Updated on October 1, 2026 by John Ingham
Formal thought disorder describes disturbances in the organization and expression of thought, usually observed through speech. It is generally considered a clinical sign or symptom rather than a single standalone DSM-5-TR diagnosis. It is commonly associated with schizophrenia-spectrum disorders and can also occur in mood disorders and other conditions.
Fortunately, treatment can help address disorganized thinking by identifying and treating its underlying cause.
What Is a Thought Disorder?
Formal thought disorder refers to disorganization in how thought is expressed, typically assessed through speech. Individuals with this condition often struggle to concentrate, organize their thinking, and form coherent sentences.
When they talk, their words may not make any sense whatsoever to those around them. They may also stop speaking suddenly in the middle of a sentence. When they resume speaking, it is often about a different topic.
Types of Thought Disorders
Clinicians describe several patterns of disorganized thought or related speech changes, including:
- Tangentiality: People with this thought disorder have difficulties staying on topic. They will go off-topic, frequently lose their train of thought, and can jump from one topic to another.
- Blocking: Individuals that experience block will abruptly stop mid-sentence, pause, and when they resume speaking, have changed the topic.
- Word salad: People with this thought disorder use a variety of random and unrelated words when they speak because their thoughts are so jumbled.
- Alogia: People with alogia typically do not speak unless spoken to, and when they do, their response is brief without any elaboration.
- Neologism: Neologism is creating new words with no real meaning other than to the person who uses them. The words will be randomly inserted into speech and writing.
- Clanging: An individual with clanging thought disorder will choose words based on the sounds they make rather than their meaning. Rhyming, puns, and alliterations are common and often do not make sense to others.
- Thinking in circles: This type of thought disorder, also known as circumstantiality, occurs when a person can maintain their train of thought but frequently goes off topic to provide an excessive amount of unnecessary details that have nothing to do with the primary topic before returning to the primary topic.
- Echolalia: Individuals with echolalia mimic and repeat what they hear other people say and often struggle to express their own thoughts.
What Are the Signs and Symptoms of a Thought Disorder?
Disorganized speech is central to formal thought disorder. Other symptoms below may accompany an underlying condition but do not independently establish thought disorder:
- Disorganized speech and thought processes
- Difficulties concentrating and focusing
- Mood swings
- Changes in behavior
- Changes in sleep patterns
- Delusions
- Social withdrawal
- Changes in appetite
- Changes in weight
- False beliefs
- Social isolation
- Difficulties managing emotions
- Self-harm and suicidal thoughts
- Hallucinations
It is important to remember thought disorder symptoms can overlap with other mental health disorders as well as certain medical conditions. A clinician evaluates mental health and medical conditions to identify the cause rather than treating formal thought disorder as a separate standalone diagnosis. People can also suffer from co-occurring mental health disorders and have overlapping symptoms.
Causes of Thought Disorders
Currently, there is no one particular cause for thought disorders. Instead, various factors could contribute towards the development of a through disorder, including:
- Genetics: A family history of schizophrenia or another relevant mental health disorder increases the risk of developing a thought disorder.
- Pre-existing mental health disorders: If someone already has an existing mental health disorder, such as anxiety disorder, schizophrenia, or bipolar disorder, it can increase the risk of developing a thought disorder.
- Brain abnormalities: Abnormalities in the chemistry and structure of the brain are a contributing factor to thought disorders.
- Traumatic brain injury (TBI): Sustaining a TBI, especially in the region responsible for thought and language processing, could result in the development of thought disorders.
- Environmental factors: Excessive stress and unresolved trauma are also related risk factors for developing thought disorders.
Risk Factors
The risk factors of having a thought disorder are related to cognitive problems and other related mental health conditions and symptoms, as follows:
- Schizophrenia
- Mood disorders
- Depression
- Anxiety disorders
- Bipolar disorder
- Psychosis
- Excess stress
- Autoimmune disease
- Prolonged hazardous chemical exposure
What Are the Treatment Options?
The treatment options for thought disorders involve using evidence-based and holistic modalities as part of a comprehensive treatment plan, such as:
- Individual psychotherapy: Individual therapy allows people to talk about their feelings, thoughts, emotions, and behaviors with a mental health professional in a private, safe, and secure environment.
- CBT: CBT is one of the most widely used forms of therapy to help people identify the underlying causes of their symptoms and develop coping skills.
- DBT: DBT combines CBT and provides additional help in developing healthier thought processes and additional coping techniques.
- Group therapy: Group therapy provides an opportunity for peer support with others also suffering from thought disorders to learn from one another, practice coping strategies, and learn more about their condition.
- Family therapy: Family therapy helps educate family members about their loved one’s thought disorder, improves communication, and provides support for everyone.
- Holistic therapy: Yoga, meditation, mindfulness, art therapy, and other holistic treatments help heal and restore balance to the mind, body, and spirit.
- Medication management: Medication may be used to treat an identified underlying condition, such as schizophrenia or bipolar disorder, when appropriate.
Contact Montare Behavioral Health to Treat a Thought Disorder
If you are exhibiting symptoms of a thought disorder, a professional assessment can identify the underlying cause and appropriate treatment. At Montare Behavioral Health, we can assess disorganized thinking and provide care for underlying mental health disorders and co-occurring conditions. Our caring and compassionate team provides comprehensive care tailored to your specific needs at our treatment facilities in California and Arizona. Contact us today to schedule an initial consultation and start the journey to improved mental health.
Published: 4/9/2025