Editing Clanging

{{Short description|Symptom of mental disorders }}
'''Clanging''' (or '''clang associations''') is a symptom of [[mental disorder]]s, primarily found in patients with [[schizophrenia]] and [[bipolar disorder]].<ref name="Radanovic Sousa Valiengo et al 2012">{{cite journal |last1=Radanovic |first1=Marcia |last2=Sousa |first2=Rafael T. de |last3=Valiengo |first3=L. |last4=Gattaz |first4=Wagner Farid |last5=Forlenza |first5=Orestes Vicente |title=Formal Thought Disorder and language impairment in schizophrenia |journal=Arquivos de Neuro-Psiquiatria |date=18 December 2012 |volume=71 |issue=1 |pages=55–60 |doi=10.1590/S0004-282X2012005000015 |pmid=23249974 |doi-access=free }}</ref> 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".{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}} 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.<ref name="Schizophrenia and the structure of">{{cite journal |last1=Covington |first1=Michael A. |last2=He |first2=Congzhou |last3=Brown |first3=Cati |last4=Naçi |first4=Lorina |last5=McClain |first5=Jonathan T. |last6=Fjordbak |first6=Bess Sirmon |last7=Semple |first7=James |last8=Brown |first8=John |title=Schizophrenia and the structure of language: The linguist's view |journal=Schizophrenia Research |date=September 2005 |volume=77 |issue=1 |pages=85–98 |doi=10.1016/j.schres.2005.01.016 |pmid=16005388 |s2cid=7206375 }}</ref>

==Example==
This can be seen by a section of a 1974 transcript of a patient with schizophrenia:
{{blockquote|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.<ref>{{cite journal |last1=Chaika |first1=Elaine |title=A linguist looks at 'schizophrenic' language |journal=Brain and Language |date=July 1974 |volume=1 |issue=3 |pages=257–276 |doi=10.1016/0093-934X(74)90040-6 }}</ref>}}

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 (thought disorder)|derailment]] driven by self-monitoring.<ref name="Schizophrenia and the structure of"/>

== As a type of formal thought disorder ==

[[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.<ref name="Andreasen Grove 1986">{{cite journal |last1=Andreasen |first1=Nancy C. |last2=Grove |first2=William M. |title=Thought, language, and communication in schizophrenia: diagnosis and prognosis |journal=Schizophrenia Bulletin |date=1986 |volume=12 |issue=3 |pages=348–359 |doi=10.1093/schbul/12.3.348 |pmid=3764356 |doi-access=free }}</ref>

Thought disorders are measured using the Thought, Language and Communication Scale (TLC) developed by Andreasen in 1986.<ref name="Andreasen Grove 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.{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}}

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.{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}}

== Occurrences in mental disorders ==

Clanging is associated with the irregular thinking apparent in [[psychosis|psychotic]] [[mental illness]]es (e.g. [[mania]] and [[schizophrenia]]).<ref>{{cite journal |last1=Peralta |first1=Victor |last2=Cuesta |first2=Manuel J. |last3=de Leon |first3=Jose |date=March 1992 |title=Formal thought disorder in schizophrenia: A factor analytic study |journal=Comprehensive Psychiatry |volume=33 |issue=2 |pages=105–110 |doi=10.1016/0010-440X(92)90005-B |pmid=1544294 }}</ref>

=== In schizophrenia ===
Formal Thought Disorders are one of five characteristic symptoms of schizophrenia according to the DSM-IV-TR.<ref name="Radanovic Sousa Valiengo et al 2012"/> FTD symptoms such as Glossomania are correlated to schizophrenia spectrum disorders and to a family history of schizophrenia.<ref name="Radanovic Sousa Valiengo et al 2012"/> 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.{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}}

=== In mania/bipolar disorder ===
[[Gustav Aschaffenburg]] found that manic individuals generated these "clang-associations" roughly 10–50 times more than non-manic individuals.<ref>{{cite book |last1=Kraepelin |first1=Emil |url=https://archive.org/details/manicdepressivei00krae |title=Manic-depressive insanity and paranoia |date=1921 |publisher=E. & S. Livingstone |location=Edinburgh |page=[https://archive.org/details/manicdepressivei00krae/page/32 32] |isbn=978-0-405-07441-7 |oclc=1027792347 }}</ref> Aschaffenburg also found that the frequency of these associations increased for all individuals as they became more fatigued.<ref>{{cite book |doi=10.7551/mitpress/4632.003.0015 |chapter=Semantic Networks |title=The Mind within the Net |year=1999 |isbn=978-0-262-28416-5 |s2cid=242159639 |first1=Manfred |last1=Spitzer }}</ref>

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.<ref name="Andreasen Grove 1986"/>

=== In depression ===
Research investigated by Steuber found no significant difference of glossomania occurrences for patients with schizophrenia compared to patients with [[Major depressive disorder|depression]].{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}}

== 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'.{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}}

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{{sfn|Steuber|2011|p={{page needed|date=March 2023}}}} – 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]] (which is linked to a familial language disorder and autism) and dysbindin 1 genes43,44.<ref name="Radanovic Sousa Valiengo et al 2012"/> 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.<ref>{{cite journal |last1=Sass |first1=Louis |last2=Pienkos |first2=Elizabeth |title=Beyond words: linguistic experience in melancholia, mania, and schizophrenia |journal=Phenomenology and the Cognitive Sciences |date=September 2015 |volume=14 |issue=3 |pages=475–495 |doi=10.1007/s11097-013-9340-0 |s2cid=254947008 }}</ref> However, more research is required into not only understanding the causes of such symptoms, but how it works.

==See also==
*[[Thought disorder]]
*[[Word salad]]
*[[Schizophrenia]]
*[[Bipolar disorder]]

== References ==
{{reflist|30em}}

==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 }}

[[Category:Medical signs]]
[[Category:Thought disorders]]