Selective Mutism 195
Personality disorders. Dependent personality disorder is characterized by an indis-
criminate tendency to rely on others, wherea s separation anxiety disorder involves con-
cern about the proximity and safety of main attachment figures. Bo rderline personality
disorder is characterized by fear of abandonm ent by loved ones, but problems in identity,
self-direction, interpersonal fu nctioning, and impulsivity are additionally central to that
disorder, whereas they are not centra l to separation anxiety disorder. 
Comorbidity
In children, separation anxiety disorder is hi ghly comorbid with ge neralized anxiety dis-
order and specific phobia. In adults, comm on comorbidities include specific phobia,
PTSD, panic disorder, generalized anxiety diso rder, social anxiety disorder, agoraphobia,
obsessive-compulsive disorder, and personality disorders. Depressive and bipolar disor-
ders are also comorbid with separation anxiety disorder in adults.
Selective Mutism
Diagnostic Criteria 313.23 (F94.0)
A. Consistent failure to speak in specific social situations in which there is an expectation
for speaking (e.g., at school) despite speaking in other situations.
B. The disturbance interferes with educational or  occupational achievement or with social
communication.
C. The duration of the disturbance is at least 1 month (not limited to the first month of
school).
D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the
spoken language required in the social situation.
E. The disturbance is not better explained by a communication disorder (e.g., childhood-
onset fluency disorder) and does not occur exclusively during the course of autism
spectrum disorder, schizophrenia, or another psychotic disorder.
Diagnostic Features