What Is Disorganized Speech?

What Is Disorganized Speech?

Experiencing moments of disorganized speech can occur to anyone. Moments of stress, intoxication, and lack of sleep are all things that can cause occasional disorganized speech.

However, disorganized speech can also be a symptom indicative of mental health concerns. There are several psychotic, mood, and anxiety disorders, most notably schizophrenia, that can cause symptoms of disorganized speech.¹ These conditions often pair disorganized speech with delusions, another core symptom of psychosis.

Types of Disorganized Speech

There are four types of disorganized speech. Although disorganized speech patterns tend to be similar, their symptoms usually fit into one of four distinct categories. Disorganized speech can involve symptoms from only one or more than one category, ranging on the severity of symptoms.

The four types of disorganized speech include:

• Symbolism: When someone struggles to connect their thoughts and the meaning behind them.
• Tempo: Refers to the flow of one’s words and speech.
• Processing: The ability to express one’s thought content appropriately.
• Continuity refers to the direction of one’s thought content and appropriateness of flow.

Signs of Disorganized Speech

If you or someone you love is experiencing disorganized speech, learning how to recognize it in ourselves or others is important. Look for repetition of words, phrases that do not make sense, and jumbled words.

Some signs of disorganized speech include:

• Repetition
• Speaking very fast
• Rapid changes in tempo and volume of speech
• Being very tangential
• Frequent loose associations in speech
• Putting ideas together that are irrelevant
• Lack or excess of words
• Word salad
• Making illogical connections and statements
• Describing things in bizarre ways, with new or irrelevant words
• Saying sounds or words that do not make sense
• Speaking in tangents
• Derailment of thoughts

Examples of Disorganized Speech

There are several different ways that disorganized speech may be present in conversation. Sometimes, it may manifest externally, such as when someone mixes up words or speaks in a pressured and rapid tone. However, sometimes, symptoms of disorganized speech happen internally, such as in the case of someone experiencing thought blocking.

Some examples of disorganized speech include:

• Pressured speech: When someone’s thoughts and words come out so rapidly, they will be difficult to follow. People experiencing pressured speech may not stop their flow of speaking or stop at appropriate intervals expected in normal speaking patterns.
• Neologism: When someone’s brain makes up a word for a known object, such as a table. It may sound somewhat like the original word, such as “tanable,” but often sounds nothing like it, leaving the listener confused about what they are talking about.
• Very tangential speech pattern: While going on a tangent is a normal part of speaking for many people, someone exhibiting disorganized speech may go on so many tangents that it is difficult to remember the original point. They will be very hard to follow.
• Alogia: Sometimes referred to as poverty of speech, alogia is when someone does not seem to be making logical sense in what they say. This is common in mental health diagnoses such as schizophrenia.²
• Echolalia: When someone exhibits echolalia, they repeat words or phrases they hear, almost like an echo. If they hear someone say “how are you?” they may repeat that phrase, or part of it: “How are you? How are you?” or even: “are you? Are you?”
• Thought blocking: Thought blocking is when someone displays breaks in their speech pattern as if they were interrupted or lost focus.
• Word salad: Speaking in words or phrases that are jumbled up and have no apparent flow or logic.
• Circumstantial: This speech pattern involves an inability to determine what information is essential and what is not. The person may speak for many minutes about the water temperature in their shower when asked, “how was your morning?”
• Thought or word repetition: The person may speak in sentences or words that appear to repeat. This is different from echolalia, where they repeat things that they hear. Instead, they are repeating their own words.
• Thought derailment: When someone appears to be speaking in a flow but suddenly stops short as if they forgot what they were saying.
• Paralogism: When someone substitutes a similar word or phrase instead of a normal word. It may make logical sense, but it will sound awkward. An example of this is calling a shower a “watering box.”

What Causes Disorganized Speech?

Disorganized speech can be affected by a number of factors, ranging from mental health conditions to environmental or behavioral factors. It is mostly associated with being present in mood and psychotic disorders.

Possible causes of disorganized speech include:

• Dementia
• Parkinsons³
• Depression
• Psychotic disorder
• Traumatic brain injury
• Bipolar disorder 
• Schizotypal personality disorder
• Schizophrenia
• Schizoaffective Disorder
• ADHD
• Substance Use
• Neurological Issue
• Anxiety

Schizophrenia

Disorganized speech is exhibited in and is most commonly attributed to mental health disorders that affect thought, such as schizophrenia. Schizophrenia, like other thought disorders, involves significant language impairment along with cognitive decline.⁴

Due to the way that the mind processes internal and external stimuli, as well as the cognitive impairments that stem from this disorder, someone with schizophrenia often struggles with social engagements⁵ as well as difficulty with processing and expressing information.

Social Anxiety

Due to the level of anxiety present during social interaction, someone with social anxiety may display symptoms of disorganized speech. However, unlike the disorganized speech that is present in someone who is displaying signs of psychosis or cognitive decline, these symptoms will likely be short-lived due to having situational rather than cognitive or organic causes.

Disorganized Speech Treatment

While no specific interventions are aimed at treating disorganized speech, treatment is usually focused on the disorders associated with the condition. Depending on one’s condition, there will be different methods of addressing the disorganized speech symptoms.

Someone who is exhibiting disorganized speech due to a medical condition such as Parkinson’s will have a treatment regimen that looks different than someone who is coping with a thought disorder such as schizophrenia.

Medications

Like treatment modalities, medication management for disorganized speech often focuses on treating the specific condition or disorder a person has been diagnosed with. For example, it is common that those with psychosis-related disorders will likely be prescribed antipsychotics.

Likewise, someone experiencing disorganized speech due to cognitive decline from Alzheimer’s or dementia will likely have their treatment focused on increasing activities that promote cognitive engagement rather than medication approaches.⁶

Psychotherapy Options

Sometimes, psychotherapy such as CBT or ACT can be a good addition to a treatment plan. This is especially beneficial if someone has the self-awareness to understand what is happening and wants to work through some of the resulting feelings. However, therapy is usually not a good idea if someone presents with symptoms of psychosis as part of their thought disorder.

How to Cope With Disorganized Speech

There are many different self-coping mechanisms for living with disorganized speech. The coping skills that work best for you will depend on your presenting symptoms and the reason behind your disorganized speech.

Here are coping methods to manage disorganized speech symptoms:

• Staying compliant with medications and treatment: Maintaining a treatment regimen provided by your medical doctors and therapists can help decrease the severity or even eliminate symptoms of disorganized speech.
• Avoiding substances or stimulants: Stimulants such as caffeine or substances such as alcohol can increase the severity of disorganized speech. Be mindful of how and where you consume or eliminate these things.
• Support groups: If someone is seeking support from peers who may be going through the same symptoms, support groups can help. Social support, in general, is crucial for maintaining health.
• Healthy stress management: Being mindful of stress levels can help manage symptoms. Healthy stress management is important to physical and mental health and can help decrease the manifestation of disorganized speech.
• Slow down: Taking time to process your thoughts while speaking can decrease the extent to which disorganized speech symptoms can manifest.
• Get adequate rest: When someone does not have adequate rest, their speech patterns can be affected, increasing symptoms of disorganized speech.

When to Seek Professional Support

If you notice disorganized speech in yourself or a loved one, monitoring it is a good idea. If it happens only occasionally, such as when someone engages in drinking or smoking or is tired or stressed, there is likely an external explanation. However, getting professional support is always a good idea to ensure nothing more serious is going on.

There are many online therapy options to find someone who can assess the situation and make recommendations or referrals depending on your presenting symptoms and medical history. Check an online therapist directory to find a therapist who can help.