Why is the DSM Important?

WHAT IS THE DSM (Diagnostic & Statistical Manual of Mental Disorders)?

WHAT IS THE DSM?The Diagnostic & Statistical Manual of Mental Disorders DSM (I) was first published in 1952 as an effort to
provide descriptive diagnostic categories to serve as a useful guide for clinicians in diagnosing mental disorders. The manual was
updated throughout the years with the DSM II 1968, DSM III 1980, DSM IV 1994 and DSM IV-TR (Text Revision) 2000. The DSM
IV-TR (Text Revision) 2000 was revised in an effort to improve diagnostic criteria for mental disorders justified by additional
legitimate findings. The DSM-IV-TR is our current manual and contains the diagnostic contents for Selective Mutism.

The more recent DSM’s contain approximately 17 classification sections, or headings. Each heading provides a list of categories
and/or disorders with official diagnostic codes. The official codes are used to distinguish each specific mental disorder or
condition. The official diagnostic codes are also mandatory to be reported by health care professionals on patient’s health
insurance forms for reimbursement, under “reason for visit”, or “principal diagnosis”. In addition, the official coding system is used
for collecting diagnostic data to produce statistic information for governmental agencies, private insurance companies and for the
World Health Organization. The DSM code for Selective Mutism is 313.23. It has been coordinated with Mental and Behavioral
Disorders section of the International Classification of Diseases (ICD) for a future reporting system for the U.S. Department of
Health. The official code for Selective Mutism in the ICD is F94.0. It is important to note that the DSM intent is to act as the first
step for a comprehensive evaluation, followed by additional sources of information. It provides guidelines for sound clinical
judgment, and includes ethnic and cultural considerations to avoid misdiagnosing.

WHY IS THIS MANUAL IMPORTANT TO YOU? Selective Mutism, (previously Elective Mutism) until the inception of our
organization in 1991, was virtually ignored, and regarded as a rare and low public interest disorder. There were no comprehensive
research studies prior to the development of the Selective Mutism Foundation, Inc., only a few compromised studies and single
case studies based upon theories. The available literature presented conflicting theories, with most describing Elective Mutism’s
essential feature as a “refusal” to speak along with characteristics of willful, controlling, and manipulative behaviors, caused by
maternal over protection, abuse, trauma, or family dysfunction. Even, the name Elective Mutism, was indicative of a deliberate
refusal to speak to EVERYONE and in ALL environments. There was no distinction between sudden mutism possibly caused by
a traumatic event, and shyness or social anxiety. There was also no distinction between a speech or language communication
disorder and social phobia. All of these characteristics, and more, were summarized together within the diagnostic and
associated features of Elective Mutism in the DSM III and III-R. The Selective Mutism Foundation’s input, in 1991 was the major
source in eliminating theories and replacing them with sound facts, including renaming the disorder Selective Mutism, for the DSM
IV, 1994.

This manual is important to you because theDSM is the most widely used mental disorders manual in the U. S. and is utilized by
a diverse group of mental health professionals. The characteristics of Selective Mutism published prior to 1994 had a devastating
impact on most families seeking professional help for their children. Especially alarming was the demoralized manner in which
most Selective Mutism students were treated due to perception of school personnel, influenced by DSM misconceptions that
were derived from available literature. Some parents were reported for, or suspected of child abuse. Others were told that they had
caused the mutism by having too many children, not enough children, working fulltime, not bonding with the child, or not
breast-feeding the child during infancy. Yet others were told that their child was keeping family secrets of dysfunction, the child
was spoiled, angry, seeking attention, stubborn, and on and on. This domino effect of misdiagnosis that began with documented
theories trickled down to many school psychologist and other school personnel who unknowingly misdiagnosed Selectively Mute
students. This resulted in inappropriate educational classifications and placements into Speech/Language therapy, segregated
programs for the Emotionally Disturbed, Resource Room, and Specific Learning Disability classes, Occupational Therapy or
Physical Therapy, etc. Some students were reprimanded, ridiculed, or denied extracurricular activities due to their “refusal to
speak”; while others were easily ignored as they were not disruptful in class.

With the foundation’s efforts, through research encouragement and participation, we continue to be the only major source
acknowledged nationally to positively effect Selective Mutism criteria for theDSM. The current DSM reflects the more positive
characteristics of Selective Mutism resulting in more parents seeking professional treatment for their children. The DSM is
important for correct diagnosis of Selective Mutism as opposed to confusion for misdiagnosis of other disorders, such as Autism,
etc. It is important for correct billing purposes to ensure insurance coverage of treatment. Also, for a more positive description of
Selective Mutism as characteristics implying social anxiety.