psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...

, thought withdrawal is the delusional belief that thoughts have been 'taken out' of the patient's mind, and the patient has no power over this. It is often associated with disturbances in self-experience,

self-agency Self-agency, also known as the phenomenal will, is the sense that actions are self-generated. Scientist Benjamin Libet was the first to study it, concluding that brain activity predicts the action before one even has conscious awareness of his ...

, and identity.Sass, L. A., & Parnas, J. (2003). Schizophrenia, consciousness, and the self. ''Schizophrenia Bulletin, 29''(3), 427–444. https://doi.org/10.1093/oxfordjournals.schbul.a007017 Thought withdrawal is classified as Schneider’s first-rank symptom (FRS) of

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 ...

in 1959, alongside related phenomena like thought insertion (the belief that thoughts are being implanted into one’s mind) and thought broadcasting (the belief that one’s thoughts are being transmitted to others). These symptoms are typically regarded as signs of psychosis and are central to the diagnosis of schizophrenia spectrum disorders.Malinowski, F. R., Tasso, B. C., Ortiz, B. B., Higuchi, C. H., Noto, C., Belangero, S. I., Bressan, R. A., Gadelha, A., & Cordeiro, Q. (2020). Schneider’s first-rank symptoms as predictors of remission in antipsychotic-naive first-episode psychosis. ''Brazilian Journal of Psychiatry, 42''(1), 22–26. https://doi.org/10.1590/1516-4446-2018-0237

Diagnostic classifications

Thought withdrawal is included in major psychiatric diagnostic systems: *

DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the '' Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiat ...

: explicitly mentioned as an example of a "delusion of control" under the criteria of schizophrenia. *

ICD-11 The ICD-11 is the eleventh revision of the International Classification of Diseases (ICD). It replaces the ICD-10 as the global standard for recording health information and causes of death. The ICD is developed and annually updated by the World H ...

: categorized under 6A20 Schizophrenia as a part of passivity phenomena -- a set of symptoms characterized by the belief that one’s thoughts, emotions, or behaviors are being directed or manipulated by an outside source.

Theoretical and explanatory models

Phenomenological psychiatry

German psychiatrist

Karl Jaspers Karl Theodor Jaspers (; ; 23 February 1883 – 26 February 1969) was a German-Swiss psychiatrist and philosopher who had a strong influence on modern theology, psychiatry, and philosophy. His 1913 work ''General Psychopathology'' influenced many ...

classified the concept of thought withdrawal as “primary delusions” and described it as “non-understandable” – abrupt experiences that cannot be interpreted by ordinary psychological processes.Jaspers, K. (1963). ''General psychopathology'' (J. Hoenig & M. W. Hamilton, Trans.). University of Chicago Press. (Original work published 1913) Jasper described thought withdrawal as the loss of intentional mental activity and considered it to involve disruptions in agency, intentionality, and consciousness.Mishara, A. L., & Schwartz, M. A. (2013). Jaspers’ critique of essentialist theories of schizophrenia and the phenomenological response. ''Psychopathology'', ''46''(6), 361–373. https://doi.org/10.1159/000353355 Together, he and other

phenomenologists Phenomenology may refer to: Art * Phenomenology (architecture), based on the experience of building materials and their sensory properties Philosophy * Phenomenology (Peirce), a branch of philosophy according to Charles Sanders Peirce (183 ...

(e.g.

Kurt Schneider Kurt Schneider (7 January 1887 – 27 October 1967) was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia, as well as personality disorders then known as psychopathic personalities. ...

) linked thought withdrawal to various features: * Hyperreflexivity (i.e. a state of heightened self-awareness that leads to excessive attention being directed toward automatic mental processes) * Disrupted intentionality (i.e. the directedness of thought and consciousness) * Disrupted temporal self-continuity (i.e. losing the personal feeling of coherence across time) * Diminished perceptual integration and self-boundaries (i.e. no longer experiences thoughts as arising from within a stable self)

Cognitive models

The self-monitoring model proposed by Chris Frith argued that schizophrenia involves failure of the brain’s self-monitoring system (i.e. the mechanism responsible for monitoring and predicting self-generated mental activities). Consequently, individuals misattribute their self-generated thoughts to externally imposed mental contents, leading to thought withdrawal, thought insertion, and delusions of control. Similarly, Bentall’s attributional model suggested that individuals with delusions often present cognitive misattributions of momentary disturbances or lapses in thought flow, attributing it to external agents (i.e. thought withdrawal). This externalization aids in the protection of self-esteem but leads to false beliefs about the cause of one’s own experiences.Bentall, R. P., Kinderman, P., & Kaney, S. (1994). The self, attributional processes and abnormal beliefs: Towards a model of persecutory delusions. ''Behaviour Research and Therapy, 32''(3), 331–341. https://doi.org/10.1016/0005-7967(94)90131-7

Neurobiological theories

Kapur’s aberrant salience hypothesis proposes that dysregulated dopamine transmission leads to exaggerated significance being assigned to neutral internal events (e.g. ordinary lapses in thoughts). When this occurs, delusions like thought withdrawal occur to make sense of “aberrantly salient experiences”.Kapur, S. (2003). Psychosis as a state of aberrant salience: A framework linking biology, phenomenology, and pharmacology in schizophrenia. ''American Journal of Psychiatry, 160''(1), 13–23. https://doi.org/10.1176/appi.ajp.160.1.13 Researchers investigating delusional experiences (i.e. delusions of being controlled, thought withdrawal, thought broadcasting, thought insertion, and mind reading) in

antipsychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of Psychiatric medication, psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), p ...

-free individuals with schizophrenia conducted a factor analysis on item-level symptom ratings. Findings proposed the link between delusions and brain areas that support self-referential processing and distinctions between internal and external experience. Specifically, hypoperfusion (i.e. reduced blood flow) in the

anterior cingulate cortex In human brains, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involved ...

(ACC) and

medial prefrontal cortex In mammalian brain anatomy, the prefrontal cortex (PFC) covers the front part of the frontal lobe of the cerebral cortex. It is the association cortex in the frontal lobe. The PFC contains the Brodmann areas BA8, BA9, BA10, BA11, BA12, BA ...

(MPFC) contribute to the emergence of symptoms like thought withdrawal.Kimhy, D., Goetz, R., Yale, S., Corcoran, C., & Malaspina, D. (2005). Delusions in individuals with schizophrenia: Factor structure, clinical correlates, and putative neurobiology. ''Psychopathology, 38''(6), 338–344. https://doi.org/10.1159/000089455 López-Silva et al.’s 20-year longitudinal study of individuals with schizophrenia and other psychosis investigated the persistence and co-occurrence of thought withdrawal, insertion, and broadcasting. Findings showed that thought withdrawal consistently appeared alongside symptoms such as

anxiety Anxiety is an emotion characterised by an unpleasant state of inner wikt:turmoil, turmoil and includes feelings of dread over Anticipation, anticipated events. Anxiety is different from fear in that fear is defined as the emotional response ...

, auditory verbal hallucinations (AVHs), delusions of control, and

depersonalization Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of ...

. This reflected broader disruptions in multimodal processing (i.e. the boundary between internal cognition and external perception) and a broader phenomenon called pseudo-coherent delusional realities (i.e. the mind’s attempt to impose coherence on anomalous experiences of reality).López-Silva, P., Harrow, M., Jobe, T. H., Tufano, M., Harrow, H., & Rosen, C. (2024). ‘Are these my thoughts?’: A 20-year prospective study of thought insertion, thought withdrawal, thought broadcasting, and their relationship to auditory verbal hallucinations. ''Schizophrenia Research, 265'', 46–57. https://doi.org/10.1016/j.schres.2022.07.005

Clinical presentations and effects

Associated symptoms of thought withdrawal include: * A diminished sense of control over one’s own mental activity * Gaps in thinking, commonly described as externally extracted * Feelings of being manipulated and monitored The aforementioned experiences may arise suddenly and involuntarily, thus significantly impairing daily functioning. This could result in social withdrawal and paranoid ideation, often accompanied by

fear Fear is an unpleasant emotion that arises in response to perception, perceived dangers or threats. Fear causes physiological and psychological changes. It may produce behavioral reactions such as mounting an aggressive response or fleeing the ...

and distress.

Associated diagnosis

* A study conducted by Malinowski et al. (2020) discovered that 41% of individuals experiencing first-episode psychosis reported symptoms of thought withdrawal, suggesting that it is a relatively frequent feature in early psychosis. * A 20-year longitudinal study done by López-Silva et al revealed that thought withdrawal is rarely reported without the presence of AVHs. This finding proposed a continuum model of self-disturbance.

Criticisms and limitations

Traditional research synthesizes all delusions under the “positive symptoms” category of schizophrenia, obscuring meaningful distinctions. Overemphasis on symptom clusters (i.e. positive vs. negative symptoms) failed to capture the experiential overlap between symptoms, which is essential for understanding and predicting schizophrenia development. Similarly, the reductionism of cognitive and neurobiological models (e.g. Kapur’s aberrant salience hypothesis) highlighted the need to examine thought withdrawal as an independent symptom alongside psychological, cultural, and interpersonal factors to fully explain its variations in symptom content. On this basis, researchers (e.g. Jaspers and López-Silva) emphasized the need to develop symptom-specific, longitudinal frameworks to bridge major gaps in cognitive neuroscience and psychiatry (i.e. the emergence of thought withdrawal, the precise link between thought withdrawal and other symptoms / varied subjective experiences). Nonetheless, despite some models emphasizing thought withdrawal as a core symptom of schizophrenia, others question its diagnostic reliability due to its rarity in some patient groups.

References

Delusional disorders {{abnormal-psych-stub