Thinking Process Abnormalities in Schizophrenia

Thinking is a complex process that encompasses our ability to make decisions, solve problems, reason, and remember. In schizophrenia, disorganized thinking is a primary symptom, leading to thought process disorders. These disorders may manifest as tangential thoughts, disjointed thoughts, abrupt disruption or cessation of thought processes, randomly spoken words, and incoherence.

Normally, thought processing follows a logical and coherent pattern. However, in schizophrenia, this process is disrupted, resulting in disorganized thoughts and disordered speech.

Causes of Disorganized Thinking

The exact cause of disorganized thinking (and schizophrenia) is unknown. Potential contributing factors include genetics, family history, environment, and past trauma. Studies have identified structural differences in the brains of individuals with disorganized thinking, particularly 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 form the essential building blocks of your brain's thinking process. Any disruption in this process, or the way these blocks are linked together, can impact other areas of your life.

Thought Content vs. Thought Process

To better understand disorganized thinking, it's helpful to consider two perspectives: thought content and thought process. Changes in thought content affect what individuals perceive or think about, while changes in thought process impact how they form and express their ideas.

Thought Content Abnormalities

• Auditory hallucinations (hearing sounds not based in reality)
• Delusions (fixed sets of ideas that are at odds with reality)
• Depersonalization or derealization
• Grandiosity

Thought Process Abnormalities

• Circumstantial thinking
• Clang associations
• Derailment
• Distractibility
• Tangential thinking
• Word salad (incoherence)

Types of Disorganized Thinking

1. Distractibility: Individuals with disorganized thinking may experience distractibility, shifting topics abruptly before completing sentences. This is often due to nearby stimuli interfering with the thought process and may involve switching to unrelated or irrelevant topics.

2. Circumstantial Thinking: Circumstantial thinking involves providing excessive and unnecessary detail before reaching the main point. The person may go on tangents that are not directly relevant to the topic, often providing a great deal of unnecessary detail.

3. Tangential Thinking: Tangential thinking occurs when someone moves from thought to thought without reaching the main point. The thoughts may be somewhat connected but only superficially or tangentially related.

4. Derailment or Loose Associations: In cases of severely disordered thinking, thoughts may lose connections with one another and become disconnected and disjointed. This illogical thinking and abrupt changes in the topic of conversation are known as derailment or "loose" associations.

5. Clang Associations: Clanging occurs when individuals choose 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.

6. Incoherence: Individuals 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.

Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) includes criteria to aid in the diagnosis of schizophrenia. Doctors look for typical symptoms such as disordered speech, delusions, hallucinations, disorganized or catatonic behavior, and reduced emotional expression.

They may also evaluate disorganized thinking by examining communication and attention. Importantly, doctors will need to rule out other conditions, which can affect thought processes, such as:

• Bipolar disorder
• Schizoaffective disorder
• Major depression with psychotic features
• Substance-induced psychosis
• Dementia

Treatment for Disorganized Thinking

Treatment for thought process abnormalities in schizophrenia often includes a combination of medication, psychotherapy, life skills training, and family support.

1. Medication: The right medication can help reduce disordered thinking and improve overall functioning. This may include antidepressants, mood stabilizers, or anti-anxiety medication alongside antipsychotics for long-term symptom management.

2. Psychotherapy: Talk therapy, including cognitive behavioral therapy (CBT), can help individuals better identify thought process abnormalities and develop coping mechanisms for unusual or dysfunctional ways of thinking.

3. Social Skills Training: An inability to clearly communicate thoughts and feelings can affect family, social life, and work relationships. Social skills training can help improve communication with others to navigate these relationships more effectively.

4. Family Support: Family members often play a crucial role in providing care for someone with schizophrenia. Family therapy can help ensure that both the individual and their loved ones understand the condition and feel supported.

Conclusion

Treatment for thought process problems depends on the root cause. In many cases, medication, psychotherapy, skill training, and family support are all part of a comprehensive treatment plan.

A Word From Verywell

Disorganized thinking can be difficult to manage, but with the help of healthcare professionals and the support of loved ones, it is possible to make progress and cope effectively. Learning more about the symptoms of schizophrenia and joining support groups (either in-person or online) can provide an outlet to express emotions and adopt strategies for better communicating thoughts.