Clang Association in Bipolar Disorder and Schizophrenia

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Clang associations are groupings of words, usually rhyming words, that are based on similar-sounding sounds, even though the words themselves don't have any logical reason to be grouped together. A person who is speaking this way may be showing signs of psychosis in bipolar disorder or schizophrenia.

In bipolar disorder, clang associations generally appear in psychotic episodes in the manic phases of the illness. In schizophrenia, clang associations are closely linked with a thought disorder, one of the hallmark features of the illness. "Clanging" also has been referred to as "glossomania" in medical literature relating to speech alterations in schizophrenia and bipolar disorder.

What Clang Associations Sound Like

Clang associations generally sound a bit like rhyming poetry, except that the poems don't seem to make any sense. (They don't make sense because there's no logical reason for those particular words to be grouped together into a poem.)

For example, in the song "X Amount of Words" by Blue October's Justin Furstenfeld (who has bipolar disorder), the words "pathetic" and "sympathetic" are rhymed with "prosthetic" and "paramedic":

Imagine the worst
Systematic, sympathetic
Quite pathetic, apologetic, paramedic
Your heart is prosthetic

These words don't have much of a logical reason to be grouped together, but they create a catchy, clang-y sort of rhythm ... hence the term "clang associations." You can have a clang association with any words that don't make sense when grouped. Here's another:

Auto, tomorrow, swallow, Zoro, borrow

The words used in clang associations generally rhyme, although they may only rhyme partially.

Part of "Word Salad"

In bipolar disorder and schizophrenia, clang associations are considered to be part of a language disorder condition called schizophasia (popularly known as "word salad"). In fact, language disturbance is a major feature of schizophrenia.

A person is said to have schizophasia when his speech is jumbled, repetitious, and simply doesn't make sense.

This speech may feature neologisms, which are made-up words or expressions or simply be mumbled and impossible to understand. People whose speech features clang associations and other symptoms of schizophasia may also have a flat-sounding voice or another unusual voice quality. They may seem to have problems with remembering words or using them correctly, as well.

Writing Associations

Along with leading to clang associations, neologisms, and another jumbled spoken language, schizophasia may also affect written the language. In 2000, Université de Montréal researchers tested the writing and dictation ability of people with "paranoid schizophrenia with glossomanic schizophasia."

They found that the patients weren't able to write down dictated words accurately—they replaced letters in words with similar-sounding, but not identical letters, for example. This indicates that the language problems inherent in schizophrenia extend beyond spoken language in patients.

In fact, there's some speculation that language problems in schizophrenia, such as clang associations, may connect to the genetic basis for the condition: "Recent research has begun to relate schizophrenia, which is partly genetic, to the genetic endowment that makes human language possible," concluded one group of clinicians.

5 Sources
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By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.