What is disordered thinking
Thought Disorder Symptoms, Diagnosis, and Treatment
Thought disorder is a disorganized way of thinking that leads to abnormal ways of expressing language when speaking and writing. It’s one of the primary symptoms of schizophrenia, but it may be present in other mental disorders such as mania and depression.
Thought disorder is one of the most difficult mental disorders to diagnose and treat, as many people exhibit symptoms of thought disorder occasionally. Some people may demonstrate thought disorder only when they’re tired.
There are more than 20 subtypes of thought disorder. In this article, we’ll break down the symptoms of some of the most common types. We’ll also examine potential treatment options to help you or someone you know manage this disorder.
Thought disorder first appeared in scientific literature in the 1980s, when it was first described as a symptom of schizophrenia. Its loose definition is any disturbance in the organization and processing of ideas.
Each type of thought disorder has unique symptoms. However, a disruption in the interconnectivity of ideas is present in all types.
Even though it’s common for most people to display some of the symptoms of thought disorder occasionally, thought disorder isn’t classified until it negatively affects the ability to communicate.
These are some of the most common types of thought disorder:
People with alogia, also known as poverty of speech, give brief and unelaborated responses to questions. People with this form of thought disorder rarely speak unless prompted. Alogia is often seen in people with dementia or schizophrenia.
People with thought blocking often interrupt themselves abruptly mid-sentence. They might pause for several seconds or minutes. When they start talking again, they often change the topic of conversation. Thought blocking is common in people with schizophrenia.
People with circumstantiality, also known as circumstantial thinking, or circumstantial speech, often include excessive irrelevant details in their speaking or writing. They maintain their original train of thought but provide a lot of unnecessary details before circling back to their main point.
Clanging or clang association
A person with clanging thought process makes word choices based on the sound of the word rather than the meaning of the word. They may rely on using rhymes, alliterations, or puns and create sentences that don’t make sense. Clanging thought process is a common symptom of mania.
A person with derailment talks in chains of only semi-related ideas. Their ideas often fall further and further from the topic of conversation. For example, a person with derailment thought disorder might jump from talking about rabbits to the hair on their head to your sweater.
A person with distractible speech thought disorder has trouble maintaining a topic. They shift quickly between topics and get distracted by internal and external stimuli. It’s commonly seen in people with mania.
For example, somebody exhibiting distractible speech might abruptly ask where you got your hat mid-sentence while telling you about a recent vacation.
People with echolalia struggle to communicate. They often repeat noises and words they hear instead of expressing their thoughts. For example, instead of answering a question, they may repeat the question.
Other types of thought disorder
The Johns Hopkins Psychiatry Guide lists 20 types of thought disorder. These include:
- Paraphasic error: constant word mispronunciation or slips of the tongue
- Stilted speech: using unusual language that’s overly formal or outdated
- Perseveration: leads to a repetition of ideas and words
- Loss of goal: trouble maintaining a topic and an inability to come to a point
- Neologism: creating new words
- Incoherence: speaking in seemingly random collections of words, known as “word salad”
The cause of thought disorder isn’t well known. Thought disorder isn’t a symptom of any particular disorder, but it’s commonly seen in people with schizophrenia and other mental health conditions.
The cause of schizophrenia also isn’t known, but it’s thought that biological, genetic, and environmental factors can all contribute.
Thought disorder is loosely defined and the symptoms vary widely, so it’s difficult to find a single underlying cause. Researchers are still debating about what might lead to the symptoms of thought disorder.
Some believe it might be caused by changes in language-related parts of the brain, while others think it could be caused by problems in more general parts of the brain.
Thought disorder is one of the defining symptoms of schizophrenia and psychosis. People have a heightened risk of developing thought disorder if they also have:
- mood disorders
- bipolar disorder
- traumatic brain injury
According to research from 2005, people with epilepsy have an increased risk of developing schizophrenia and psychosis compared to the general population.
A traumatic brain injury increases your risk of developing schizophrenia and other mental disorders, such as depression, bipolar disorder, and anxiety disorders.
The following risk factors might also be risk factors for schizophrenia, and by extension, thought disorder:
- use of mind-altering drugs
- inflammatory and autoimmune disease
- exposure to toxic chemicals before birth
It’s not uncommon for people to demonstrate symptoms of thought disorder occasionally. However, if these symptoms are frequent or severe enough to cause problems communicating, it’s a good idea to speak with a doctor.
Thought disorder may be a symptom of a mental disorder. Many mental disorders such as schizophrenia are progressive and don’t improve without treatment. However, people with mental disorders are often unaware of their symptoms and need help from a family member or friend.
If you notice any other symptoms of schizophrenia in somebody you know, you may want to encourage them to see a doctor:
- disorganized thinking or speech
- neglecting personal hygiene
- lack of emotion
- lack of facial expression
- withdrawing from social life
When diagnosing thought disorder, a medical professional will consider a person’s intelligence, culture, and education to see if they’re acting inconsistently.
Rorschach inkblot test
The Rorschach inkblot test was first invented by Hermann Rorschach in 1921. The test uses a series of 10 inkblots to identify a potential thought disorder.
The inkblots are ambiguous and the patient gives their interpretation of each. The administrating psychologist then interprets the patient’s responses to search for potentially disordered thinking.
Thought Disorder Index
After engaging a patient in an open-ended conversation, a medical professional will transcribe the conversation and score it using the thought disorder index.
The Thought Disorder Index, also called Delta Index, is the first standardized test to identify thought disorder. It measures 23 areas of potential thought disturbance and weighs the severity of each on a scale from zero to one.
Treatment for thought disorder targets the underlying medical condition. The two primary types of treatment are medication and psychotherapy.
Antipsychotic medication may be prescribed depending on the cause of thought disorder. These medications can balance out the brain chemical dopamine and serotonin.
Psychotherapy helps people replace their thoughts with more realistic ones and teach them ways to manage an illness.
Cognitive behavior therapy, a form of psychotherapy, and cognitive enhancement therapy may both be beneficial for people with schizophrenia.
If you suspect that a loved one has a thought disorder, encourage them to seek medical attention. Treatments that can effectively manage thought disorder symptoms are available, and a doctor can help determine the right treatment method based on the underlying condition.
Thought disorder is a disorganized way of thinking that leads to unusual speech and writing. People with thought disorder have trouble communicating with others and may have trouble recognizing that they have an issue.
If you suspect that somebody close to you has a thought disorder, it’s a good idea to encourage them to see a doctor as soon as possible.
What is Disordered Thinking? And Is It a ‘Thought Disorder’?
Are you thoughts so jumbled you are worried there might be something wrong? Disordered thinking is often related to diagnosable and treatable mental health disorders.
What is disordered thinking?
It is what it sounds like — thinking that has become disorganised and hard to follow.
If you have disordered thinking, you can’t control your thoughts or express yourself well, which can make relating with others difficult.
Symptoms of disordered thinking
Symptoms can see you:
- unable to think straight
- Feeling like your head is full of fog or sand
- struggling to concentrate
- rapidly jumping from one subject to the next
- not finishing your thoughts
- speaking in a confusing way: too fast, too many pauses, drifting off
- losing a logical order to your ideas.
Why does it matter if my thoughts are a mess?
For starters, when we can’t think well we can’t communicate well. And when we can’t communicate well, it affects our ability to cope. We can’t ask for what we need, or state how we feel, or what is upsetting us. Relating to others becomes difficult, which can leave us feeling shunned and rejected.
And in some cases disorganised thinking can be the beginning of a more serious mental health disorder like schizophrenia.
Related mental health issues
photo by: Joseph Frank
Disordered thinking is connected to severe depression, which can leave you feeling so foggy and confused it can be hard to form useful thoughts, or to speak clearly.
It can also form a part of mania, where your thinking can get too fast, and you can’t keep up with your own ideas.
But disordered thinking is most commonly known as a symptom of schizophrenia. Here it is usually (but not always) joined by delusions (believing things are real that aren’t) and hallucinations (sensing things to be there that aren’t).
What is a thought disorder?
The term ‘thought disorder’ can be confusing. It’s called a disorder, yes. But it’s not currently a standalone diagnosis. Nor is it an actual listed, standalone disorder in the DSM-V or the ICD-10, the two most used manuals for diagnosing mental health disorders. It’s instead more of a feature of other disorders, or used as a synonym for severely disorganised thinking.
At one point, the argument was made for ‘thought disorders’ to refer to several different issues. In the 1980s, neuroscientist Nancy C. Andreasen argued that thought disorder “has often been treated as if it were unitary, but in fact it is composed of a number of different language behaviours.” She identified no less than 18 different types of thought disorders, along with a scale that attempted to measure them.
But nowadays, when psychiatrists and mental health professionals say ‘thought disorder’, they are generally just talking about disorganised thinking that is severe enough it affects the way someone speaks and presents themselves.
If it helps, see thought disorders as ‘sub disorders’, a symptom of other listed major mental health disorders.
Diagnosis in the UK
Here in the UK, if you go see your GP, you won’t come home with a diagnosis of ‘thought disorder’ but with a related diagnosis like severe depression, schizophrenia, or psychotic disorder.
The National Institute of Health and Care Excellence (NICE), which is used to diagnose in Britain, makes no mention of thought disorders. It instead offers a ‘Guide to Psychosis and Schizophrenia‘.
Formal thought disorder
This is a more exact term for thought disorder, and is again often used as a synonym for severely disorganised thinking.
Formal thought disorder is about the form your thoughts take, and is related to organisation and expression.
It means your thoughts are so disorganised and messy it affects the way you talk and write, and that this is not caused by a medical condition.
It’s not the same as being tired or depressed and speaking differently. Or of having a short episode of talking strangely, such as after a shock like an accident. If you have formal thought disorder, your talking is inconsistent and incoherent for no known reason, and it has been for some time.
Formal thought disorder can include things like:
- talking too fast and loud, or in a garbled manner
- strange pauses
- incoherent tangents of thought
- excessive detail
- or talking very little and in a vague way that confuses others
- using outdated, formal, or strangely elevated language
- repeating certain words again and again
- being more obsessed with the sound of words than what they mean
- making words up, or using the wrong words to explain things.
Content thought disorder
‘Content thought disorder’ is about what you think about. Your thoughts are illogic and confused. An example is having delusions. You might believe you are being persecuted by aliens, or that everyone is secretly out to get you. You might not talk about this, but you think it.
If you have schizophrenia, you could have both formal and content thought disorders.
This is confusing…
There is some irony in the fact that mental health professionals and the mental health industry has made their description and diagnosis of disorganised thinking, well… disorganised. And highly confusing.
Perhaps neuroscientist Andreasen should have been listened to when she actually identified this confusion. “Because the term “formal thought disorder” has been so misunderstood and misused, it is recommended that it no longer be used,” she suggested. She pointed out that, “Most of them are in fact disorders of communication…[that] can be better conceptualised as “disorders of thought, language, and communication. ”
But the trouble is also that we simply don’t have a standard ‘normal’ for language we can compare everything to, when it is influenced by culture, amongst many other things. As a 2017 review of research around disordered thinking explains,
“Language “distortion” is a sign—in the medical sense—that is potentially measurable but currently without a universally accepted measure.”
What really matters about disordered thinking
The thing to keep in mind is mental health terms and diagnoses are not an exact science. They are just words created by mental health professionals to more easily describe groups of people with similar issues. And, as this article shows, terms and diagnoses can change with the times.
What matters is that if your thinking, or that of your loved one, means they can’t communicate, connect, and cope? Then it’s time to seek help.
Worry you have a thought disorder and want to talk to someone who is informed? We connect you to a team of highly regarded mental health experts in London. Or use our online booking platform to find a UK-wide therapist now.
Still have a question about what is disordered thinking? Ask below. Note we are unable to provide free counselling via comments.
Schizophrenia - American Medical Clinic
St. Petersburg, embankment of the river Moika, 78.
+7 (812) 740-20-90
Schizophrenia is a mental disorder in which there is a breakdown of thought processes and emotional reactions. The disease does not cause disturbances in consciousness and does not change many intellectual processes, however, with its prolonged course, perception, memory and attention are disturbed.
Lack of treatment leads to a complete loss of a sense of one's own "I", the loss of the integrity of a person's personality. In order to avoid this, it is necessary to diagnose the signs of schizophrenia in a timely manner and start treatment as soon as possible.
Symptoms of schizophrenia
Schizophrenia develops for a long time and imperceptibly for the patient. The first signs appear when a person is sure that he is completely healthy.
Early symptoms of schizophrenia:
- Isolation from society, unsociableness.
- Indifference to yourself, friends and family.
- Emotional coldness.
- Gradual loss of interest in everything that previously worried.
- Sleep disorders.
Adolescents often experience these symptoms during the transition period. However, in any case, take a closer look at your child and consult a doctor if you suspect.
As the disease progresses, common symptoms and signs of schizophrenia occur:
- Hallucinations - the patient sees and hears something that is not there.
- Nonsense - illogical beliefs in which the patient cannot be persuaded.
- Disorderly thinking - the patient either speaks too quickly, then stops in the middle of a thought and at the same time names non-existent words.
- Unnatural movements - a patient with schizophrenia moves slowly and freezes in an unnatural position, or vice versa moves too quickly and jerkily.
- Inability to express emotions - the patient constantly looks depressed and out of touch with reality.
- Thought disorder - the patient does not absorb information well, cannot concentrate and forgets everything.
In order to alleviate the situation of the patient, it is necessary to urgently consult a doctor and not push the patient away from himself. Remember that all changes in a person's personality are not his fault, but a manifestation of the disease.
Treatment of schizophrenia
Unfortunately, there is currently no cure for schizophrenia. The doctor can only alleviate the course of the disease. However, this is not a reason to put an end to yourself or your loved one. In the UK, people with schizophrenia even find employment, work successfully and lead a normal life.
From a medical point of view, the ideal solution for the treatment of schizophrenia is the placement of a patient in a hospital. Especially during an exacerbation of the disease. However, it should be borne in mind that hospitalizations are a great stress for a person who is associated with a restriction of freedom. Before doing so, consider possible alternatives.
The main treatment for schizophrenia is drug therapy. After a thorough diagnosis, the doctor individually prescribes a set of drugs that extinguishes the manifestations of the disease.
In addition to drug therapy, the patient needs professional psychological help and support from loved ones. All this together allows you to minimize the symptoms and provide the patient with the most comfortable conditions for life.
- Surgeon phlebologist
- Paid pediatrician
- Department of Traumatology
FGBNU NTsPZ. ‹‹Thinking disorders››
The incoherence (incoherence) of thinking is expressed in the loss of the ability to form associations. Thinking becomes fragmented - separate perceptions, images, concepts are not connected with each other. It is impossible to form even the simplest, mechanical associations by similarity and contiguity in time and space. The purposefulness of thinking is grossly violated. The patient loses the mental task, his thinking does not reflect the surrounding reality.
Incoherent thinking leads to gross violations of perception. New impressions are not associated with the old ones. In this regard, the patient does not recognize familiar faces, the situation already known to him. He does not comprehend what is happening around him, he is completely disoriented in time, space and, with a significant degree of amentally disturbed consciousness, in his own personality.
The face of the patient expresses confusion, bewilderment. Thinking disorders are manifested in the random, chaotic appearance of images and ideas that are not subject to purposeful intellectual processing. In this regard, amorphous, unstable, unsystematized perceptual delusions and delusional experiences arise.
The incoherence of thinking is reflected in the speech of patients, consisting of separate fragments of memories of the past, between which it is impossible to establish any connection. A random, chaotic set of words that are not connected either in semantic or grammatical terms is characteristic. Phrases are constructed incorrectly, the speech of patients consists mainly of fragments of sentences.
As S. Wernicke (1906) noted, patients with incoherent thinking can carry out separate simple orders (stretch out their hand, show their tongue, name themselves), but they cannot determine the time by the clock; correctly listing the coins, they cannot name the amount.
A sharp exhaustion of mental processes is characteristic, a correctly begun action is not brought to an end. Incoherence can manifest itself not only in thinking and speech, but also in the mismatch of motor acts and relatively complex skills with pronounced disorders of ideational and motor praxis.
Incoherence of thinking is observed in acute exogenous psychoses. A relatively lighter degree of it occurs with the deepening of asthenia and the inconsistency of judgments characteristic of it. With an unfavorable course of the disease, the incoherence of thinking is aggravated as the transition from asthenia to an amental state. However, amentia can also occur acutely, most often this is observed with exogenous harmfulness of high intensity, in such cases the asthenic stage is often not noticed due to its short duration and rapid increase in confusion. V.P. Osipov (1923), taking into account the role of asthenia in the development of amentia and, accordingly, amental confusion, considered it correct to define this type of thought disorder at all its stages as asthenic, adynamic associative ataxia. The term "asthenic confusion" is also used by F.I. Sluchevsky (1975), seeing the essence of this disorder in the loss of the possibility of synthesis, covering the situation with disorderly disturbances of all sides and levels of mental activity.
The reverse development of amentia - through an asthenic symptom complex, without the appearance of signs of an organic psychosyndrome - is considered as a sign of a favorable course of exogenous psychosis.
We give an example of incoherent thinking (recording of a conversation with a patient).
- How are you feeling?
- Where is Petya ... I went and slept. What do they want? And yesterday it was ... everything is ...
- Where are you?
- Stay... everyone is here. Put out the light. Where's the wife? I went ... Well, how? Lost glasses. My wife came to go again yesterday. Go here…
Everything is fine.
- Say today's date.
- The number ... is always winter (the conversation takes place on a hot summer day).