Schizophrenia Symptoms and Diagnosis What Is a Thought Disorder? By Kendra Cherry, MSEd Kendra Cherry, MSEd Facebook Twitter Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." Learn about our editorial process Updated on February 13, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Klaus Vedfelt / Getty Images Table of Contents View All Table of Contents What Is a Thought Disorder? Symptoms Identifying a Thought Disorder Causes Types Treatment Coping What Is a Thought Disorder? A thought disorder involves a disturbance in how thoughts are organized and expressed. It causes disorganized thinking and leads to people expressing themselves in unusual ways when speaking or writing. Formal thought disorder is also known as disorganized speech. It is marked by disruption to the structure or form of thought. It is one of the key symptoms of schizophrenia and psychotic disorders. Because these symptoms can be observed, they can be used to help assess the severity of psychosis. Thinking requires the ability to think about a subject and organize those thoughts mentally and then express those thoughts in an understandable way. A thought disorder can create problems with any or all of these areas. Disruptions in thought are connected to difficulties in day-to-day functioning, social relationships, and psychological well-being. This article discusses the symptoms, causes, and types of thought disorders. It also covers how a thought disorder is diagnosed and some of the treatment options that are available. Symptoms While thought disorders are characterized by problems with thought and language, those symptoms are not enough on their own for a diagnosis. This is because such symptoms can also occur temporarily when people are over-stressed or over-tired. These symptoms can become indicative of a thought disorder depending on their frequency, severity, and the impairment that they cause. Symptoms associated with a thought disorder can include: An inability to stay on topicLack of speechRapid, pressured speechIncoherenceIllogical speechWandering train of thought Other symptoms that can be associated with thought disorders include delusions, hallucinations, poor judgment, changes in movement, irritability, lack of emotion, lack of expression, and paranoia. Such symptoms are associated with conditions including schizophrenia, schizoaffective disorder, and psychosis. Identifying Thought Disorder Thought disorders are diagnosed by a healthcare professional. A diagnosis usually involves asking people open-ended questions and then assessing their verbal responses. Several assessment tools can be utilized to measure thought disorders, including: The Rorschach inkblot test: The Rorschach inkblot test is a projective test in which people are shown a series of ambiguous inkblots. Mental health professionals can then use a scoring system when interpreting verbal responses to the inkblots to look for signs of disordered thinking. The Thought Disorder Index (TDI): This assessment involves a health professional engaging in a conversation with the individual that is recorded and then transcribed. The TDI (also known as the Delta index) is then used to evaluate the exchange, including looking at 23 different areas that may indicate a thought disturbance. Scale for the Assessment of Thought, Language, and Communication (TLC): One of the most widely used thought disorder assessments. It involves making observations and giving them a severity rating based on definitions of different aspects of thought disorders. Many medical conditions can also impact verbal and written language performance. These may include: Autism spectrum disorder Attention deficit hyperactivity disorder (ADHD) Endocrine disorders Hearing loss Infections Intellectual disabilities Metabolic disorders Substance use Traumatic brain injury Vitamin deficiencies A doctor will need to rule out underlying medical factors before diagnosing a thought disorder. In addition to evaluating the individual’s speech, a doctor may also give the individual a physical exam and conduct lab tests to look at overall health and check for other medical conditions. Abnormalities in language are pretty common in everyday speech and often due to stress and lack of sleep. Johns Hopkins Medicine notes that the severity and frequency of symptoms are important factors to consider when making a diagnosis. Diagnosing a thought disorder involves observing and evaluating a person's verbal responses to questions. In addition to these assessments, medical providers must also rule out other conditions that can cause similar symptoms affecting speech. Causes The exact causes of thought disorders are not known. However, it is believed that a number of variables may play a contributing role including genetics, brain abnormalities, and environmental factors. Disorganized thought can be seen in a number of mental health conditions, including schizophrenia. In the case of schizophrenia, some research has suggested that the condition is linked to abnormalities in the brain's semantic system. Types Each type of thought disorder has its own set of symptoms that interfere with the thought process. However, in each case, there is a disruption to the organization and expression of ideas and thoughts. Some of the many different types of thought disorders include: Alogia: This thought disorder is characterized by poverty of speech and is commonly seen in people with schizophrenia or dementia. Responses are often abrupt and incomplete. Blocking: People with thought disorders may stop speaking mid-sentence and pause for an extended period. When they resume speaking, it is often on an entirely different topic. Circumstantial thinking: This type of disorganized thinking involves including a lot of unnecessary detail that is often indirect or even unrelated to the main point of the conversation. Clanging: This involves using words based on their sounds rather than their meaning. This includes rhyming words or puns. Echolalia: This involves repeating back the speech of other speakers. They may often repeat sounds or words that they hear from others. Neologism: This involves coining new words spontaneously. These words are meaningless and unrecognizable but incorporated into speech. Tangentiality: This type of disordered thought involves moving from one idea to another. The ideas are connected superficially but never get to the main point. Word salad: This involves a mixture of random words and phrases that are unintelligible. These are characterized as both types of thought disorders as well as symptoms of formal thought disorder. Treatment Treatments are available that can help people manage the symptoms of thought disorders. Some treatment strategies that may be used are discussed below. Psychotherapy Therapy may be useful for helping people who are also experiencing symptoms of delusional or distorted thoughts. Types of therapy that might be utilized depending on the individual's symptoms include: Cognitive-behavioral therapy (CBT) can help people identify and change distorted thoughts. Family therapy can help families learn what they can do to support their loved one who has a thought disorder. Group therapy can be a useful treatment for practicing skills and finding support. Medications Medications may sometimes be prescribed to help treat symptoms associated with schizophrenia or psychotic disorders. Such medications may include antipsychotics, antidepressants, and mood stabilizers. Coping In addition to therapy and medications, people with thought disorders can also benefit from life skills training and social support: Social skills training: Because problems with disorganized thinking affect communication, it can create challenges in relationships. Learning and practicing social skills can help people with thought disorders find ways to improve their communication abilities in ways that benefit their relationships.Social support: Social support is also essential for people who have disorders that impact thought organization. Family therapy and support groups may be helpful for both people who have this condition as well as family members and other loved ones.Stress management: Relaxation techniques may also be helpful since stress can sometimes worsen the symptoms of conditions such as schizophrenia. An Overview of Stress Management A Word From Verywell If you are experiencing symptoms of a thought disorder that are affecting your ability to communicate, you should talk to your doctor. They can evaluate your symptoms and make a diagnosis. Getting the right diagnosis is the best way to ensure that you receive an appropriate treatment that can help you manage the symptoms that you are experiencing. 9 Sources 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. Hart M, Lewine RR. Rethinking thought disorder. Schizophr Bull. 2017;43(3):514-522. doi:10.1093/schbul/sbx003 Roche E, Creed L, MacMahon D, Brennan D, Clarke M. The epidemiology and associated phenomenology of formal thought disorder: a systematic review. Schizophr Bull. 2015;41(4):951-962. doi:10.1093/schbul/sbu129 American Speech-Language-Hearing Association. Spoken language disorders. Rivkin P, Barta P. Thought disorder. Johns Hopkins Psychiatry Guide. Updated August 2, 2017. Kircher T, Bröhl H, Meier F, Engelen J. Formal thought disorders: from phenomenology to neurobiology. The Lancet Psychiatry. 2018;5(6):515-526. doi:10.1016/S2215-0366(18)30059-2 Balaram K, Marwaha R. Circumstantiality. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Updated May 9, 2021. L, Parnas J. Thought disorder, subjectivity, and the self. Schizophr Bull. 2017;43(3):497-502. doi:10.1093/schbul/sbx032 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 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 Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book." 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