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Clanging (or clang associations) is a symptom of mental disorders, primarily found in patients with schizophrenia and bipolar disorder.[1] This symptom is also referred to as association chaining, and sometimes, glossomania.

Lucas C. Steuber defines it as "repeating chains of words that are associated semantically or phonetically[,] with no relevant context".[2] This may include compulsive rhyming or alliteration without apparent logical connection between words.

Clanging refers specifically to behavior that is situationally inappropriate. While a poet rhyming is not evidence of mental illness, disorganized speech that impedes the patient's ability to communicate is a disorder in itself, often seen in schizophrenia.[3]

Example

[edit]

This can be seen by a section of a 1974 transcript of a patient with schizophrenia:

We are all felines. Siamese cat balls. They stand out. I had a cat, a manx, still around here somewhere. You'll know him when you see him. His name is GI Joe; he's black and white. I have a goldfish too, like a clown. Happy Halloween down. Down.[4]

The speaker makes semantic chain associations on the topic of cats, to the colour of her cat, which (either the topic of colours/patterns, or the topic of pets) leads her to jump from her goldfish to the associated clown, a point she reaches via the word clownfish. The patient also exhibits a pattern of rhyming and associative clanging: clown to Halloween (presumably an associative clang) to down.

This example highlights how the speaker was distracted by the sound or meaning of her own words, and led herself off the topic, sentence by sentence. In essence, it is a form of derailment driven by self-monitoring.[3]

As a type of formal thought disorder

[edit]

Formal thought disorders (FTD) are a syndrome with several symptoms, leading to thought, language and communication problems, being a core feature in schizophrenia.[5]

Thought disorders are measured using the Thought, Language and Communication Scale (TLC) developed by Andreasen in 1986.[5] This measures tendencies of 18 subtypes of formal thought disorder (with strong inter-coder reliability) including clanging as a type of FTD.

The TLC scale for FTD sub-types remains the standard and most inclusive – so clanging is officially recognised as a type of FTD.[6]

There has been much debate about whether FTDs are a symptom of thought or language, yet the basis for FTD analysis is the verbal behaviour of the patients. As a result, whether abnormal speech among individuals with schizophrenia is a result of abnormal neurology, abnormal thought or linguistic processes – researchers agree that people with schizophrenia do have abnormal language.[6]

Occurrences in mental disorders

[edit]

Clanging is associated with the irregular thinking apparent in psychotic mental illnesses (e.g. mania and schizophrenia).[7]

In schizophrenia

[edit]

Formal Thought Disorders are one of five characteristic symptoms of schizophrenia according to the DSM-IV-TR.[1] FTD symptoms such as Glossomania are correlated to schizophrenia spectrum disorders and to a family history of schizophrenia.[1] In an analysis of speech in patients with schizophrenia compared to controls, Steuber found that glossomania (association chaining) is a characteristic of speech in schizophrenic patients - despite no significant difference between normal controls and individuals with schizophrenia.[6]

In mania/bipolar disorder

[edit]

Gustav Aschaffenburg found that manic individuals generated these "clang-associations" roughly 10–50 times more than non-manic individuals.[8] Aschaffenburg also found that the frequency of these associations increased for all individuals as they became more fatigued.[9]

Andreasen found that when comparing Formal Thought Disorder symptoms between people with schizophrenia and people with Mania, that there was greater reported incidence of clang associations of people with mania.[5]

In depression

[edit]

Research investigated by Steuber found no significant difference of glossomania occurrences for patients with schizophrenia compared to patients with depression.[6]

Disagreements in the literature

[edit]

Being a niche area of symptoms of mental disorders, there have been disagreements in the definitions of clanging, and how it may nor may not fall under the subset of Formal Thought Disorder symptoms in schizophrenia. Steuber argues that although it is a FTD, that it should come under the umbrella of the subtype 'distractibility'.[6]

Moreover, due to limited research there have been discrepancies in the definition of clanging used: an alternative definition for clanging is: "word selection based on phonemic relatedness, rather than semantic meaning; frequently manifest as rhyming". Here it is evident that the semantic association chains are not included as part of the definition seen at the start[6] – even though it is the more widely used definition of clanging and glossomania (where the terms are used interchangeably).

Biological factors

[edit]

Understanding of such language impairments and FTDs take a biological approach.

Candidate genes for such vulnerability of schizophrenia are the FOXP2 (which is linked to a familial language disorder and autism) and dysbindin 1 genes43,44.[1] This distal explanation not only does not explain clanging specifically, but also fails to include other environmental influences on the development of schizophrenia. Moreover, if a person does develop schizophrenia, it does not guarantee they have the symptom of clanging.

Sass and Pienkos 2013 suggest that a more nuanced understanding of structural (neural changes) patterns that occur in a sufferer's brain could be important in understanding the disorder.[10] However, more research is required into not only understanding the causes of such symptoms, but how it works.

See also

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References

[edit]

Sources

[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Clanging

View on Grokipedia
from Grokipedia
Clanging, also known as clang association, is a form of disordered speech in which words are linked together primarily based on their phonetic similarity—such as rhyming, , or punning—rather than their logical or semantic connections, resulting in speech that sounds rhythmic or poetic but lacks coherent meaning. This symptom is classified as a type of and is most commonly observed in psychotic conditions, where it disrupts effective communication. Clanging typically emerges as a manifestation of underlying disorders, particularly and during manic phases. In , it contributes to the broader category of formal thought disorders, often co-occurring with other speech anomalies like loose associations or neologisms. Similarly, in , clanging may intensify during episodes of , where rapid, pressured speech amplifies the phonetic-driven word selection. Research indicates that such speech patterns are linked to disruptions in executive functioning and , though the exact neurobiological mechanisms remain under study. Examples of clanging include phrases like "I like to bike and hike with Mike," where the words but convey no substantive idea, or repetitive puns such as "The bell tolls for the soul in the hole." These patterns can range from mild, incidental rhyming to severe, where entire conversations devolve into nonsensical sound play, impairing social and functional interactions. Diagnosis of clanging involves clinical assessment through the , focusing on speech characteristics during interviews, and is confirmed in the context of psychotic symptoms meeting criteria in the for disorders like . Treatment targets the primary condition rather than clanging in isolation; antipsychotic medications are standard for , while bipolar management may include mood stabilizers alongside antipsychotics. , such as , and supportive interventions can aid in improving communication skills post-acute episodes.

Definition and Features

Definition

Clanging, also known as clang association, is a output abnormality characterized by the selection and linkage of words based on phonetic similarity—such as , , or —rather than semantic or logical relevance. This pattern disrupts coherent communication, as the auditory qualities of words drive the progression of speech or thought, overriding conventional meaning-based associations. The term was introduced in early 20th-century by in his seminal 1911 work or the Group of Schizophrenias, where it described a characteristic disturbance in associative thinking observed in psychotic conditions. highlighted clanging as a form of abnormal word connection, distinguishing it from other associative patterns like those in , and emphasized its role in illustrating the loosening of normal thought processes. At its core, clanging represents a of logical thought into sound-based associations, resulting in incoherent that prioritizes phonetic resemblance over conceptual continuity. This mechanism reflects a broader disruption in formal thought disorders, where the usual semantic structure of is supplanted by superficial auditory links.

Linguistic Features

Clanging manifests through distinct phonetic elements that prioritize auditory similarity over semantic meaning in word selection. Key features include rhyming, where words are linked by shared vowel and sounds at their ends, such as "cat" and "hat"; punning, which exploits homophonic or near-homophonic words for playful but contextually irrelevant associations; and consonance, involving the repetition of sounds across words, like "king," "coming," and "crown." Additionally, words may be sequenced based on initial sounds or syllables, such as alliterative patterns starting with the same (e.g., "silver ships sailing"), without regard for logical or narrative flow. These phonetic choices create a clangorous, echo-like quality in speech, as described in analyses of disorganized thought patterns. Structurally, clanging often produces rhyming couplets or chains of repetitive syllables that form quasi-poetic or rhythmic sequences, accelerating the pace of delivery to mimic rap or verse. For instance, a speaker might produce strings like "I tied a , got a pot, bought a yacht, took a shot," where the progression relies on sonic linkage rather than grammatical or topical continuity. This results in neologistic or hybrid forms blending existing terms through overlap, contributing to an overall impression of amid incoherence. Such patterns disrupt standard structure, favoring auditory chaining over syntactic rules. A distinguishing trait of clanging is its disregard for grammatical coherence and prosodic norms of everyday , where sound associations dominate linkages between over half of consecutive words in severe instances, leading to fragmented yet phonetically cohesive output. Unlike typical prosody, which balances intonation with meaning for communicative clarity, clanging flattens or exaggerates without semantic anchoring, marking it as a hallmark of formal . This phonological derailment preserves segmental —basic sound production rules—but impairs higher-level integration, as evidenced in linguistic surveys of schizophrenic speech.

Clinical Presentation

Illustrative Examples

One illustrative example of clanging appears in documented clinical cases where speech shifts to phonetic associations, such as a patient repeatedly stating, "The Pope is a dope without hope," linking terms through rhyme and consonance while ignoring semantic relevance. In a hypothetical dialogue drawn from typical psychiatric descriptions, a patient might respond to inquiries about daily activities with: "The moon is blue, true through and through, shoe on the floor, more and more." This pattern connects words via rhyme and assonance, bypassing any coherent narrative. A real-world inspired vignette from clinical interviews could involve a answering "How are you?" with "Fine wine, divine line, time to shine," redirecting the response toward sound-based play rather than substantive content. Clanging varies in intensity across presentations. Mild forms may feature occasional rhyming intrusions in otherwise structured speech, such as sporadically adding "good mood, like food" to affirm . Severe cases, however, can encompass entire monologues dominated by such clangs, like extended sequences of phonetically chained words that obscure all meaning.

Differentiation from Similar Patterns

Clanging, as a formal , must be differentiated from other speech patterns to ensure accurate clinical recognition and avoid misdiagnosis, particularly in contexts like or manic episodes where multiple abnormalities may coexist. Unlike loose associations—also known as —where speech shifts to unrelated or tangentially related ideas based on semantic content or weak logical connections, clanging is primarily driven by phonetic associations such as rhymes, , or , regardless of meaning. For instance, a might say, "The cat in the hat sat on the mat, flat, bat, chat," progressing through sound similarities rather than conceptual links, as defined in standardized assessment scales for thought disorders. In contrast to , which involves the immediate and often automatic repetition of another person's words or phrases without creative elaboration—typically observed in catatonic states or developmental disorders—clanging features original, self-generated chains of existing words linked by auditory resemblance. This distinction highlights clanging's associative rooted in sound, whereas echolalia is a more passive, imitative response lacking independent phonetic progression. Clanging also differs from neologisms, where individuals invent entirely new words or phrases that may carry idiosyncratic meanings or be incomprehensible, often disrupting communication through novel lexicon rather than sonic linkage. While neologisms introduce fabricated terms (e.g., "blurf" to describe an emotion), clanging relies on familiar vocabulary rearranged by auditory patterns, preserving but sacrificing semantic coherence. This phonetic focus in clanging underscores its unique among language-based thought disorders.

Role in Thought Disorders

As a Formal Thought Disorder

Clanging is classified as a subtype of formal , also known as primary or essential , which disrupts the structure and organization of thinking rather than its content. In the , formal thought disorders manifest as disorganized speech, of which clanging is a clinically recognized example observed in psychotic disorders such as . Similarly, the describes disorganized speech in as involving frequent or gross incoherence, of which clanging is a form of associative disruption where sound-based connections supplant logical progression. This positioning highlights clanging's role within the formal category, distinct from content-based disorders like delusions. Cognitively, clanging reflects a breakdown in executive function and semantic processing, where individuals prioritize phonological similarities over meaningful associations, resulting in fluent verbal output that lacks substantive content—often termed "poverty of content." impairs the ability to maintain goal-directed thought and inhibit irrelevant associations, while semantic processing deficits disrupt the retrieval and integration of word meanings, favoring superficial sound links instead. This dual impairment leads to a disconnect between form and function in , underscoring clanging's implications for broader cognitive disorganization in thought disorders. Diagnosis of clanging relies on clinical of speech patterns during interviews, where examiners note the prevalence of rhyming or punning associations devoid of semantic relevance. It is quantitatively assessed using standardized scales such as the Thought, Language, and Communication (TLC) scale, which includes clanging as a specific item rated on a 0-4 severity scale based on and disruptiveness in discourse. This approach ensures reliable identification through structured evaluation, emphasizing observable linguistic features over subjective interpretation.

Comparison to Other Thought Disorders

Clanging, a formal characterized by speech guided primarily by sound associations such as rhymes, puns, or rather than semantic meaning, differs markedly from other subtypes in its auditory-driven structure. In (also known as loose associations), thoughts deviate through conceptual or thematic shifts that connect ideas obliquely or unrelatedly at the level of sentences or clauses, preserving some logical thread absent in clanging's phonetic focus. This distinction highlights clanging's unique emphasis on auditory patterns, which can create a superficial coherence based on sound while rapidly eroding meaningful content, whereas relies on idea-based slippage. Tangentiality, another associative disorder, involves replies that stray from the original question via semantic digressions without returning to the point, often maintaining at a surface level but evading direct answers. In contrast, clanging adheres to phonetic chains that may indirectly relate to the query through but lose semantic direction entirely, without the goal-directed evasion typical of tangentiality. This sound-over-meaning priority in clanging thus produces a more fragmented than tangentiality's oblique but conceptually traceable paths. Word salad, or severe incoherence, represents an extreme breakdown where speech consists of disjointed words or phrases lacking connections at both intra- and inter-sentence levels, rendering it largely incomprehensible. , however, preserves a degree of word recognizability and structure through its auditory links, allowing listeners to detect rhyming or punning patterns even as overall meaning dissolves, distinguishing it from the total semantic dissolution in . These differences underscore clanging's specific role within formal thought disorders as an acoustically anchored disruption.

Associations with Psychiatric Conditions

In Schizophrenia

Clanging, a form of formal thought disorder characterized by speech guided by sound rather than meaning—such as rhyming, punning, or alliteration—manifests in schizophrenia as part of disorganized language production. In clinical assessments using scales like the Thought, Language, and Communication (TLC) scale, clanging is rated based on its frequency and impact on intelligibility, ranging from mild (one occurrence) to extreme (rendering speech incomprehensible). Prevalence of clanging in varies across studies but appears relatively low compared to other thought disorders. A 2021 of 100 patients found clanging in 4% of cases, exclusively during acute episodes and associated with the paranoid subtype (p=0.003). Similarly, a 2023 study of 50 patients found clanging more frequent in males (p=0.06) and present only in acute (1 case vs. 0 in chronic, p=0.43), indicating low overall prevalence. It is typically observed in the disorganized subtype, where it contributes to broader linguistic disorganization during the positive symptoms phase. As a marker of acute , clanging correlates with heightened disorganization and verbosity in , often appearing alongside other positive formal thought disorders like or neologisms. Longitudinal research indicates that positive formal thought disorders, including clanging, tend to decline over time with treatment, unlike persistent negative symptoms, persisting in a minority of chronic cases. This pattern underscores clanging's role as an indicator of episodic severity rather than a stable trait in the disorder.

In Bipolar Disorder and Mania

Clanging, characterized by the selection of words based on sound rather than semantic meaning, such as through rhyming or , is a recognized feature of thought and language disturbances during manic episodes in . It commonly co-occurs with pressured speech and flight of ideas, core symptoms of , where rapid verbal output leads to associations driven by phonetic similarity. In clinical assessments, formal thought disorders, including clanging, are observed in approximately 19% of manic episodes, though this may underestimate isolated clang associations as they often blend with other disorganized speech patterns. The presentation of clanging in is typically transient and mood-congruent, often manifesting as playful or euphoric rapid rhyming that enhances or tangential storytelling. For instance, a patient might exclaim, "I'm fine, divine, like wine in shine," shifting topics via sound while expressing elevated self-importance. This euphoric quality distinguishes it from more tangential or neologistic forms seen elsewhere, and it aligns with increased phonological clustering in verbal tasks during acute . Such episodes usually resolve with mood stabilization through , such as mood stabilizers or antipsychotics, restoring coherent speech as the manic state remits. In terms of , clanging in is episodic and tied to affective dysregulation, contrasting with the more persistent, non-mood-congruent forms in . The describes manic speech disturbances, including pressured speech and flight of ideas that can incorporate clang-like elements, as diagnostic criteria for when present with elevated mood. This episodicity aids differentiation, emphasizing the need for longitudinal assessment to distinguish mood-driven clanging from primary psychotic disorders.

In Depression and Other Conditions

Clanging manifests rarely in depressive disorders, most notably within the context of , where it contributes to disorganized speech patterns characterized by sound-driven word selection over meaningful content. In , such speech disturbances can align with severe mood states, though they differ from the more pressured forms seen in by appearing subdued and fragmented. Studies indicate that formal thought disorder, encompassing features like clanging, affects up to 53% of patients with when assessed via standardized scales, highlighting its presence amid broader language impairments, though specific rates for clanging remain underreported. Beyond depression, clanging appears infrequently in other psychiatric and neurological conditions. In obsessive-compulsive disorder (OCD), rare cases involve compulsive rhyming or repetitive sound-based verbal patterns as part of intrusive thoughts or rituals, distinguishing it from the more pervasive disorganization in primary psychotic disorders. In dementia, particularly behavioral variant frontotemporal dementia (bvFTD), clanging has been documented in approximately 25% of cases without speech poverty, linked to right anterior temporal atrophy and manifesting as rhyming or punning based on phonetic associations rather than semantics. Substance-induced psychosis also features clanging, as evidenced in cannabis-related cases where it occurs more frequently than in primary schizophrenia, with mean severity scores indicating mild but notable phonetic derailments. The occurrence of clanging in these contexts underscores its limited study outside core psychotic illnesses, with a 2022 analysis noting overlaps in language disorganization between depression and , where symptoms like clanging may bridge mood and psychotic features. This rarity emphasizes the need for targeted assessments in atypical presentations to differentiate clanging from other speech anomalies, such as semantic loss in .

Research Perspectives

Disagreements in the Literature

In psychiatric research, clanging is subject to ongoing classification debates, with some scholars conceptualizing it as a primarily linguistic phenomenon involving superficial sound-based associations in speech production, distinct from disruptions in conceptual thought. In contrast, proponents of the Thought, Language, and Communication (TLC) scale argue that clanging reflects broader cognitive impairments, such as disorganized semantic processing and abstract thinking deficits, integrating it within a multidimensional framework of formal thought disorder. This divergence highlights the challenge in delineating whether clanging stems from language-specific mechanisms or underlying cognitive dysfunctions, with no consensus emerging from factor analytic studies of thought disorder scales. Diagnostic overlap further complicates classification, particularly in distinguishing pathological clanging—where sound-driven associations derail coherent communication—from rhyming or punning in neurotypical creativity, which typically maintains semantic relevance and intentionality. Pre-2020 literature predominantly linked clanging to schizophrenia and manic states, underemphasizing its potential role in depression, where it may manifest subtly amid affective symptoms rather than overt disorganization. Post-2020 research has examined speech anomalies as potential predictors of onset, with automated analyses identifying patterns in high-risk but yielding mixed results on specificity and prognostic value across transdiagnostic contexts. For instance, while some studies associate such patterns with heightened transition risk in clinical high-risk groups, others note their occurrence in psychotic conditions such as cannabis-induced , tempering claims of reliable predictive power. As of 2025, models trained on speech-derived features have shown promise in detecting ultra-high-risk , though clanging specifically remains underexplored as a distinct marker.

Biological Factors

Clanging, as a form of positive formal , has been linked to disruptions in networks involved in and executive function through studies. Structural MRI analyses further reveal reduced cortical thickness and surface area in frontal areas, including the orbitofrontal and , correlating with the severity of positive formal thought disorders like clanging. In the temporal lobes, heightened activity or altered connectivity has been observed during tasks, potentially reflecting impaired semantic and phonological processing that contributes to sound-based associations in clanging speech, as noted in reviews of linguistic abnormalities in . Genetic factors underlying clanging are primarily inferred through its overlap with , where polygenic risk scores (PRS) for the disorder are associated with increased disorganized symptoms, including formal thought disorders. These PRS capture a portion of schizophrenia's , estimated at around 80%, with genetic overlap explaining up to 40% of variance in related psychotic traits through shared loci influencing neural development. dysregulation, a core genetic and neurochemical feature of , contributes to these links; variants affecting genes, such as reduced prefrontal D1 receptor density, are implicated in the executive and language impairments seen in clanging. Neurologically, clanging correlates with frontotemporal network disruptions, where aberrant connectivity between prefrontal executive regions and temporal language areas leads to decoupled semantic and phonological processing. Such disruptions are evident in but extend to broader psychotic conditions, with polygenic influences exacerbating network instability. Clanging remains rare in non-psychotic neurological contexts, emerging only in cases involving , where focal lesions mimic phonological associations without the broader associative derailment.

References

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