A person suffering from, a severe anxiety disorder, is able to speak freely with certain people only and is not able to speak with others, especially with certain social groups such as classmates at school?

Appeared in: AIIMS Patna NO - 2020

Explanation

Selective mutism is characterized by a persistent failure to speak in specific social situations (like school) where speaking is expected, despite being able to speak in other, more comfortable settings (like home).
This condition is considered an anxiety disorder, as the inability to speak is triggered by social anxiety or distress.
The description of being able to speak freely with certain people but not with others, especially social groups like classmates, is the classic presentation of selective mutism.

Why Other Options Were Wrong

Option A: Mutism is a general term for the inability to speak. It is incorrect here because the person in the scenario can speak, but only in specific situations, making their condition 'selective' rather than total.
Option B: Aphasia is a language disorder that results from damage to the parts of the brain responsible for language. It affects the ability to produce or comprehend speech and is not caused by anxiety or social situations.
Option D: Epilepsy is a neurological disorder characterized by recurrent seizures. While some seizures can temporarily affect speech, it is not the primary cause of a persistent, situational inability to speak as described.

Related Visual

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of speech and communication disorders, specifically selective mutism as background academic context rather than a clinical decision trigger.
Nurses, especially in pediatric or school health settings, play a vital role in identifying children with selective mutism and differentiating it from shyness or defiance.
The primary nursing intervention is to create a safe, non-pressuring environment. Forcing a person with selective mutism to speak can increase anxiety and worsen the condition.
Collaboration with the family, teachers, and mental health professionals is essential to implement a consistent behavioral plan.

How to Approach the Question

First, analyze the core symptoms presented in the question: the person can speak, but their ability to do so is dependent on the social context and is linked to anxiety.
Identify the key phrase: 'able to speak freely with certain people only and is not able to speak with others'. This points to a selective or situational problem.
Evaluate the options based on this core feature. 'Selective mutism' directly incorporates the 'selective' nature of the symptom.
Eliminate options that do not fit the cause or presentation. Aphasia is caused by brain injury, not anxiety. Epilepsy is a seizure disorder.
Differentiate between 'Mutism' (a general term) and 'Selective mutism' (a specific, situational condition). The detailed scenario strongly supports the more specific diagnosis.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of speech and communication disorders, specifically selective mutism.
Stem keywords: severe anxiety disorder, speak freely with certain people, not able to speak with others, social groups, classmates at school
Lead-in keywords: NOT
Clinical cues: The link between anxiety and the inability to speak is a key clinical cue.
Clinical cues: The situational nature of the symptom (speaking with some but not others) points away from a universal speech deficit.

Question ID

Q_kFQsyNjZOzWQn4MfVXFC

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 637-639, 638-640

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 15571-15573

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