Disorganized Speech: What It Is And How To Respond

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.

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. Below, we’re going to provide 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. 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

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”.   

Disorganized 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?” and they respond 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 

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.

Semantic memory impairment

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.

Working memory impairment

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. 

Genetic factors

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.

Early experiences

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.  

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
• Unlimited energy vs listless
• Indulging in excessive pleasurable activities vs hopelessness and suicidal thoughts.

Suicide Prevention: If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and 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 screenings and help determine whether further testing, a diagnosis, and treatment are necessary. Often, treatment for schizophrenia and other conditions associated with disorganized speech consists of a combination of medication and therapy. 

It can also be important for you 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).