Stuttering and Mental Health: The Statistics

Stuttering and Mental Health: The Statistics I'll preface this by saying that I hope this post gives people empathy and understanding, rather than depression or less hope. If you're suffering under your stutter, you are not alone and you're not doomed. These statistics are pretty sobering, but mental health disorders are not a life sentence. Cognitive-behavioral therapy (CBT) is very effective for treating anxiety disorders like the ones listed below. [This study](https://pubs.asha.org/doi/abs/10.1044/1092-4388%282008/07-0070%29?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org) showed that while CBT didn't immediately improve fluency, nor did it increase the efficacy of speech therapy, it eliminated social anxiety and improved functioning/quality of life for everyone who took it. So, if you feel like you may qualify for one of these diagnoses, maybe consider CBT. If therapy isn't an option, or your first choice, there are books like "Feeling Good" that allow you work through CBT on your own. These sections are drafts from a larger writing project. So please excuse anything that's confusing, or feels like it's missing context. I'm always open to feedback and happy to explain/clarify where needed. (Also, I use "stutterer" rather than "person who stutters." It's just shorter to write. FWIW, I have a stutter myself.) # Mental Health It's one thing to describe the experiential side of stuttering, but what about hard data? Are there objective measurements on the impact of stutter on a person's mental health and quality of life? For that, we can examine peer-reviewed studies that quantified the effect of stuttering. The Diagnostic and Statistic Manual of Mental Disorders (DSM-5) defines the criteria for *social anxiety* as "Persistent, intense fear or anxiety about specific social situations because you believe you may be judged, embarrassed or humiliated. Avoidance of anxiety-producing social situations or enduring them with intense fear or anxiety. Excessive anxiety that's out of proportion to the situation." That sounds like a diagnosis that would apply to many stutterers, who may suffer through a lifetime of unpleasant social interactions. Multiple [studies](https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Social+anxiety+disorder+in+adults+who+stutter&btnG=) have compared the rates of social anxiety in stutterers to the general population. Figures vary, but the prevalence\* of social anxiety in fluent speakers is about 4%. The rate of social anxiety in stutterers is about 40%, *ten times* the rate of fluent speakers. \*(How many people have a disorder right now, versus have had a disorder at some point.) That elevated rate of social anxiety is not too surprising given the effect stuttering has on one's social interactions. But is the distress associated with stuttering limited to socializing? After all, one only stutters when one speaks, which is usually done with others. Unfortunately, stuttering and the pain of unpleasant social interactions can affect one's entire mental well-being. A [2011 study](https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Subjective+distress+associated+with+chronic+stuttering&btnG=) led by Yvonne Tran compared the mood symptoms in a large set of stutterers and fluent speakers to those of psychiatric outpatients\*. The majority of fluent speakers had normal scores of distress, and only a small proportion had scores typical of psychiatric outpatients. **\***(People engaging in outpatient treatment - i.e., therapy - for a mood disorder, like obsessive-compulsive disorder, depression, or anxiety.) The results for the stutterers were significantly worse. Even among stutterers who didn't have scores high enough to match pscyhiatric outpatients, it was clear they were suffering more distress than the average person. Eleven percent of fluent speakers were within a "danger zone" of distress; defined as two standard deviations of pscyhiatric outpatient's scores on global severity. However, 55% of stutterers were within two standard deviations; implying elevated distress, and that they were much closer to needing treatment than the average person. Lisa Iverach, in a [2009 study](https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Prevalence+of+anxiety+disorders+among+adults+seeking+speech+therapy+for+stuttering&btnG=), examined stutterers seeking speech therapy for a broad swath of mental health diagnoses. Compared to the general population, this group had six-to-seven times the rate of any DSM-IV/ICD-10 anxiety diagnosis in the past twelve months. Stutterers also had six times the rate of panic disorders, and four times the rate of generalized anxiety disorder. (Anxiety that goes beyond social situations.) In a [2009 study](https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=The+impact+of+stuttering+on+the+quality+of+life+in+adults+who+stutter&btnG=), Daniel Craig used questionnaires to compare the effects of stuttering to other medical issues. He found that stuttering correlated with decreases in mental health, vitality, and emotional and social functioning. The negative effects on one's mental health were on par with quadriplegia or suffering a traumatic brain injury. The effects on vitality, emotional functioning, and social functioning were similar to diabetes and coronary heart disease. # The Case for Optimism It's important to acknowldge the true depth of stuttering, as bad as it can get. Honestly acknowledging and confronting the suffering caused by your stutter is necessary, but we're not going to linger here any longer than necessary; this is one step on the journey, not the end of the road. We're acknowledging our suffering so that we can process it, and eventually let it go. Nor are we going to be hopeless about the possibility of improving our fluency. Peer-reviewed research has shown us reliable, robust ways to improve fluency. We'll cover that later, and how we can best put that research into action. As dark as a stutter can be, and deep as your suffering may get, there is always the possibility of improvement. It's important that we look at how dark it can get, but we're only going up from here. The depth of this suffering will only make the higher end-result more satisfying/gratifying. ​ **Note on the studies**: If the link takes you to Google Scholar, you can view the full study by clicking on the **\[PDF\]** link on the right side of the page. If the link takes you to a shortened version of the study, then the full version is behind a paywall.