Clanging (or clang associations) is a symptom of

mental disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

s, primarily found in patients with

schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

and

bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...

. This symptom is also referred to as association chaining, and sometimes, glossomania. Steuber defines it as "repeating chains of words that are associated semantically or phonetically with no relevant context". 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.

Example

This can be seen by a section of a 1974 transcript of a patient with schizophrenia: 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 In rail transport, a derailment is a type of train wreck that occurs when a rail vehicle such as a train comes off its rails. Although many derailments are minor, all result in temporary disruption of the proper operation of the railway sys ...

driven by self-monitoring.

As a type of formal thought disorder

Formal thought disorders (FTD) are a syndrome with several symptoms, leading to thought, language and communication problems, being a core feature in schizophrenia. Thought disorders are measured using the Thought, Language and Communication Scale (TLC) developed by Andreasen in 1986. 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. 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.

Occurrences in mental disorders

Clanging is associated with the irregular thinking apparent in

psychotic In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoher ...

mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

es (e.g.

mania Mania, also known as manic syndrome, is a Psychiatry, psychiatric Abnormality (behavior), behavioral syndrome defined as a state of Abnormality (behavior), abnormally elevated arousal, affect (psychology), affect, and energy level. During a mani ...

and

In schizophrenia

Formal Thought Disorders are one of five characteristic symptoms of schizophrenia according to the DSM-IV-TR. FTD symptoms such as Glossomania are correlated to schizophrenia spectrum disorders and to a family history of schizophrenia. 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.

In mania/bipolar disorder

Gustav Aschaffenburg Gustav Aschaffenburg (May 23, 1866 – September 2, 1944) was a German psychiatrist born in Zweibrücken. In 1890 he received his medical doctorate from the University of Strasbourg with a thesis on delirium tremens. Later he worked as an a ...

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

In depression

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

Disagreements in the literature

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'. 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 – even though it is the more widely used definition of clanging and glossomania (where the terms are used interchangeably).

Biological factors

Understanding of such language impairments and FTDs take a biological approach. Candidate genes for such vulnerability of schizophrenia are the

FOXP2 Forkhead box protein P2 (FOXP2) is a protein that, in humans, is encoded by the ''FOXP2'' gene. FOXP2 is a member of the forkhead box family of transcription factors, proteins that Regulation of gene expression, regulate gene expression by DNA- ...

(which is linked to a familial language disorder and autism) and dysbindin 1 genes43,44. 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. However, more research is required into not only understanding the causes of such symptoms, but how it works.

References

Sources

* {{cite thesis , last1=Steuber , first1=Lucas Carl , date=2011 , title=Disordered Thought, Disordered Language: A corpus-based description of the speech of individuals undergoing treatment for schizophrenia , id={{ProQuest, 904159072 , doi=10.15760/etd.63 , oclc=775308103 , doi-access=free Medical signs Thought disorders