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 an anxiety disorder where a person who is capable of speech is unable to speak in specific social situations.
The key feature is the situational nature of the mutism, as described in the stem (speaking to some but not others like classmates).
The condition is strongly associated with social anxiety and typically begins in childhood, often becoming apparent in a school setting.
The individual has the physical and cognitive ability to speak, which they demonstrate in comfortable settings (e.g., at home).

Why Other Options Were Wrong

Option A: Mutism refers to a complete inability to speak in all situations, not just specific ones. The person in the scenario can speak, just not in certain contexts.
Option B: Aphasia is a language disorder resulting from brain damage (e.g., stroke, head injury). It affects the ability to produce or comprehend language and is not caused by anxiety.
Option D: Epilepsy is a neurological disorder characterized by seizures. While some seizures can temporarily affect speech, it is not the primary diagnosis for a persistent, situational inability to speak due to anxiety.

Related Visual

A diagnostic flowchart to differentiate between mutism, selective mutism, and aphasia based on key questions e.g., Is there an ability to speak in any situation?, Is it link...

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Selective Mutism as background academic context rather than a clinical decision trigger.
Nurses, especially in school or pediatric settings, are in a prime position to identify signs of selective mutism and initiate referrals for psychological evaluation.
Nursing interventions focus on creating a safe, non-pressuring environment, encouraging non-verbal communication initially, and collaborating with the family and school to implement behavioral strategies.
It is a critical patient-safety and mental health issue, as untreated selective mutism can lead to social isolation, poor academic performance, and worsening anxiety.

How to Approach the Question

First, analyze the core symptoms presented in the question stem. The key phrase is 'able to speak freely with certain people only and is not able to speak with others.'
This immediately points to a 'selective' or 'situational' problem, rather than a total inability to speak.
Next, evaluate each option against this core symptom.
Eliminate 'Mutism' because it implies a total lack of speech.
Eliminate 'Aphasia' and 'Epilepsy' as they are neurological conditions with different primary causes and presentations not related to social anxiety.
Identify 'Selective mutism' as the only option that perfectly describes an anxiety-driven, situational inability to speak.

Concept Tested & Keywords

Concept Tested: Selective Mutism
Stem keywords: anxiety disorder, speak freely with certain people, not able to speak with others, social groups, classmates
Lead-in keywords: able to speak freely with certain people only, not able to speak with others
Clinical cues: The situational nature of the inability to speak (only with certain groups) is the primary clinical cue.
Negative lead-in flag: NOT changes the reasoning strategy; look for the exception or incorrect statement rather than the true statement.

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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