Understanding Clang Association in Mental Health Disorders

Also known as clanging, clang association is a type of speech pattern in which people tend to put words together based on how they sound instead of what the words actually mean.

Clang associations are referred to groups of words that are usually rhyming words and based on similar sounds. However, these words, when put together, do not have any logical meaning behind them. A person who speaks using clang association is typically known to be showing signs of psychosis in mental health conditions like schizophrenia or bipolar disorder. Clanging can also incorporates puns and alliterations. Read on to find out everything you need to know about clang association.

While it may sound like a speech disorder, clang association is actually identified as a sign of a thought disorder. A person with a thought disorder experiences an inability to process, organize, or communicate their thoughts properly. Thought disorders are typically associated with mental health disorders like schizophrenia or bipolar disorder.⁽¹⁾ However, a recent study has also shown that people with certain forms of dementia may also experience clang association as a symptom.^(2,3)

In most cases, a clanging sentence may start with a coherent thought, but as it progresses, the sentence then tends to get derailed by the repetitive sound associations. An example of a clanging sentence can be “I was on my way to the store to the bore the chore and then some more.” As can be seen from the example, clanging sentences do not make sense.⁽⁴⁾

Clang association can also be a sign that a person is having or about to have an episode of psychosis. During these psychosis episodes, people may end up hurting themselves or even others, so upon hearing clanging words or sentences, one should ideally get some help quickly.

In people with bipolar disorder, clan associations tend to occur during psychotic episodes during the manic phase of the disease.⁽⁵⁾ In people with schizophrenia, on the other hand, clang associations are closely associated with thought disorder. It is interesting to note that thought disorder is one of the key characteristics of schizophrenia. Clanging, sometimes, is also referred to as glossomania in some medical literature, especially in reference to the various speech disruptions seen in patients with bipolar disorder and schizophrenia.^(6,7,8)

When you first hear clanging or clang associations, it will sound just like rhyming poetry. The only difference is that these poems do not many any sense.⁽⁹⁾ The reason clanging does not make any sense is that there is no logical reasoning behind why the chosen words have been put together in a poem or sentence. They have only been put together because they create a rhyming and ‘clangy’ kind of sound. While the words used in clanging are usually rhyming, they do not always have to rhyme completely. They may also sound rhyming just partially.

The sound of the words may be similar in terms of their beginning sound, ending sound, or both. For example, a person might say “I like biking, hiking, and striking” instead of “I like biking, hiking, and swimming.”

When a person is experiencing clang associations, their speech may sound jumbled or nonsensical, as they are essentially stringing together words based on their sound rather than their meaning. The speech may also sound repetitive, as the person may repeat certain words or phrases based on their sound associations.

Some other examples of clanging include:

1. I walked the dog, fog, log, and jog.
2. The cat sat on the mat, hat, bat, and rat.
3. I like to ride bikes, hikes, mics, and strikes.
4. The sun is bright, light, might, and fight.
5. The train, rain, and pain all came at the same time.

On the whole, though, the speech of someone experiencing clang associations may sound disjointed and difficult to follow.

Schizophrenia is a complex mental health disorder that causes people to experience delusions, hallucinations, disorganized thought, and an overall distortion of reality. The symptoms of schizophrenia also affect speech, and researchers have actually found an association between clanging and schizophrenia dating as far back as 1899. Furthermore, more recent studies have also confirmed this link.⁽¹⁰⁾ 

People who are going through an acute episode of schizophrenia psychosis are also likely to display other forms of speech disruptions. These may include:

• Pressure of speech in which their speech is too fast, loud, and hard to understand.⁽¹¹⁾
• Poverty of speech in which the patient gives only one to two-word answers to questions.⁽¹²⁾
• Neologisms where speech includes made-up words.⁽¹³⁾
• Schizophasia also known as word salad where patients use random and jumbled words.⁽¹⁴⁾
• Loose associations, where the speech suddenly changes over to an unrelated topic.⁽¹⁵⁾
• Echolalia where the patient tends to repeat whatever anyone else is speaking.⁽¹⁶⁾

Bipolar disorder, formerly known as manic-depressive illness, is a mental health disorder that causes a person to experience extreme mood swings that can range from episodes of depression to episodes of mania or hypomania. During the depressive episodes, people with bipolar disorder are likely to experience feelings of extreme sadness, hopelessness, and worthlessness, as well as a loss of interest in activities they once enjoyed. They may also experience changes in appetite, sleep patterns, and energy levels, and may have thoughts of suicide.⁽¹⁷⁾ On the other hand, though, during the manic or hypomanic episodes, people with bipolar disorder are likely to experience an elevated or irritable mood, very high levels of energy, racing thoughts, and a decreased need for sleep. They may also engage in impulsive or risky behaviors, such as going on spending sprees or indulging in reckless driving, and may experience hallucinations or delusions in severe cases.^(18,19)

People with bipolar disorder are more likely to experience the signs of clang association when they are experiencing episodes of manic or hypomanic behavior. Studies have found that clang association is commonly observed in bipolar patients when they are in the manic phase of the disease.⁽²⁰⁾ During the manic episodes, people with bipolar disorder are more likely to experience racing thoughts, which are believed to be the cause of clanging. Due to the racing thoughts combined with high levels of energy, their speech is prone to become jumbled and difficult to follow. Structured interventions, including online outpatient treatment, focus on improving mental clarity and helping individuals manage these symptoms effectively. Clang associations are believed to occur as a result of these racing thoughts as the person’s speech becomes governed more by sound associations rather than meaning or logic. The high levels of energy also often make bipolar patients speak in a hurried manner, during which the speed of their speed increases to match their racing thoughts.

In some cases, the presence of clang associations in someone with bipolar disorder may be a sign that they are experiencing a manic or hypomanic episode. However, it is important to keep in mind that not everyone with bipolar disorder will experience clang associations, and not everyone who experiences clang associations will end up having bipolar disorder.⁽²¹⁾

However, clang association is not entirely unheard of in people with bipolar disorder during depressive episodes.

While clang association does not directly affect written communication, it can indirectly impact a person’s ability to communicate in writing. For example, if a person is experiencing a manic or hypomanic episode characterized by racing thoughts and clang associations, they may have difficulty organizing their thoughts and expressing themselves clearly in writing. They may also struggle to understand written communication from others due to difficulties with focus and attention.

Studies have shown that any type of thought disorder usually disrupts the ability to communicate, including both spoken and written communication.⁽⁹⁾ Researchers typically believe that the problems in written communication are linked with disturbances in the patient’s working memory as well as the semantic memory. This refers to the ability of a person to remember words and what they mean.

A study carried out in 2000 showed that it was quite common that when some people with schizophrenia are told to write down words that are read out to them, they tend to interchange the phonemes while writing. For example, this means that they are prone to writing the letter ‘v’ in place of the letter ‘f’ which appeared in the actual correct spelling.⁽²²⁾ In such cases, the sounds being produced by ‘v’ and ‘f’ are very similar, but they are not quite the same. This indicated that the patient was not able to recollect the correct letter for the sound they were hearing.

However, at the same time, it is important to note that not everyone with schizophrenia or any other mental health condition that can cause clang association experience difficulty with written communication.⁽²³⁾ Furthermore, there are many known effective strategies and treatments that can help individuals manage their symptoms and also improve their communication skills. These may include medication, therapy, and various other types of accommodations and supports, such as assistive technology or getting extra time to complete any written assignments in school, college, or work.

Since clang association is linked with mental health conditions like schizophrenia and bipolar disorder, the treatment for this issue depends on the treatment of the underlying medical condition. The treatment options may include:

• Medications: Medications that are commonly used to treat bipolar disorder and schizophrenia, such as antipsychotics and mood stabilizers, can help reduce the severity and frequency of clang associations. These medications work by regulating the levels of neurotransmitters in the brain that are associated with mood and thought processes.⁽²⁴⁾
• Therapy: Psychotherapy, such as cognitive-behavioral therapy (CBT), can be one of the most effective treatments for clang association. This form of therapy can help people learn how to identify and challenge their disordered thought patterns and develop more effective communication and coping strategies.⁽²⁵⁾
• Other supportive interventions: Other interventions that may be helpful for managing clang association include lifestyle changes, such as maintaining a regular sleep schedule, avoiding drugs and alcohol, managing a healthy weight, as well as reducing stress. In some cases, the use of assistive technology or other therapies may also be useful in improving the patient’s communication skills and also reducing the impact of clang associations on daily life.⁽²⁶⁾

It is important to be aware that treatment for clang association is usually individualized and based on the specific needs and symptoms of each patient. Only a qualified mental health professional can help develop an appropriate and individualized treatment plan that takes into account a person’s unique symptoms, overall health condition, and their underlying illness.

Clang association or clanging are terms used to refer to a thought disorder that causes a person to speak in rhyming words that do not make any sense. The particular group of words is usually chosen by a person because of the ‘clangy’ or catchy way they sound and not because of their meaning. Clanging words do not make any sense when put together. It has been observed that people who tend to speak using repetitive clang associations usually have an underlying mental health condition like bipolar disorder or schizophrenia. Both of these disorders are known to be types of thought disorders since they affect the manner in which the brain processes and then communicates information.

In some cases, when a person starts speaking in clang associations, it might be a sign that an episode of psychosis is on the way. This is why it is important to get help for a person who suddenly starts to speak in clanging or whose speech turns unintelligible. Different types of treatments exist for treating the underlying medical conditions that cause clang association, including antipsychotic medications, cognitive behavioral therapy, lifestyle changes, and many others.

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