Thinking Process Abnormalities in Schizophrenia
From Tangential Thought to Incoherence
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Medically reviewed by Daniel B. Block, MDMedically reviewed by Daniel B. Block, MD
Thinking refers to our ability to make decisions, solve problems, reason, and remember. In a broader sense, thinking is the totality of experiences in one’s mind.
People with schizophrenia have trouble keeping their thoughts straight and expressing them. Disorganized thinking is one of the primary symptoms of schizophrenia.
Disorganized thinking can lead to various thought process disorders that cause tangential thought, disjointed thoughts, a collapse or sudden stop in the thought process, randomly spoken words, and incoherence.
Typically, we process our thoughts logically and coherently. However, this process is disrupted in those with schizophrenia, leading to disorganized thought and disordered speech.
Causes of Disorganized Thinking
The causes of disorganized thinking (or schizophrenia) are unclear. It may be related to a factors such as genetics and family history, environment, and trauma. Some people with disorganized thinking have structural differences in their brains, as evidenced by unusual activation in regions involved in:
Language and speech processing
Auditory perception
Social interaction
Higher-order cognitive functions like decision-making, evaluating, brainstorming, and learning
Takeaway
Thoughts, emotions, sensations, memories, and fantasies are the essential building blocks of the way the brain functions. Any disruption in the thought process—the way these blocks are linked—will affect certain areas of life.
Related: Positive Symptoms in Schizophrenia
Thought Content vs. Thought Process
It makes sense to try to understand disorganized thinking from two perspectives: thought content and thought process. While changes in someone's thought content affect what they perceive or think about, changes in thought process impact the way they form their ideas and express them.
Thought Content Abnormalities
Auditory hallucinations (hearing sounds not based in reality)
Delusions (fixed sets of ideas that are at odds with reality)
Grandiosity
Thought Process Abnormalities
Circumstantial thinking
Clang associations
Derailment
Distractibility
Tangential thinking
Word salad (incoherence)
Types of Disorganized Thinking
Here's a more in-depth look at those thought process abnormalities.
Distractibility
Some people with disordered thinking experience distractibility. They may begin talking about one thing and then completely shift topics before completing their sentence. This is often due to nearby stimuli that interfere with the thought process.
For example: "I moved to New York after college. What are you eating for lunch?"
Circumstantial Thinking
Circumstantial thinking occurs when a person talks in circles, providing excessive and unnecessary detail before getting to the point.
One Classic Example
Here's an example from neuroscientist and neuropsychiatrist researcher Nancy Coover Andreasen:
Question: "What is your name?"
Response: "Well, sometimes when people ask me, I have to think about whether or not I will answer because some people think it's an odd name even though I don’t really because my mom gave it to me and I think my dad helped but it's as good a name as any in my opinion, but yeah it's Tom."
Tangential Thinking
Tangential thinking occurs when someone moves from thought to thought but never seems to get to the main point. Instead, the thoughts are somewhat connected but in a superficial or tangential way.
For example: "I really got mad as I was waiting in line at the grocery store. I cannot stand lines. Waiting and waiting. I waited for a long time to get my driver's license. Driving these days is just crazy."
Derailment or Loose Associations
In cases of severely disordered thinking, thoughts lose almost all connections with one another and become disconnected and disjointed. This illogical thinking is called derailment or "loose" associations.
For example: "I really enjoyed some communities and tried it, and the next day when I’d be going out you know, um I took control like uh, I put, um, bleach on my hair in, in California. My roommate was from Chicago and she was going to the junior college. And we lived in the YMCA so she wanted to put it, um, peroxide on my hair…"
Clang Associations
Clanging is when the individual chooses words based on sound (rhyming or pun associations) rather than meaning. They may also use made-up words or neologisms and may speak in a flat- or unusual-sounding voice.
For example: "I had a little goldfish too, like a clown. …Happy Halloween down."
Related: Clang Association in Bipolar Disorder and Schizophrenia
Incoherence
People with very severe disordered thinking may experience incoherence, where there are no discernible connections between words. This incoherence (also known as "word salad") makes it impossible to understand the individual’s thought process.
For example: "They’re destroying too many cattle and oil just to make soap. If we need soap when you can jump into a pool of water, and then when you go to buy your gasoline, my folks always thought they should, get pop but the best thing to get, is motor oil, and, money..."
Diagnosis
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders includes criteria to help your doctor diagnose schizophrenia. Your doctor will look for typical symptoms of the condition, like disordered speech, delusions, hallucinations, disorganized or catatonic behavior, and reduced emotional expression.
Takeaway
They may also look for disorganized thinking by examining how you communicate and direct your attention.
Your doctor will also need to rule out other conditions that can affect thought processes, like:
Treatment for Disorganized Thinking
Treatment for thought process abnormalities in schizophrenia often includes medication, psychotherapy, life skills training, and family support.
Medication
The right medication can help to reduce disordered thinking and improve functioning. This may include antidepressants, mood stabilizers, or anti-anxiety medication alongside antipsychotics for long term management of the symptoms of schizophrenia.
Psychotherapy
Talk therapy, including cognitive behavioral therapy (CBT), can help you better identify thought process abnormalities and find ways to cope with unusual or dysfunctional ways of thinking.
Social Skills Training
An inability to clearly communicate your thoughts and feelings can take a toll on your family, social life, and work relationships. Social skills training can help you improve communication with others to better navigate these relationships.
Family Support
Family members are often crucial providers of care for someone with schizophrenia. Family therapy may help ensure that you and your loved ones understand your condition and feel supported.
Recap
Treatment for thought process problems depends on the root cause. In many cases, medication, psychotherapy, skill training, and family support are part of a treatment plan.
Related: The 13 Best Online Therapy Services That Are Tried, Tested, and Expert-Approved
The Takeaway
Disorganized thinking can be difficult to deal with, but with the help of a healthcare provider and the people close to you, you can make great strides and find strategies that work for you.
Learning more about the symptoms of schizophrenia can help with this process, as can joining an in-person or online support group. Finding support can provide an outlet to express your emotions and help you develop strategies to communicate your thoughts.
Read Next: Living With Schizophrenia
Read the original article on Verywell Mind.
