Individuals with an autism spectrum disorder, schizophrenia or another psychotic disor- der, or severe intellectual disability may have problems in social communication and be unable to speak appropriately in social situations. In contrast, selective mutism should be diagnosed only when a child has an established capacity to speak in some social situations (e.g., typically at home).
Social anxiety disorder (social phobia). The social anxiety and social avoidance in so- cial anxiety disorder may be associated with selective mutism. In such cases, both diagno- ses may be given.
The most common comorbid conditions are other anxiety disorders, most commonly so- cial anxiety disorder, followed by separation anxiety disorder and specific phobia. Oppo- sitional behaviors have been noted to occur in children with selective mutism, although oppositional behavior may be limited to situations requiring speech. Communication de- lays or disorders also may appear in some children with selective mutism.
A. Marked fear or anxiety about a specific object or situation (e.g., ﬂying, heights, animals, receiving an injection, seeing blood).
Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.
B. The phobic object or situation almost always provokes immediate fear or anxiety.
C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.
D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
F. The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
G. The disturbance is not better explained by the symptoms of another mental disorder, including tear, anxiety, and avoidance of situations associated with panic-Iike symptoms obsessions (as in obsessive-compulsive disorder); reminders of traumatic events (as in aration anxiety disorder); or social situations (as in social anxiety disorder).
Specify if:
Code based on the phobic stimulus: 300.29 (F40.218) Animal (e.g.. spiders, insects, dogs).
300.29 (F40.228) Natural environment (e.g., heights, storms, water).
300.29 (F40.23x) Blood-injection-iniury (e.g., needles, invasive medical procedures).
Coding note: Select specific tCD-10-CM code as follows: F40.230 tear of blood;
F40.231 fear of injections and transfusions; F40.232 tear of other medical care; or
F40.233 fear of injury.
300.29 (F40.248) Situational (e.g.. airplanes, elevators, enclosed places).
300.29 (F4o.298) Other (e.g., situations that may lead to choking or vomiting; in chil- dren, e.g., loud sounds or costumed characters).
Coding note: When more than one phobic stimulus is present, code all |CD-10-CM codes that apply (e.g., for fear of snakes and flying, F40.218 specific phobia, animal, and
F40.248 specific phobia, situational).
It is common for individuals to have multiple specific phobias. The average individual with specific phobia fears three objects or situations, and approximately 75% of individuals with specific phobia fear more than one situation or object. In such cases, multiple specific phobia diagnoses, each with its own diagnostic code reﬂecting the phobic stimulus, would need to be given. For example, if an individual fears thunderstorms and ﬂying, then two diagnoses would be given: specific phobia, natural environment, and specific phobia, situational.