient Psychiatry for further evaluation and treatment. Although he was admitted with a diagnosis of psychosis not otherwise specified (NOS), after consideration of cultural factors and by ruling out concurrent thought disorder, a diagnosis of selective mutism was made. To our knowledge this is the first reported case of selective mutism in a soldier. This case serves as a reminder of the need for cultural awareness during psychological evaluation, diagnosis, and treatment of patients.

Addressing trauma in collaborative mental health care for refugee children

“…Selective mutism can be a presenting symptom in situations of organized violence, linking speaking up with death (Babikian, Emerson, & Wynn, 2007; Hollifield, Geppert, Johnson, & Fryer, 2003). Beyond the fact that selective mutism is a sign of anxiety, it may also replay, as in the case of Lin, complex avoidance strategies linked to survival.…”