“Psychogenic” speech disorders: is it all in your head?
What is a Psychogenic Speech Disorder?
A psychogenic speech disorder can be defined as a broad category of speech disturbances that represent the manifestation of one or more types of psychological processes. This can include, but is not limited to, anxiety, depression, conversion disorders, or an emotional response to a traumatic event. These psychological changes interfere with the person’s voluntary control over any component of speech production and can most commonly be perceived as disturbances in fluency, such as stuttering, or changes to voice (Aronson, 1990).
Speech Disorder + Psychological Disorder(s) does not always = Psychogenic Speech Disorder
A person may have both a speech disorder and a psychological disturbance, but this does not necessarily mean that this person has a psychogenic speech disorder. In other words, the presence of a psychological disturbance may not affect a person’s speech or voice. For example, a person with a voice disorder may be living with depression, but the origin of his or her voice disorder can be explained by a structural abnormality of the vocal cords.
It is also possible to have a combination of a motor speech disorder and a psychogenic speech disorder. This would mean that the perceptual changes in a person’s speech could partially be explained by muscle weakness or specific neurologic changes. However, there are additional characteristics in the person’s speech that are not consistent with the “lawful manifestations” of the muscle weakness or neurologic diagnosis and are instead attributable to psychological processes (Duffy 2008). It is the Speech-Language Pathologist’s responsibility to determine which characteristics of the person’s speech are consistent or inconsistent with the person’s structural or neurologic changes.
On the other hand, it is possible for a person to have a purely psychogenic speech disorder. This means that there are not specific anatomic (structural) or physiologic (function-related) abnormalities to account for the significant disturbances in the person’s speech.
When absorbing this information, it is very common for people with psychogenic speech disorders to feel discouraged and misunderstood. They may ask themselves why they are so impaired when they were told there is nothing to account for their impairments.
The Truth Behind Psychogenic Speech Disorders
The reality is that when someone has a psychological disorder, there are significant physiologic changes that occur. These changes may be initially challenging for a health care professional to identify because they are not the same physiologic changes that are typically associated with a speech or voice disturbance. Instead, the underlying physiology is directly related to the psychological disturbance. Anything that disrupts normal brain functions, including psychological processes such as anxiety or depression, has the potential to cause emotional or cognitive symptoms (Tucker et al., 1997). Therefore, it is crucial for the patient to see a mental health professional in addition to seeking the help of a Speech-Language Pathologist in order to manage the underlying psychological disorder.
What is the Speech-Language Pathologist’s Role?
The Speech-Language Pathologist (SLP) will collaborate with the client’s neurologist, psychologist, and/or other health care professionals to establish the client’s medical and surgical history.
The SLP will obtain a case history from the client in order to learn what types of changes the patient is experiencing, when these changes began, and if these changes are getting worse.
The SLP will then evaluate the mechanisms involved in the production of speech. This may involve listening to the person’s speech in conversation or in conjunction with specific speech tasks. Additional evaluations may be indicated, such as an endoscopy to examine the vocal cords or an oral motor exam to analyze the musculature and movements of the mouth.
Based on the information gathered from the client’s history and evaluation, the SLP will determine if the client has an organic speech or voice disorder, a psychogenic speech disorder, or a combination of the two.
Counseling & Treatment
If the SLP determines that the person’s speech disorder is psychogenic or has a psychogenic component, the SLP will explain, in terms relatable to the client, how he or she came to a conclusion regarding the diagnosis. This will involve an overview of the SLP’s findings in terms of the client’s anatomy and physiology related to the speaking mechanism.
In deciding if treatment is the right option, it is important for the SLP and the client to understand that “not everyone wishes to be helped, is ready to be helped, or can be helped” (Duffy, 2008).
If the client and the SLP agree that treatment is appropriate at this time, the SLP’s primary role becomes that of a communication counselor. Although the SLP is serving as a counselor for the client, this does not mean that that he or she is stepping into the realm of a psychologist or mental health counselor. The SLP and the client will discuss the ways in which the individual’s ability to communicate is impacted by the psychogenic speech disorder. The SLP may also inquire if there are certain communication environments or communication partners that make the client’s speech disorder more pronounced.
In addition to counseling, the SLP will also employ various treatment techniques based on the client’s primary symptoms. The treatment techniques will be highly individualized based on the client’s needs. The following are examples of treatment technique that may be used:
If the client is experiencing changes to voice, a manual laryngeal musculoskeletal tension reduction technique may be used. This technique would involve a massage near the area of the voice box in order to reduce excess tension. Abdominal breathing exercises may also be used in order to relax the vocal cords and encourage deep, diaphragmatic breathing.
If the client is experiencing psychogenic stuttering, the SLP may try traditional techniques such as speech modification strategies, which aim to make changes to the timing of pauses between syllables and words. If excess movements of the jaw, for example, impact the person’s fluency of speech, the SLP may experiment with different postural techniques. An example of a postural technique would be placing a hand under the chin in order to help stabilize the jaw.
A psychogenic speech disorder is a speech disturbance that is caused by underlying psychological processes. This is in contrast to an organic speech or voice disorder, which has structural or neurologic components that cause the speech disturbance. It is possible to have a combination of a psychogenic and an organic speech disorder; it is the SLP’s responsibility to disentangle the speech symptoms in order to provide the most appropriate patient care. It is normal for a person with a psychogenic speech disorder to feel misunderstood and frustrated with his or her speech disorder. The SLP can provide a safe and comfortable environment for the person to talk about his or her speech disturbances. The SLP is also responsible in helping the individual understand that there are physiologic changes that are associated with the diagnosis of a psychogenic speech disorder and that physiologic changes are directly related to an existing psychological process. There are various treatment techniques that the SLP can employ in speech therapy, if the patient is willing and ready to participate.
 Motor speech disorder: type of speech disorder that disturbs the body’s natural ability to speak due to muscle weakness, incoordination, or difficulty in the planning of voluntary motor movement.
 The term “lawful manifestations” is referring to the fact that certain structural or neurologic conditions consistently result in distinct speech characteristics.
 Organic speech and voice disorders: caused by a specific physical or neurologic problem
Thanks to graduate student clinician Michelle Valenti for providing this blog post.