Foot in Mouth Syndrome: More Prevalent Than Previously Suspected

The phenomenon of embarrassing one's self by speaking thoughtlessly has been recognized as a reflection of impulsivity but has only been studied as a clinical issue in recent years. Now, finally getting the attention from the psychiatric community that it deserves, the disorder now designated as "FMS" is slated for inclusion in the upcoming revision of the American Psychiatric Association's Diagnostic Criteria Manual, the DSM-V.

Foot in Mouth Syndrome (FMS) is a condition wherein a person speaks without adequately thinking enough about it first and, consequently, winds up saying something embarrassing or inappropriate. Long viewed as a function of impulsivity, medications used to successfully address impulsivity in people diagnosed with ADHD have not proven to be effective in the treatment of FMS.

Unlike many other clinical conditions, most people are afflicted with FMS at one time or another in their lives. However, just because the disorder appears to be ubiquitous in the general population, it is not OK to ignore it or do deny the need to seek out an effective treatment for it. Some people experience the condition only infrequently while others appear to have developed a more chronic version of Foot in Mouth Syndrome. The target of the research is directed to diagnosing and treating those who appear to have the chronic variety of FMS.

There are many examples of FMS in everyday life for most people.

Parents, employers, researchers and mental health professional around the world have been hard at work trying to develop successful treatment interventions and strategies for reducing both the intensity and frequency of the symptoms of the people afflicted with this potentially debilitating and socially isolating disorder.

At this time, the most promising avenues of treatment interventions include the medicinal, the psychotherapeutic and a combination of those two strategies. The findings of the current state of research investigations for each is summarized below:

Medicine alone

As mentioned earlier, the first investigations into the use of medicine to treat FMS focused on the psycho-stimulant drugs often used to treat ADHD. The reasoning seems sensible. To the extent that FMS is driven by impulsivity, a common symptom of ADHD, it was thought likely that FMS could be positively managed with the same type of medication.

The most recent investigations have tried to measure the relative effectiveness of treating Foot in Mouth Syndrome with 1) Medicine alone, 2) Psychotherapy alone and 3) A combination of medicine and psychotherapy.

In four studies done at major medical centers using a total sample of nearly 300 adults who met the criteria for Foot in Mouth Syndrome, Chronic Type, psycho-stimulant medication was shown to have no discernible effect.

It is interesting to note that in these four studies, participants given placebos (tablets or capsules containing no active ingredients) actually fared considerably better than those give the ADHD-type medications.

There are several investigations under way testing the utility of drugs commonly prescribed for anxiety and depression (SSRIs) but there are not, as yet, any reported outcome.

Psychotherapy alone

Those same four studies compared the outcomes of people diagnosed with FMS who were treated with psychotherapy.

Using once-a-week talk therapy with an emphasis on what is called Cognitive Behavior Therapy (CBT), study participants showed a slight but measurable improvement. After twelve sessions, their family members and colleagues reported a 15% reduction in the frequency of their FMS episodes.

The psychotherapy was not the "let's explore how you feel about things" variety. Rather, it was focused on helping the person develop specific new skills to better manage themselves.

Medicine and Psychotherapy

Although the medicine alone showed no positive effects, when combined with the psychotherapy, the reported improvement shot up to 30%. Although it is unclear how the one thing impacts the other, the statistical finding is significant and cause for optimism in developing more effective treatment tools to help those suffering with FMS.

This combination has been found to be most effective with other conditions, as well including depression in very difficult to treat populations.

Prevalence

Foot in Mouth Syndrome is estimated to impact nearly 90% of the adult population of the US and Britain in its occasional/intermittent form and about 20% in its more serious, chronic variety. This figure is considerably higher than that of other psychiatric disorders.

Further investigation is warranted and, in the meantime, the diagnosis will be formally applied one the DSM-V is released early in 2012.