Disorganized Speech: What It Is And How To Address Mental Health
Effective verbal communication is vital to our ability to connect with one another, get things done, and generally thrive as humans. So, it can be concerning when language (either yours or someone else’s) is marked by non-sequiturs, confusing phrasing, words that don’t exist, or similar abnormalities. These types of irregularities are known as disorganized speech, and are a common characteristic of schizophrenia and other mental health concerns.
Disorganized speech refers to verbal communication that is irregular and difficult to understand. Also called formal thought disorder, disorganized speech is a common characteristic of schizophrenia and other mental health concerns.
If you think you or a loved one may be experiencing disorganized speech, it can help to know how to recognize and respond to these challenges. Here, you’ll find an overview of disorganized speech, covering why it occurs, how it can manifest, and what you can do if you notice a loved one exhibiting signs of formal thought disorder.
What is disorganized speech?
According to the American Psychological Association, disorganized speech involves verbal discourse in which “ideas shift from one subject to another seemingly unrelated subject” and may also include responding to questions in an irrelevant way, reaching illogical conclusions, and making up words.
When you’re talking to someone who speaks in such a way, you may have trouble following their train of thought or predicting what they might say next. Also known as formal thought disorder, Disorganized speech is a primary characteristic of schizophrenia and is also associated with schizotypal personality disorder and autism spectrum disorder.
Disorganized speech patterns can affect a person’s social skills, making it difficult for them to communicate effectively and engage in meaningful conversations. Additionally, to someone who is not familiar with disordered speech, the phenomenon can be alarming. There are different irregular verbal patterns that may be used by someone experiencing disorganized speech, several of which are listed below.
Loosening of associations in disorganized speech
Also called derailment, this phenomenon occurs when a person connects ideas or words that don’t seem to go together. They may quickly move from one idea to a concept that doesn’t seem to be related. For example, they might say something like, “I went to the store today. Soccer is a boring game. Grapefruit is too sour”.
Tangential speech
Similar to forming loose associations, answering a question for someone with disorganized thinking may involve a non-sequitur. This is known as tangential speech. The answer might be vaguely related to the question, or it might not seem to be an answer to the question at all. For instance, if you asked a person with disorganized speech how they’re feeling today, they might answer by saying, “It’s cloudy outside”.
Paralogism
Sometimes, disorganized speaking involves coming to a conclusion that is not based on reason. Paralogism is an unintentionally illogical assertion. For example, a person might say, “I heard a bird outside, so I know Friday is the last day of the month”.
Neologism
A person with disorganized speech might make up a new word that does not relate to any established term. For example, they may call an orange a “tofuela”.
Disordered speech: “Word salad”
In some cases, a person might use both words and sentences that don’t bear any resemblance to ordinary speech. It may be difficult or even impossible to understand what they’re trying to say. This is often referred to as word salad.
Word approximations
Some people who display disorganized speech use words that make sense but are unconventional. They may, for example, call a hat a “head topper”.
Echolalia
An individual with formal thought disorder may repeat words that their conversation partner is using. For example, if you ask someone, “What time is it?” may be responded to with, “What time”, they may be engaging in echolalia.
Causes of disorganized speech
While there is no unified theory explaining why formal thought disorder develops, several potential contributing factors have been identified. The following are potential causes and risk factors that have been connected with disorganized speech.
Alterations in brain function/structure related to schizophrenia
Structural changes and dysfunction in certain regions of the brain are considered a primary cause of disorganized speech. A meta-analysis of brain imaging studies found that brain activity in certain regions, including the prefrontal cortex and temporal lobes, is altered in those who have formal thought disorder. These significant alterations can lead to difficulties in organizing thoughts and expressing ideas coherently, which are hallmark features of disorganized speech.
Semantic memory impairment and its impact on mental health
People who have schizophrenia are thought to experience deficits in semantic memory. This term usually refers to the part of your long-term memory that deals with concepts and ideas outside the realm of your own experiences. It can include common knowledge, such as how to turn on a television or the names of state capitals. Alterations in semantic memory function can make it hard to develop the required network of connected words and concepts that facilitate effective communication. These impairments can contribute to difficulties in expressing thoughts clearly, impacting overall mental health and functioning.
Working memory impairment and its connection to formal thought disorder
Your working memory holds conscious, short-term thoughts. A crucial component of executive function, this type of memory helps us get and synthesize information, contributing to our ability to communicate. It is thought that people with formal thought disorder may experience working memory impairment. This impairment can impact the diagnosis and treatment of related mental health issues, including challenges in expressing coherent thoughts.
Genetic factors and their role in treatment for schizophrenia or delusions
Schizophrenia and similar conditions associated with disorganized speech are thought to have a strong genetic component. For example, one study linked schizophrenia and formal thought disorder to a mutation that affects a specific coding gene. Understanding these genetic factors can inform treatment approaches, particularly for individuals experiencing delusions.
Early experiences and their impact on the diagnosis of thought disorder
Some experts believe that the established connection between thought disorder and social functioning challenges can be partially explained by upbringing. Having parents who interpret the world in idiosyncratic ways may increase an individual’s risk of experiencing similar challenges. This connection highlights the importance of considering early experiences in the diagnosis and treatment of an individual who may also experience delusions.
Symptoms and signs of schizophrenia & bipolar disorder
Because disorganized speech is one of the dominant characteristics of disorganized schizophrenia and bipolar disorder, it can help to know how to recognize other signs of these serious mental disorders. (Previously, disorganized schizophrenia was considered a subtype of schizophrenia, but is now considered to be the same mental health condition.)
The following are some of the symptoms of schizophrenia:
Disorganized thinking and speech
Delusions (false beliefs not based on reality)
Hallucinations (seeing or hearing things that aren’t really there)
Childlike behavior
Agitation
Engaging in activities that aren’t focused on any goal
Resisting instructions
Sitting, standing, or laying in inappropriate positions
Unresponsiveness
Moving excessively
Neglecting personal hygiene
Lacking any signs of emotion
Loss of interest in daily activities
Disorganized behavior
Socially isolating
Inability to feel pleasure
Symptoms of bipolar disorder vary depending on whether the person is in a manic episode or depressive episode.
Elated or irritable vs sad or anxious
Jumpy or wired vs. slowed down or restless
Decreased need for sleep vs. sleep difficulties
Talking fast about many things vs. talking slow and forgetfulness
Racing thoughts vs lack of concentration
Endless energy vs listless
Indulging in excessive pleasurable activities vs hopelessness and suicidal thoughts.
If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.
How to respond to disorganized speech
It can be hard to know what to do when someone with whom you’re conversing displays signs of formal thought disorder. And it may be concerning if you are experiencing some of the types of disorganized speech listed above. If you or someone you know is experiencing symptoms of formal thought disorder, the following are some tips for addressing the situation.
Seek help
One of the most important steps you can take when addressing formal thought disorder is to consult a mental health or medical provider. A healthcare professional can provide testing, diagnosis, and treatment. Often, treatment for schizophrenia and other conditions associated with disorganized speech consists of a combination of medication and therapy.
While disorganized speech can be alarming, try to avoid trying to diagnose the problem yourself. What seems like disorganized speech may have a cause that is unrelated to a brain disorder. For instance, if a person quickly shifts from one subject to another, it might be that they are distracted easily or have a lot on their mind. If a person responds to a question with an answer that doesn’t have anything to do with what was asked, it might be that they’re attempting to avoid answering the question, not that they are experiencing disorganized speech. If you suspect that what you’re seeing is disorganized speech, it is typically best to get a professional opinion.Avoid parsing their speech
It might seem natural and constructive to point out irregularities in someone else’s verbal communication. However, it’s possible the person with whom you’re speaking might feel judged or criticized by this response. Instead, try to listen to what they’re saying in a respectful manner, even if you don’t understand it. You can respond to the ideas that have a logical basis and provide emotional support as you listen to those that might not.
Coping with disorganized speech through online therapy
Disorganized speech often develops alongside other mental health conditions, such as depression and anxiety. Medically reviewed research suggests that online therapy can help individuals navigate complex emotions that may arise out of these challenges. In a meta-analysis that included over 90 studies and almost 10,000 total participants, researchers concluded that online therapy is an effective form of care when addressing a range of mental health concerns.
If you or someone you love is exhibiting signs of formal thought disorder, you may be experiencing complex feelings. With an online therapy platform like BetterHelp, you can work through your emotions with a mental health professional in several different ways—through video call, voice call, or in-app messaging—which can be more comfortable if you struggle with disorganized speech. Online therapy is also an affordable option, with BetterHelp registration starting at $65 to $100 per week (based on factors such as your location, referral source, preferences, therapist availability and any applicable discounts or promotions that might apply).
Takeaway
What are the symptoms of disorganized speech in schizophrenia?
Disorganized speech is typically defined by a lack of coherence. The person may shift from one subject to a seemingly unrelated one, reach illogical conclusions, make up words, or respond to questions with irrelevant answers. One of the common features is a loosening of associations, wherein a person is easily derailed from one idea and may jump to another seemingly at random. A person’s speech patterns and cadence may also be affected. Recognizing these mentioned symptoms is crucial, as they can significantly impact communication and social interactions.
What is an example of a disorganized speech?
Loose associations between words or concepts commonly characterize disorganized speech. Sometimes, people may make up their own words or combine phrases into a “word salad” with no discernible meaning. Some examples might include:
“I always liked my teacher, Mr. N. He was very tall, so I knew he taught math.”
“I’m feeling okay, but the last thing I saw made me think that the fours and fives were keeping my watch.”
“I set my keys down on the laddlebotter.” (This is a made-up word, likely replacing “counter”).
They’re taking too many people from the pond, so when you buy biscuits or garages its where people’s parents are as well. (Word salad).
What do disorganized thoughts look like?
Disorganized thoughts are often jumbled and may not make sense when the person tries to communicate them. The person may struggle to think coherently and may exhibit significant confusion. The disorganized thoughts might also impact their ability to think logically or make rational decisions. A person experiencing disorganized thinking often has a difficult time recognizing their symptoms, making it challenging to evaluate their internal monologue.
What is an example of a disordered thought in mental health?
Disordered thoughts are often characterized by a lack of coherence, poor associations between subjects, and misidentification of words. A person experiencing a disorganized thought might think something like, “I need to assemble the plate now, or I won’t be able to pet the cat.” They may also make up their own words or misuse words. These patterns can indicate underlying mental health disorders, such as schizophrenia, and may require professional assessment and support.
What causes disordered speech?
Disorganized speech is a feature often reported in mental illness, most commonly schizophrenia and schizoaffective disorder. It can also be caused by other conditions that affect the structure and function of the brain, such as a traumatic brain injury (TBI) or stroke. In the case of TBI or stroke, disorganized speech is caused by physical damage to the brain due to traumatic injury or ischemic injury. An ischemic injury occurs when the blood supply to a particular brain area is disrupted long enough that the neurons in that area cannot recover.
There are two prominent theories describing how disorganized speech works in schizophrenia and related disorders, although the underlying causes have not been proven with certainty. The first theory suggests that abnormalities in semantic memory cause language dysfunction. Semantic memory links words and concepts together based on how often they occur together. Those with schizophrenia may not link words and concepts strongly enough to organize their speech, leading to the characteristic loosening of associations seen in those with the condition.
The second theory asserts that language dysfunction arises due to a person’s inability to derive contextual clues necessary to organize speech. It is possible that problems with working memory, which allows a person to “hold” information for processing, and executive function, which is responsible for directed behavior, may make it challenging for a person to correctly understand how words and phrases should be used.
Is disorganized speech a symptom of ADHD or another disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), does not report disorganized speech as a symptom of ADHD or its subtypes. However, there may be confusion surrounding the fact that ADHD often causes problems with organization, including organizing thoughts or speech. The symptoms typically do not rise to the level of functional impairment that may be seen in schizophrenia. A person with ADHD, especially if they are young, may sometimes speak in a manner that lacks coherence, but they are often able to slow down, repeat themselves, or take time to organize their thoughts.
Is disorganized speech a symptom of autism?
Disorganized speech, such as moving rapidly from topic to topic, misunderstanding logical links, and using made-up words, can sometimes appear in those with autism spectrum disorder (ASD). However, unlike schizophrenia, the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not directly indicate disorganized speech as a criterion for diagnosing ASD. Medical and mental health professionals use the DSM to diagnose mental health conditions, but it does not provide a comprehensive list of all symptoms that appear, just the ones that are clinically significant when making a diagnosis to provide medical advice.
What is disorganized behavior?
One of the features of schizophrenia is disorganized motor behavior. In that context, disorganized behavior typically refers to any abnormal movements or actions, such as unpredictable agitation, repeated movements without purpose, or catatonia—where a person barely moves at all. Disorganized behavior might also refer to more complex behavior that results from illogical or irrational thought processes.
Why does my brain jump from topic to topic?
There are many reasons why your brain may jump from topic to topic. Disorganized thinking may be a cause, as could poor executive function, anxiety, or a myriad of other conditions. You might also be someone who is predisposed to rapid thought processes. If your brain jumping from topic to topic concerns you, scheduling an appointment with a mental health professional who can provide an assessment to address your concerns would likely be helpful. They may be able to offer insight, rule out severe concerns, and make appropriate referrals to address your rapidly changing thoughts.
What is grossly disorganized speech?
Grossly disorganized speech likely refers to speech that is so disorganized it is nearly or completely unintelligible to those listening to it. A person with schizophrenia, for example, may make up their own words or misunderstand the meaning of words. That might make the person’s speech extremely difficult to understand to those around them, even if they feel they are communicating effectively.
How does the diagnosis of disorganized speech relate to treatment options for delusions?
Disorganized speech often indicates a mental health condition like schizophrenia, where delusions can also occur. Recognizing this connection allows healthcare providers to choose appropriate treatments, such as therapy or medication, to address both the disorganized speech and any delusions.
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