Stuttering and social anxiety disorder (SAD) are both included as Axis 1 disorders in the Diagnostic and Stastical Manual of Mental Disorders (DSM-IV). However, SAD is categorized as an anxiety disorder while stuttering is categorized as a disorder usually diagnosed in infancy, childhood or adolescence.
What is Stuttering?
Stuttering is described as dysfluent speech involving overt and covert (hidden) symptoms.
- Overt symptoms are obvious to other people and include such things as repeating or prolonging sounds and blocks when speaking.
- Covert symptoms may not be apparent to the outside observer. They include omitting words, substituting words and circumlocution (rearranging words in a sentence).
How are Stuttering and SAD Diagnosed Together?
If you stutter, you may also suffer with psychological reactions about your speech difficulty such as anxiety, avoidance, low self-esteem and embarrassment. However, you would not be diagnosed with SAD unless the fear, avoidance and anxiety is 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 indicates that there is likely a relationship between stuttering and social anxiety, but the nature of the relationship remains unclear. Although estimates of the rate of overlap between social anxiety and stuttering have been as high as 75%, there has been a lack of consistency across studies in how social anxiety has been defined (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 incidence 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 implicated in both stuttering and SAD.
Treatment of Stuttering and SAD
Treatment options for stuttering depend on whether or not there are associated 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 suffer with both SAD and stuttering, it is important to realize that SAD can be overcome even if your stuttering is not completely resolved.
Molt L. Stuttering and Social Phobia (Social Anxiety Disorder): Background Information and Clinical Implications. Accessed October 20, 2010.
Irwin, M. What is Stuttering? Defining stuttering from the speaker's viewpoint. Accessed October 20, 2010.