What Is A Thought Disorder? Understanding the Types, Causes, and Effects

Thought disorders represent a complex realm of mental health, characterized by an individual's impaired ability to think clearly or logically. These disorders can profoundly disrupt the organization, process, and expression of thoughts, often leading to communication that is fragmented, disjointed, or bizarre. 

Here, you will find an introductory guide to thought disorders, their symptoms, underlying causes, and options for diagnosis and treatment.

What is a thought disorder? 

Which mental health conditions can cause thought disorders?

Thought disorders are commonly associated with:

• Schizophrenia
• Bipolar disorder I (specifically during mania) 
• Psychosis
• Delusional disorder
• Brief psychotic disorder 
• Dementia 

A thought disorder may be diagnosed by a doctor or mental health professional after careful observation of one's speech, writing, or social interactions.

Types of thought disorders: Formal thought disorder and content thought disorder

There are two main types of thought disorders—content thought disorder, which affects the meaning and significance of thoughts, and Formal Thought Disorder, which impacts the organization and expression of thoughts.

Formal thought disorder (FTD)

Formal Thought Disorder (FTD) is a specific type of thought disorder that primarily affects the organization and expression of thoughts, making communication challenging for those affected. As a subcategory of thought disorders, FTD is characterized by a disruption in the flow and coherence of thought, manifesting in speech that is often difficult to understand due to its disorganized nature.

FTD is most commonly observed in individuals with schizophrenia, but it can also occur in other mental health conditions such as bipolar disorder and major depressive disorder. The presence of FTD significantly impacts communication, social interaction, and overall quality of life, making it a crucial focus of treatment.

Content thought disorder

Content Thought Disorder is a distinct category of thought disorders that primarily affects the content or substance of an individual's thoughts, leading to significant disturbances in belief systems and perception. Unlike Formal Thought Disorder, which disrupts how thoughts are structured and expressed, Content Thought Disorder involves the actual ideas and meanings behind the thoughts, often manifesting as delusions, irrational beliefs, or obsessions.

Content Thought Disorder is commonly seen in psychiatric conditions such as schizophrenia, where delusions are a hallmark symptom, but it can also be present in severe mood disorders like major depressive disorder and bipolar disorder, especially in episodes of mania or severe depression.

Cognitive symptoms: Examples of disordered thinking

Thought disorders affect how people form, process, and express their thoughts, leading to speech and writing that can be hard to follow, disjointed, or illogical. The manifestation of a thought disorder can vary widely among individuals but may be characterized by: 

Disorganized thinking or derailment

A person living with a  thought disorder might experience racing thoughts and struggle to finish one sentence before moving on to the next. They may go off on tangents or not answer questions directly. Their thoughts may be loosely connected or unrelated, making their speech difficult to follow.

Illogical or incoherent speech

They may use words that do not make sense or make sounds that don't sound like words. Their thought process may not be processed or transmitted, so it could sound jumbled when they attempt to express their thoughts. They might string together many unrelated words or concepts that don't form an idea or story. This symptom can be common in those experiencing severe mania from bipolar disorder I.

False beliefs and delusions

Thought disorders are often accompanied by psychotic delusions. For instance, they may believe that the government is out to get them or have other conspiracy theories that lead to their thoughts or speech.

Difficulty telling a story

A person with a thought disorder may struggle to tell a story. They may find it difficult to form a timeframe or organize their sentences. 

Thought blocking

The person may suddenly stop speaking mid-sentence as if the thought has been removed from their mind.

Poverty of speech (Alogia)

Thought disorders can sometimes lead to alogia, which is characterized by limited speech output and content. This can manifest as one-word answers or very short sentences with little to no unnecessary detail.

Perseveration

Perseveration involves an individual's inability to shift away from a specific thought or topic, even when it is no longer relevant to the conversation at hand. This repetitive focus can manifest through constant repetition of words, phrases, or ideas, making it difficult for the person to engage in fluid and dynamic exchanges of thoughts with others.

Treatment options for thought disorders

Because disordered thinking is often a symptom of a serious psychiatric or neurological condition, it is essential to seek a diagnosis from a doctor. The treatment of thought disorders typically involves a comprehensive approach involving medication, psychotherapy, and more.

Medication 

Antipsychotic medications are typically recommended for managing symptoms of psychosis, including delusions, hallucinations, and disordered thinking. Common medications include haloperidol, risperidone, and olanzapine, among others. These medications work by affecting neurotransmitters in the brain, particularly dopamine, which plays a significant role in how we perceive reality. 

Pharmaceutical treatment typically necessitates close collaboration with a care team. Finding the right medication and dosage can be a process of trial and error, as healthcare providers carefully monitor progress and adjust the treatment plan to maximize benefits while minimizing side effects.

Psychotherapy

Little research has been done on the effectiveness of psychotherapy for thought disorders. However, psychotherapy is commonly used as an adjunct therapy for many of the disorders commonly associated with thought disorders, such as schizophrenia and bipolar disorder. 

Psychotherapy can be helpful for learning coping strategies, receiving emotional support, and improving communication skills. Techniques such as cognitive-behavioral therapy (CBT) are particularly useful for addressing maladaptive thought patterns, managing the impact of the disorder on daily living and relationships, and enhancing the individual's ability to engage in social and occupational activities. 

While more research is needed to fully understand the efficacy of psychotherapy in treating thought disorders specifically, its value in comprehensive treatment plans that include medication and other interventions is well-recognized.

Combined treatment approaches

Doctors often recommend a combination of medication and therapy. Medication can help manage psychotic symptoms, allowing for behavioral interventions to be more effective. However, each person is different and may respond differently to different levels of treatment. 

Medical testing for mental health or cognitive disorders 

As part of your diagnosis and treatment, your doctor may recommend medical tests, including magnetic resonance imaging (MRI) or a computed tomography scan (CAT scan) to see brain activity and rule out a physical component of your symptoms. Bloodwork may also be completed to ensure that a hormonal or chemical imbalance is not a contributing factor.

How to proceed after a serious mental health diagnosis 

If you have been diagnosed with a mental health condition involving a thought disorder, it may be worth adding weekly therapy to your treatment plan. 

Online therapy through platforms like BetterHelp have been found to be just as effective as traditional face-to-face therapy, with some studies suggesting it may have some advantages over in-person modalities.

For example, one literature review of 17 studies on the effectiveness of online CBT contrasted with traditional therapy found that eCBT was more effective for depression. It was also noted that eCBT was often less expensive than face-to-face therapy. Online therapy for CBT can also be used for other mental health conditions.