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  • Toni Pakula
    • Jul 22
    • 7 min read

Selective Mutism and Obsessive Compulsive Disorder (OCD).

Written by Toni Pakula ©| Voice Holistic Health Practitioner | 2024


Selective Mutism extends beyond mere social challenges outside the home; it affects the entire nervous system. Non-verbal communication is as demanding as verbal expression, and individuals with Selective Mutism often contend with perfectionism and sensory processing difficulties. They are also highly sensitive and remarkably creative, but anxiety is a constant struggle. There's an urgent need for further research into how Selective Mutism impacts children, teenagers, and adults, and how it intersects with conditions like Obsessive Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD), which extend beyond social engagement challenges in specific situations outside the home.


OCD and Selective Mutism is something that has personally affected my family. I know first-hand the challenges of raising a child with Selective Mutism and OCD. When my daughter started showing signs of OCD around the age of 10, I struggled to know how to help her. Like Selective Mutism, finding suitable resources and advice for supporting her was incredibly difficult. Her struggle with Selective Mutism added another layer of complexity. How could she receive therapy for OCD when she couldn't communicate with the therapist or psychologist? This is a struggle many parents are facing today. It's paramount to understand the link between different conditions and how they can be impacting yourself or your child's emotional regulation and mental well-being.


It's crucial to grasp the physiological aspects of Selective Mutism, including the role of the nervous system and gut, and how OCD and OCD-type behaviours can interplay in this network. This understanding will guide you in supporting yourself, child or teen, reframing their behaviour, and equipping you with the tools to nurture your relationship, preventing strain and stress.




So, what is the relationship between Selective Mutism (SM) and Obsessive Compulsive Disorder (OCD)?


Many children and teens struggling with Selective Mutism can exhibit Obsessive Compulsive Disorder (OCD) behaviours, as their brain attempts to gain control over their immediate environment to bring calm to the nervous system.


When someone experiences Selective Mutism, their nervous system is "hijacked" by the 'freeze stress response' in social situations, leaving them feeling misunderstood, vulnerable, and out of control. Those who struggle with Selective Mutism do not understand why they suddenly lose their ability to engage socially, make eye contact, or express their needs verbally. Selective Mutism is misunderstood by the wider social environment too. What others take for granted can leave them wondering why those with SM cannot speak to them, which leads to judgmental comments and misconceptions that foster self-doubt and inner shame in those affected, as they struggle to explain their shutdown and communication difficulties.


It's not uncommon for parents to observe their children with Selective Mutism becoming agitated at home, often having meltdowns and being in a fight/flight state after school or social gatherings, and exhibiting controlling behaviours with siblings at home, displaying particular "quirks" such as insisting on specific routines or arrangements. So, it is important to beware, co-occurrence with OCD is common. OCD typically emerges in pre-teen or teenage years but can manifest earlier. Individuals may attempt to manage anxiety by imposing rules at home or on themselves, such as using the same cup or arranging clothes in a specific manner, and insisting on completing tasks in a particular order.


When the nervous system fluctuates between dorsal shutdown (freeze response) and sympathetic fight/flight responses, rarely entering the calm, regulated ventral vagus state, the brain attempts to self-regulate by seeking control over the environment. Alongside OCD-type behaviours, this can also manifest as perfectionism, a trait often seen in individuals with selective mutism.


Understanding Obsessive-Compulsive Disorder (OCD):


Obsessive-Compulsive Disorder (OCD) is a complex mental health condition that affects people worldwide, including in New Zealand. Its prevalence in Aotearoa mirrors global trends, with an estimated 2-3% individuals of the population grappling with this disorder at some point in their lives. However, beyond statistics, it's crucial to delve into what OCD truly entails, what it isn't, and how various factors, including gut health, can influence its manifestation.



What OCD Is and Isn't:


OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that individuals feel driven to perform. Contrary to common misconceptions, OCD isn't just about being excessively tidy or perfectionistic. It's a serious mental health condition that can significantly impair daily functioning and quality of life.


Onset and Triggers:


OCD typically begins in childhood, adolescence, or early adulthood. While it can emerge following a traumatic event, it doesn't always have a clear trigger. Genetic predispositions and environmental factors also play roles in its development.


Effective Treatment: ERP Therapy:


Exposure and Response Prevention (ERP) therapy is considered the gold standard treatment for OCD. This behavioural therapy involves gradually exposing individuals to feared obsessions (exposure), while preventing the accompanying compulsive behaviours (response prevention). Over time, this helps reduce anxiety and disrupts the cycle of obsessions and compulsions.

 



Nutritional Support and Histamine Intolerance:


Micronutrients, such as those from Hardy Nutritional’s, play a role in supporting overall mental health, and research is showing how they are benefiting individuals with OCD. Histamine intolerance, linked to genetic polymorphisms, could indicate a need for specific nutrients like Niacin (B3), which can influence mental health and neurological function. It's worthwhile to seek out clinical nutritional support from a trained clinician - either a Naturopath who also works with mental health, a Clinical Nutritionist, and/or Dietician. Mental health needs a holistic, interdisciplinary approach for best effective results.



The Role of Gut Health and PANS/PANDAS:


Emerging research suggests a potential link between gut health and OCD. The gut-brain axis, a bidirectional communication system between the gut and the brain, can influence mental health conditions, including OCD. Moreover, Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are conditions where OCD-like symptoms can arise suddenly in children following infections. Understanding these connections underscores the multifaceted nature of OCD.


If OCD is a result from PANS/PANDAS, it is important your child or teen gets the right support immediately. The traditional therapies for OCD will not be so effective if you are, in fact, dealing with PANS/PANDAS. So, it's key to know if your child was sick before they started to show signs of OCD and to get them tested by a clinician to test for PANS/PANDAS before any treatment is given. Antibiotics and support for the gut are the go-to treatment for OCD which has been triggered by PANS/PANDAS before any behavioural intervention is put into place.



 

Resources for Support

 


These resources offer valuable information and support networks for individuals and families affected by OCD. These platforms provide access to resources, treatment options, and community support.


OCD is more than a collection of symptoms—it's a complex interplay of biological, psychological, and environmental factors. By fostering understanding, promoting effective therapies like ERP, and leveraging supportive resources, we can empower individuals and families in their journey towards managing and overcoming OCD. Through education, empathy, and research-driven interventions, we can continue to break the stigma surrounding OCD and advocate for comprehensive mental health care for all.


Providing children and teens with as much control as feasible can help them feel empowered and support their nervous system, albeit within reasonable limits.



The Safe and Sound Protocol is an amazing non-invasive therapy that works by stimulating the vagus nerve to help reshape the pathways, reducing stress and building myelination. There are numerous case studies demonstrating its effectiveness in supporting those with mental health issues, particularly Selective Mutism and OCD-like behaviours, especially when delivered alongside other therapeutic modalities such as nutritional intervention and gradual exposure.  This approach also involves working on the immediate environment and educating others about Selective Mutism and how to support our children when they are away from home and at school.



If you would like to learn more about these holistic, bottom-up therapies, contact me today! I have a special offer for the Safe and Sound Protocol for both parent and child, and I would love to support you!


As a Holistic Health Practitioner, I offer a combined approach to supporting Selective Mutism and helping with OCD. I can support you with nutrition, the Safe and Sound Protocol, and trauma-informed selective mutism/mental health coaching specifically tailored to your unique needs. If you are a parent looking for support, I can support you with all these modalities as well, and health and nutrition coaching. Don't forget to check out my services and to reach out for support.





 

Here is one case study on how the SSP helped a child with selective mutism and emotional dysregulation – click here. https://integratedlistening.com/case-study/child-with-selective-mutism-and-temper-tantrums-learns-to-communicate-in-new-ways-after-the-safe-and-sound-protocol-ssp-2/

 

Here is a peer reviewed journal on successful treatment of OCD with the micronutrients by Hardy Nutritionals.



References:

 

Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism

Felix Vogel1 · Angelika Gensthaler2 · Christina Schwenck1

Accepted: 22 December 2021 / Published online: 8 January 2022 © The Author(s) 2022.  https://link.springer.com/content/pdf/10.1007/s10608-021-10289-3.pdf

 

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

Siebke Melfsen1,2 · Marcel Romanos2 · Thomas Jans2 · Susanne Walitza1

Received: 10 June 2021 / Accepted: 6 August 2021 / Published online: 14 August 2021 © The Author(s) 2021

 

Suffering in Silence: Breaking Through Selective Mutism

D Mac LCPC - 2015 - books.google.com

 

Symptoms of selective mutism beyond failure to speak in children and adolescents

Felix Vogel1,3 · Carolin Röse2,3 · Christina Schwenck3

Received: 15 November 2023 / Accepted: 10 March 2024 © The Author(s) 2024

 

Vogel and Schwenck

Child and Adolescent Psychiatry and Mental Health

RESEARCH ARTICLE

(2021) 15:81

Child and Adolescent Psychiatry and Mental Health

Open Access

 Psychophysiological mechanisms

underlying the failure to speak: a comparison between children with selective mutism

and social anxiety disorder on autonomic arousal

Felix Vogel* and Christina Schwenck

 

Frost, R. O., & DiBartolo, P. M. (2002). Perfectionism, anxiety, and obsessive-compulsive disorder. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 341–371). American Psychological Association. https://doi.org/10.1037/10458-014

Review article


Is obsessive–compulsive disorder an anxiety disorder?

Jennifer A. Bartz *, Eric Hollander

Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1230, New York, NY 10029, USA

Accepted 2 November 2005 Available online 7 February 2006

 

The impact of generalized anxiety disorder in obsessive-compulsive disorder patients.

Prerika Sharmaa, Maria C. Rosáriob, Ygor A. Ferrãoc, Lucy Albertellaa, Euripedes C. Migueld, Leonardo F Fontenellea,e

 

Abnormal Psychology in Context  The Australian and New Zealand Handbool – Edited by Nadine Pelling and Lorelle Burton - Cambridge university press. Cambridge United Kingdom.

Obessesive- Compulsive and Related Disorders page 129 Rebecca Anderson and David Garratt-Reed.

 

OBSESSIVE-COMPULSIVE DISORDER: DEFINING THE ROLE OF GENE-BASED VARIANTS AND IMMUNOLOGICAL FACTORS

 

Support of the histaminergic hypothesis in Tourette Syndrome: association of the histamine decarboxylase gene in a large sample of families Iordanis Karagiannidis,1 Sandra Dehning,2 Paul Sandor,3 Zsanett Tarnok,4 Renata Rizzo,5 Tomasz Wolanczyk,6 Marcos Madruga-Garrido,7 Johannes Hebebrand,8 Markus M Nöthen,9 Gerd Lehmkuhl,10 Luca Farkas,4 Peter Nagy,4 Urszula Szymanska,6 Zachos Anastasiou,1 Vasileios Stathias,1 Christos Androutsos,11 Vaia Tsironi,11 Anastasia Koumoula,11 Csaba Barta,12 Peter Zill,2 Pablo Mir,7,13 Norbert Müller,2 Cathy Barr,3 Peristera Paschou. Retrieved from http://jmg.bmj.com/ on February 11, 2015 - Published by group.bmj.com

 

Margoob, M. A., & Mushtaq, D. (2011). Serotonin transporter gene polymorphism and psychiatric disorders: is there a link?. Indian journal of psychiatry, 53(4), 289-299. https://biblio.ugent.be/publication/470691

 

 

 

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