PITTSBURGH (KDKA) – A lot of people have social anxiety to varying degrees. For some, it’s so severe they physically can’t speak around certain people.

It’s called selective mutism, but it can be treated.

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On the hit CBS show “The Big Bang Theory” the character Raj Koothrappali suffers from selective mutism. Because of this social anxiety condition, he’s not able to talk to women who are not family members.

You can’t tell now, but Brianna Russo also had this condition, which affects just one in 1,000 people.

“When I was 3-years-old, my hair started falling out, I stopped talking to adults,” Russo said.

She was able to talk to family, but at school and other social situations, she wouldn’t speak.

“What typically happens when you’re faced with anxiety is you have a fight, flight, or freeze response. Well, these kids are having a freeze response,” Dr. Gary Swanson, of Allegheny General Hospital Psychiatry, said.

The childhood onset is classic and noticed as the child enters preschool or kindergarten.

Because the mutism can suddenly turn on and off, some people thought she was just being rude, and responded in ways Russo thought was rude. For example, she vividly remembers a play date at a friend’s house.

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“Her dad, actually I remember being cornered on the stairs by her dad, and he said I wouldn’t be able to go down the stairs, until I talked to him,” she said.

It has to be there for at least a month, and it has to be problematic for them in certain settings,” Dr. Swanson said. “We have to look and understand whether there’s a hearing problem, a speech problem, some other cultural language barrier that’s a problem, or a developmental delay like autism.”

Most of the time, the condition is treated with therapy, rewarding nods and grunts and progressing to full speech. Sometimes they can text or email, or speak into a tape recorder as opposed to directly to another person. But, even then it can produce anxiety.

Sometimes medicine can help if the anxiety is overwhelming the therapy – drugs like escitalopram or Lexapro, fluoxetine or Prozac, sertraline or Zoloft.

“Those are probably the safest, but again, for little kids, that’s typically an off label use,” Dr. Swanson said.

Russo took medication, tried hypnosis, and did the therapy. Nine years later, she has overcome the selective mutism. She plans to attend college next year and study nursing.

“In school, I’m still known as the quiet girl,” she said.

“They still might be somewhat shy, they might have a hard time in a new situation, with new strangers, and they might have difficulty in public speaking, too. So, you may still see vestiges of the anxiety, but in general, we see the kids get better, and they’re able to talk,” Dr. Swanson said.

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Dr. Maria Simbra