Thought disorders: what they are, classification and characteristics

Among the many mental illnesses that exist, those that affect thinking represent an important part of them.

We are going to try to condense some of the most important data to know what they are the main thought disorders, how they can be distinguished between them and other relevant information to learn more about these pathologies.

• Related article: "The 16 most common mental disorders"

What are thought disorders?

In order to talk about thought disorders, we must first have some very basic notions about psychopathology and its diagnostic classification.

All mental illnesses are included in some manuals that are, mainly, the DSM-5 (Diagnostic and statistical manual of Mental Disorders, from the American Psychiatric Association) and the ICD-10 (International Classification of Diseases, from the WHO). These manuals classify all known psychopathologies and are updated cyclically to make the pertinent modifications according to the new investigations that have been carried out in that period. For this reason, in the year 2021, the DSM is in its version number five, while the CIE is in its tenth iteration.

Once we are clear about where the classification of mental illnesses is, we can place thought disorders as one of the blocks of these diagnostic manuals. Other of the most important typologies that we can find are somatoform, internalizing, externalizing or detachment disorders.

After this introduction, we can now focus on thought disorders to understand the characteristics of this type of pathologies, to later learn about some of the clearest examples of these diseases mental.

Classification and characteristics

Thought disorders are psychological alterations whose main symptom is an alteration in the subject's cognitions. These alterations result in a dysfunction in communication, both at the level of thought itself and in language. Within this type of ailments, we must make a distinction, since thought can be altered both in its content and in its form.

1. Formal thought disorders

When we talk about thought disorders, in general, we usually refer to those with altered shape. One of the most frequent pathologies in which we can observe clear indications of problems in the form of is schizophrenia. TPFs can also be referred to as disorganized thinking or disorganized speech, as it is one of the classic symptoms of these disorders.

Formal thought disorders are a sign of psychosis and as such must be taken into account as an indicator of serious pathology in the individual. In order to assess the extent of this disease, Nancy Andreasen developed two scales, the SAPS, to analyze the positive symptoms, and the SANS, to assess the negative ones.. We will return to these scales later to see them in depth.

2. Content Thinking Disorders

We already anticipated that thought disorders can also refer to their content. This would also be a characteristic of schizophrenia, since it has to do with delusions. It is also observed in pathologies such as Obsessive-Compulsive Disorder. But the TPC does not necessarily have to translate into delusions. It can also be seen as a pathological level of worry or obsession.

Another symptom of these thought disorders is magical thinking., which consists of establishing arbitrary and illogical relationships about one's own thoughts and the repercussions in the world. Without going to that extreme, ideas can also be overestimated, exaggerating our own mental processes and therefore making them lose realism.

Similarly, very significant signals can be seen for oneself in totally random events, which are known as reference ideas. Phobias towards certain stimuli and even self-injurious ideations can also arise. As we can see, the symptomatology of content thinking disorders is very broad.

SANS Negative Symptom Scale

Returning to the SANS scale that we mentioned earlier as an instrument to evaluate the negative symptoms of formal thought disorders, we are going to see what type they can be.

1. Affective flattening

One of the first characteristics that we can observe in these subjects is affective dullness, that is, the lack of display of emotions. This can be captured by the lack of facial gestures or expressions, a very poor performance of movements spontaneous, non-affective resonance with the content being discussed or the demonstration of inappropriate affect with the same.

In the eye contact itself, or rather in the lack of it, signs of this symptom can also be seen.

• You may be interested in: "Affective flattening: symptoms, causes and treatment"

2. Praise

Formal thought disorders can also translate into Difficulty emitting speech, or praise. The vocabulary may be poorer than usual and so may the content. It can be observed that the subject takes longer than normal to answer the questions and that he is blocked during speech.

3. Apathy

Symptoms of apathy can also be seen in these people. Hygiene care itself may be affected. Likewise, it can be an abnormal decrease in performance in tasks and a clear demonstration of a lack of physical energy on the subject.

4. Attention

The fourth factor that can be affected in formal thought disorders is attention. The individual will have trouble concentrating on the test he is performing.

SAPS Positive Symptom Scale

The other scale developed by Andreasen is the SAPS. This allows us to see the positive symptoms of formal thought disorders, that is, those that are observed by their presence and not by their deficit, as was the case with negatives. They are as follows.

1. Derailment

The derailment consists of the realization of a random association in the speech, jumping from one topic to another that may or may not have a relationship with the previous one. This positive symptom can be observed in the subject's speech but can sometimes also be reflected in writing.

2. Tangentiality

Tangential-type speech is another observable symptom in formal thought disorders. In this case, the person concerned may be talking about a specific issue and, at a given moment, make an abrupt jump to another question totally unrelated to the previous one and not give more explanations to the respect.

3. Incoherence

The so-called word salad, or incoherence, is another symptomatology in which the subject utters a totally accident in which there is no common thread and therefore it is impossible to understand what they are trying to say. All the words that they use exist, but the succession of the same ones that they make does not give rise to any coherent message.

4. Loss of logic

Formal thought disorders can also be seen in which a symptom is loss of logic. Faced with a certain question, the individual may try to answer in a way that is grammatically correct, but that in reality is not answering the question that has been asked and therefore does not keep a logic.

5. Excess of details

Excessive detail or circumstantial speech could also indicate the existence of a thought disorder. In this case, we would observe that the person focuses on giving an obviously excessive amount of contextual detail rather than just answering the central question you have been asked about.

6. Speech pressure

Speech pressure or pressed speech is another indicator that can be assessed on the SAPS scale. In this case, said characteristic It is manifested by a run-over speech, without any pause, which seems to demonstrate an urgency in the person to explain the idea that he is presenting, although this urgency is not apparently observable for the interlocutor.

7. Distractions when speaking

Formal thought disorders can also be detected by excessive distractions during speech. If a person is talking about a specific topic but any environmental stimulus makes him forget why complete what he is saying to go on to talk about that other topic, we may think that we are facing this symptom.

8. Sound associations

The last characteristic of formal thought disorders that we can analyze using SAPS has to do with so-called sound associations, also called clanging. This phenomenon occurs when the subject begins to introduce words into his speech by the mere fact of their sound proximity with those they were using, either in the form of rhymes, or similar.

This makes the speech keep a certain harmony in terms of sounds, but is nevertheless incoherent at the content level, making it, therefore, unintelligible to the interlocutor.

Bibliographic references:

• Andreasen, N.C., Grove, W.M. (1986). Evaluation of positive and negative symptoms in schizophrenia. Psychiatry and Psychobiology.
• Andreasen, N.C. (1989). The Scale for the Assessment of Negative Symptoms (SANS): conceptual and theoretical foundations. The British journal of psychiatry.
• Kotov, R., Krueger, RF, Watson, D., Achenbach, TM, Althoff, RR, Bagby, RM, Brown, TA, Carpenter, WT, Caspi, A., Clark, LA, Eaton, NR, Forbes, MK, Forbush, KT, Goldberg, D., Hasin, D., Hyman, SE, Ivanova, MY, Lynam, DR, Markon, K., Miller, JD, Moffitt, TE, Morey, LC, Mullins-Sweatt, SN, Ormel, J., Patrick, CJ, Regier, DA, Rescorla, L., Ruggero, CJ, Samuel, DB, Selbom, M., Simms, LJ, Skodol, AE, Slade, T., South, SC, Tackett, JL, Waldman, ID, Waszczuk, MA, Widiger, TA, Wright, AGC (2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A Dimensional
• Alternative to Traditional Nosologies. Journal of Abnormal Psychology. American Psychological Association.
• McGrath, J. (1991). Ordering thoughts on thought disorder. The British Journal of Psychiatry.