Connections Between Stuttering and Social Anxiety Disorder

Stuttering and SAD

Speech therapy Treatment of stuttering : woman doing articulation and breathing exercises.
Stuttering treatment includes articulation and breathing exercises. GARO/PHANIE/Getty Images

Stuttering and social anxiety disorder (SAD) are both included in the Diagnostic and Stastical Manual of Mental Disorders (DSM-V).

However, SAD is categorized as an anxiety disorder and childhood-onset fluency disorder (Stuttering) is now considered a communication disorder in the chapter on neurodevelopmental disorders. 

What is Stuttering?

Stuttering is described as dysfluent speech involving overt and covert (hidden) symptoms.

Overt symptoms are obvious to other people and include

  • repeating or prolonging sounds
  • blocks when speaking

Covert symptoms may not be obvious to others and include

  • omitting words
  • substituting words
  • circumlocution (rearranging words in a sentence)

How are Stuttering and SAD Diagnosed Together?

If you stutter, you may also feel bad about your speech difficulty and experience anxiety, avoidance, low self-esteem, and embarrassment.

However, you would not be diagnosed with SAD unless the fear, avoidance, and anxiety are about more than the stuttering.

If you are only anxious because you stutter, you would not be diagnosed with SAD because the fear is about stuttering, not social and performance situations.

How are Stuttering and Social Anxiety Related?

Current research shows that there is likely a relationship between stuttering and social anxiety, but the nature of the relationship is not clear.

Although the rate of overlap between social anxiety and stuttering is thought to be as high as 75%,  studies have not been consistent in how they define social anxiety (e.g., stuttering-specific or general).

Research has shown that the neurotransmitter dopamine plays a part in both stuttering and SAD. And, in fact, a higher rate of SAD has been found in people with Parkinson's disease, a disorder involving dopamine production and metabolism.

Neuroimaging research has shown that people with SAD and those who stutter have differences in the dopamine D2 receptor, meaning that they process dopamine differently than people without these disorders.

The amygdala has also been shown to be related to both stuttering and SAD.

Treatment of Stuttering and SAD

Treatment options for stuttering depend on whether or not you are also experiencing psychological reactions.

  • If you stutter but do not have anxiety, fear or avoidance, you would receive speech training alone.
  • If you stutter and also have psychological reactions or a comorbid diagnosis of SAD, you would also receive treatment such as cognitive-behavioral therapy (CBT).

Although medication such as selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating SAD, there is not enough research to support their use for stuttering.

If you experience both SAD and stuttering, it is important to realize that SAD can be overcome even if your stuttering does not completely go away. While stuttering can be embarrassing, it is possible to improve and feel better about the way that you talk.

Sources:

Molt L. Stuttering and Social Phobia (Social Anxiety Disorder): Background Information and Clinical Implications

Irwin, M. What is Stuttering? Defining Stuttering From the Speaker's vVewpoint.

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