This study examined stuttering severity by reviewing 21 formal definitions from a comprehensive review of over 500 sources in English, Spanish, and Portuguese. While most definitions are primarily focused on observable characteristics, the study emphasizes the importance of considering the internal experience of stuttering, such as the speaker's sense of "loss of control.” Through an online survey, people who stutter, speech-language pathologists, and those who are both, were asked to define stuttering severity and explain the factors that influence it. Qualitative analysis of the definition of severity revealed five themes across all participants: disfluencies and visible physical tension, effective communication, affective, behavioral, and cognitive responses, adverse impact, and variability. People who stutter reported two additional themes: internal struggle and effort, and struggle may not be visible. Analysis of the factors that influence severity revealed seven themes: psychological factors, speech and language factors, situational factors, cultural factors, individual factors, speech therapy experiences, and perspectives and responses of the listeners. People who stutter reported an additional theme: force to produce speech. The results indicated that while speech speech-language pathologists who do not stutter provided important insights that largely matched the perceptions of people who stutter, they did not identify the internal experience that people who stutter reported. This study advocates for incorporating both external observations and the subjective experience to better capture the complexity of stuttering severity, fostering a more comprehensive approach.
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