Disorganized Thinking in Schizophrenia

From Distractibility to Incoherence

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It's fairly common for people with schizophrenia to have trouble keeping their thoughts straight and expressing what's in their minds. Disorganized thinking is one of the primary symptoms of schizophrenia, and it can lead to a variety of thought process disorders that cause disjointed thoughts, a collapse or sudden stop in thought process, randomly spoken words, and incoherence.

What Is Disorganized Thinking?

Thinking refers to our ability to make decisions, solve problems, reason, and remember. In a broader sense, thinking is the totality of experiences that happen inside one’s mind. Typically, we process our thoughts in a logical and coherent manner. However, for those with schizophrenia, this process is disrupted, leading to disorganized thoughts and disordered speech.

Causes

It's not clear what causes disorganized thinking (or what causes schizophrenia). It may be related to a variety of factors, like genetics and family history, environment, and past trauma. There is evidence that people with disorganized thinking have structural differences in their brains, as they show 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

Your thoughts, emotions, sensations, memories, and fantasies are the essential building blocks of the way your brain thinks. Any disruption in your thought process, or the way these blocks are linked together, will impact other areas of your 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 Disordered 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. 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 signs of disorganized thinking by examining the way you communicate and direct your attention.

Your doctor will also need to rule out other conditions that can affect thought processes, like:

Treatment

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 communicate your thoughts and feelings clearly can take a toll on your family and social life as well as your work relationships. Social skills training can help you improve your communication with others so you can 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.

A Word From Verywell

Disorganized thinking can be difficult to deal with, but with the help of your doctor and the support of those close to you, you can make great strides and cope. 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 adopt strategies to better communicate your thoughts.

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