Thinking Process Abnormalities in Schizophrenia

Key Takeaways

• Schizophrenia can cause disorganized thinking, making it hard for people to keep their thoughts and speech in order.
• Treatment for disorganized thinking often includes medication, talk therapy, and social skills training.

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

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.

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

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.”

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.

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.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Hart M, Lewine RR. Rethinking thought disorder. Schizophr Bull. 2017;43(3):514-522. doi:10.1093/schbul/sbx003

2. Wensing T, Cieslik EC, Müller VI, Hoffstaedter F, Eickhoff SB, Nickl‐Jockschat T. Neural correlates of formal thought disorder: An activation likelihood estimation meta‐analysis. Hum Brain Mapp. 2017;38(10):4946-4965. doi:10.1002/hbm.23706

3. Hinzen W, Rosselló J. The linguistics of schizophrenia: Thought disturbance as language pathology across positive symptoms. Front Psychol. 2015;6:971. doi:10.3389/fpsyg.2015.00971

4. Sass L, Parnas J. Thought disorder, subjectivity, and the self. Schizophr Bull. 2017;43(3):497-502. doi:10.1093/schbul/sbx032

5. Andreasen NC. Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability. Arch Gen Psychiatry. 1979;36(12):1315-21. doi:10.1001/archpsyc.1979.01780120045006

6. Kuperberg GR. Language in schizophrenia Part 1: an Introduction. Lang Linguist Compass. 2010;4(8):576-589. doi:10.1111/j.1749-818X.2010.00216.x

7. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013. doi:10.1176/appi.books.9780890425596

8. Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: Overview and treatment options. P T. 2014;39(9):638-645.

9. Chen X, Long F, Cai B, Chen X, Chen G. A novel relationship for schizophrenia, bipolar and major depressive disorder Part 5: a hint from chromosome 5 high density association screen. Am J Transl Res. 2017;9(5):2473-2491.

10. Stepnicki P, Kondej M, Kaczor AA. Current concepts and treatments of schizophrenia. Molecules. 2018;23(8). doi:10.3390/molecules23082087

11. Almerie MQ, Okba Al Marhi M, Jawoosh M, et al. Social skills programmes for schizophrenia. Cochrane Database Syst Rev. 2015;(6):CD009006. doi:10.1002/14651858.CD009006.pub2

12. Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: Challenges and solutions. Neuropsychiatr Dis Treat. 2015;11:145-151. doi:10.2147/NDT.S51331

By Adrian Preda, MD

Adrian Preda, MD, is a board-certified psychiatrist with specialties in adult and geriatric psychiatry and clinical neuropsychiatric research.

Thanks for your feedback!

What is your feedback?

Helpful

Report an Error

Other