Your words are often a reflection of your thoughts, which is why language changes can sometimes be a hallmark of mental health conditions, like schizophrenia.
It’s natural to have moments where you can’t put what you’re feeling into words. Stress, frustration, fatigue — and many other factors — can all make thoughts feel unclear from time to time.
It’s OK to be unable to express yourself clearly once in a while.
But when you live with certain mental health disorders, what you say and how it comes out can be an important indicator of where your thoughts are.
Speech patterns can be clues to issues and deficits in thought process, such as those found in schizophrenia, and may offer insight into the development of the disorder and its progression.
Disorganized speech is known clinically as “formal thought disorder” or “disorganized thinking.” These phrases describe atypical language patterns that can make communication and comprehension difficult.
In a diagnostic setting, disorganized speech is considered a representation of disorganized thoughts, which is why this symptom is related specifically to cognition and not language.
You can experience thought disorder in a number of ways. Disorganized speech may be subtle or hard to notice at first or may be a more extreme expression of mixed, incoherent sounds and sentences referred to as “word salad.”
Thought disorder is often seen as schizophrenia speech patterns, but it can also be a symptom of other mental health disorders and degenerative brain conditions, like neurocognitive disorder (dementia).
Schizophrenia can affect speech patterns on several levels, including:
- the conversation level
- the sentence level
- the singular word level
Schizophrenia speech patterns can manifest in a number of ways and may look different for everyone experiencing this symptom.
Alogia
Alogia is listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition and indicates a “poverty of speech.” This means having difficulty speaking spontaneously without encouragement and giving short replies to questions.
You may also have a tendency to talk excessively with alogia, but experience challenges with communicating information clearly, which is sometimes called “poverty of content.”
Example
Question: “Would you like to buy hair conditioner?”
Alogia response: “Hair’s dry.”
Derailment
Derailment is often a steady progression of “getting off track” during conversation.
Your thoughts may be loosely connected, eventually getting further away from one another as discourse continues.
Example
“I had to go to the market today to get milk. You know they don’t process milk like they used to. People are too caught up in technology now. Computers are going to take us over one day. I had a camera once so advanced I never used it. I do like to have photos on my wall to remind me of the places I’ve been.”
Derailment can have additional forms, including:
- Flight of ideas. You lose your train of thought under pressured speech.
- Circumstantiality. The details of your expressions are excessive and loosely related to the overall idea conversation goal, which does eventually get reached.
- Tangentiality. You lose your train of thought in immediate response to a question.
- Blocking. You pause for extended periods of time during conversation and then change topics.
Clanging
When your word choice is dependent on an associated sound or rhyme rather than the actual word meaning, this is known as clanging.
Example
“I enjoy learning to bake to cake to make.”
‘Word salad,’ or incoherence
Word salad is often any speech pattern that is beyond comprehension. It can occur alongside other speech disorders, like derailment, but can also happen on its own.
Word salad can contain semblances of direction toward a goal, but the words and sentences are often fragmented or misplaced to a point where the response is unintelligible.
Example
“Trees summer… green… I gardening… water hard sun summer set… best time.”
Neologisms
A schizophrenia speech pattern where new words or phrases are invented is called a neologism.
Example
“I would have done that but the flugehimetz got in the scharn.”
Word approximations
Word approximations are the use of traditional words in untraditional ways, often with an obvious meaning.
Example
Referring to a hammer as a “nail pounder.”
Echolalia
When you experience echolalia as a schizophrenia speech pattern, you’re more likely to repeat words and sounds from another person, rather than communicating your own thoughts.
Example
Question: “Have you heard the train whistle lately?”
Echolalia response: “Train whistle lately?”
Disorganized speech is not a condition, but rather a symptom. It’s a part of formal thought disorder, which can also manifest as disorganized behaviors.
Signs and symptoms may include:
- atypical communication patterns
- responding externally to internal thoughts (laughing to yourself, speaking to yourself)
- purposeless movements
- agitation
- inappropriate behaviors
- disheveled appearance
- decreased reactivity and engagement with the environment
- unpredictable or repetitive movements
- mimicking
- poor concentration
The exact causes of thought disorder are still unclear.
As a symptom seen across multiple disorders, experts believe disorganized speech has a complex origin, and what contributes to it in one condition may not be what leads to it in another.
Neurological changes
These changes may impact the brain regions associated with language, but on a larger scale could impact:
- processing speed
- memory recall
- attention
- association
If you’re unable to retrieve the memory of a word, for example, it might manifest as long pauses in your speech pattern. Or, you might find yourself jumping from one topic to another, perhaps not completing thoughts or sentences before switching gears.
Heredity
In addition to changes in the brain, some experts believe schizophrenia speech patterns may be linked to the disorder genetically.
In a 2016 study looking at the genetic foundations of brain rhythmicity, researchers noted genes knowingly associated with schizophrenia were overrepresented among the same genes linked to language faculty.
No matter the cause for disorganized speech, there are ways you may be able to improve communication with your loved one.
Leading with empathy
Remember, schizophrenia speech patterns and thought disorders aren’t deliberate acts of defiance. Your loved one isn’t being stubborn or difficult.
In many cases, people living with schizophrenia want to communicate but are unable to do so clearly. Arguing, correcting, and expressing your anger or frustration won’t improve their ability to hold a conversation.
Communication tips
Consider these tips for communicating with someone experiencing a cognitive impairment condition:
- Foster empathy. Approach communication with a focus on empathy and understanding, and offer your loved one gentle word assistance if needed.
- Have patience. Try to be patient and encouraging when communicating, and give your loved one as much time as they need to respond.
- Communicate clearly and slowly. If necessary, speak clearly and slowly, and offer clear, step-by-step directions. Rephrase your questions to get additional details on a topic.
- Keep it simple. Try to ask yes or no questions while asking only one question at a time. Avoid arguing or correcting.
- Try active listening. Show signs you’re engaged and listening, like making eye contact and nodding.
- Get creative. Offer alternative methods of communication, such as writing out responses and using gestures or images.
- Engage emotions. Focus on the emotion in the words, rather than the words themselves, such as sensing anger, sadness, or happiness.
Thought disorder is a symptom, not a condition on its own.
Treating thought disorder and disorganized speech often starts with managing underlying conditions, like schizophrenia.
The type of treatment you receive will depend on why you’re experiencing disorganized speech. Treatment for neurocognitive disorder (dementia), for example, will typically vary from schizophrenia treatment.
In many cases, thought disorder treatment means a combination of medication and psychotherapy approaches.
Cognitive behavioral therapy (CBT) is one form of psychotherapy commonly used to treat schizophrenia and its symptoms, including disorganized speech.
Being unable to communicate can be frustrating. Language is often the first way people express themselves, and when you’re unable to use that skill as intended, you and those around you can feel the impact.
If you or a loved one have been experiencing language changes recently, speaking with your healthcare team can help identify underlying causes.
In many cases, managing what’s at the core of thought disorder — such as mental health conditions, like schizophrenia — can help.
While schizophrenia is a life-long condition, schizophrenia speech patterns and other symptoms can be managed with the right treatment plan. Consider contacting your family doctor or therapist to discuss your symptoms and options for treatment.
Like all mental health conditions, it may take time plus trial and error to find the best course of treatment for you.