Question

Are you suggesting psychological/emotional trauma is a bona fide etiology of fluency disorder? I was trained otherwise. Could you please share your scientific research supporting this? Thank you.

My response

Traumatic experiences?

On this website, in the article entitled ‘The Causes of Stuttering’ I do state that:

“Some traumatic experiences may create the psychological conditions that lead to the onset of stuttering. In some instances, the stutter may persist even when the effects of the initial trauma have been minimized.

Arguably then, I am claiming that psychological/emotional trauma is a bona fide etiology. However, in that article I am not making any claims about its incidence or prevalence or whether or not it manifests mainly in children or adults.

Operationalizing the variable

It is claimed that “in the 20th century, stuttering was primarily thought to be a psychogenic disorder” (Büchel and Sommer, 2004). Quite rightly, researchers have challenged this view and developed new insights into possible causes, asking such questions as whether or not stuttering is a sensory, motor or cognitive disorder – or perhaps a multi-factorial condition. Some researchers have concluded that stuttering cannot have a psychogenic cause (at least in children). For example, Craig (2000:173) claims that, “From the available evidence, stuttering should be now regarded as a physical developmental disorder…” However, in order to reach our own informed conclusion we must ask, ‘what is meant by psychogenic?’ Whether or not we are persuaded that stuttering may – in some instances, and for some people – have a psychogenic etiology is dependent on how we operationalize the term ‘psychogenic’. We need to be clear about the exact definition(s) being used in the literature. As one might imagine, they vary widely. What they all have in common, however, is the notion that the cause is psychological in origin rather than physical, invoking notions of emotional trauma and/or anxiety states (e.g. following bereavement). Indeed, Mahr and Leith (1992:286) suggested three criteria for the diagnosis of psychogenic stuttering (in adults):

1. absence of organic etiology
2. altered speech patterns suggesting stuttering
3. discernible psychological factors, e.g. onset of symptoms associated with emotional conflict, symbolic significance of the symptoms, and/or the presence of primary or secondary gain

Research that considers psychogenic origin

There is a reasonable amount of literature that suggests that, according to whatever definition of psychogenic stuttering is subscribed to, stuttering can indeed – for some clients, in some situations – have a psychogenic cause. The following provide a flavor of some of the available literature.

Binder, L.M., Spector, J. and Youngjohn, J.R. (2012) ‘Psychogenic Stuttering and Other Acquired Nonorganic Speech and Language Abnormalities’ Arch Clin Neuropsychol 27, 5, 557-568.

“We propose that severe dysfluency or language abnormalities persisting after a single, uncomplicated, mild traumatic brain injury are unusual and should elicit suspicion of a psychogenic origin.” p.557

Lundgren, K., Helm-Estabrooks, N. and Klein, R. (2010) ‘Stuttering following acquired brain damage: A review of the literature’ Journal of Neurolinguistics 23, 5, 447–454.

“Another challenge to the precise characterization of acquired stuttering is the fact that some cases of acquired stuttering apparently have a psychological or neuropsychiatric genesis rather than a neuropathological one.” p.23

Ward, D. (2008) ‘The aetiology and treatment of developmental stammering in childhood’ Arch Dis Child 93:68-71.

“DS [developmental stammering] may be distinguished from neurogenic stammering, which can occur subsequent to neurological damage of various aetiologies (for example, stroke, tumour, degenerative disease) and psychogenic stammering, whose onset can be related to a significant psychological event such as bereavement. While a diagnosis of neurogenic stammering might be made in early childhood and adolescence, both neurogenic and psychogenic types are typically associated with an adult onset.” p.93

Ward, D. (2010) ‘Sudden onset stuttering in an adult: neurogenic and psychogenic perspectives’ Journal of Neurolinguistics 23, 5, 511–517.

“This paper considers the relationship between psychogenic and neurogenic stuttering generally, then more specifically in regard to (the selected) client, and the treatment he received. The paper concludes by considering problems in differentially diagnosing neurogenic from psychogenic stuttering.” p.511

Conclusion

Of course, as with most available literature, one has to critically evaluate the evidence and the claims in order to arrive at one’s own conclusion. Having reviewed some of the research, I have concluded for myself that there is sufficient evidence to make the claim that:

“Some traumatic experiences may create the psychological conditions that lead to the onset of stuttering.”

Footnote

It is interesting to note that the American Speech-Language-Hearing Association (ASHA, 2010) provides diagnosis codes for dysfluency that includes a code for ‘Adult onset fluency disorder’ that can be used to describe the situation when:

1. an adult develops stuttering
2. no organic basis is evident
3. the stutter appears “psychogenic” in origin

Currently, therefore, the professional body for speech-language pathologists in the USA recognizes a psychogenic origin for stuttering. Therefore, ASHA would seem to concur that psychological/emotional trauma is a bona fide etiology of fluency disorder.

I hope these thoughts are of some help to you in coming to your own conclusions about the reality or otherwise of a psychogenic cause of some types of stuttering.

References

ASHA (2010) New Diagnosis Codes for Fluency [WWW] http://www.asha.org/uploadedFiles/New-Diagnosis-Codes-for-Fluency.pdf#search=%22psychogenic%22 Accessed 07 Nov 2012.

Büchel, C. and Sommer, M. (2004) ‘What causes stuttering?’ PLoS Biol 2, 2.

Craig, A. (2000) ‘The developmental nature and effective treatment of stuttering in children and adolescents’ Journal of Developmental and Physical Disabilities 12, 3, 173-186.

Mahr, G. and Leith, W. (1992) ‘Psychogenic stuttering of adult onset’ Journal of Speech and Hearing Research 35, 283-286.