Clang Association

Clang association can be seen during acute manic episodes of bipolar disorder and schizophrenia. Learn the signs to identify clang association and know what to do if you or someone you know has it.

Clang association involves the use of words in the speech that sound similar but have no connection or meaning. Words with similar sounds or that rhyme are grouped together. This type of speech is often seen in those with bipolar disorder and schizophrenia. This illogical form of communication is referred to as disorganized thinking and is a sign of acute psychosis present in both manic and depressive episodes.

What Are Clang Associations?

The word clang is associated with sounds, such as bells or metal ringing. In contrast, speech produces sounds and words with the effect of communicating thoughts and ideas. A person who speaks using clang associations uses actual words, but the effect is only sound and no real communication. The rhyming words do not convey any clear thoughts or ideas. Therefore clang association can be defined as words based on sounds without logical communication.

Mood disorders can have a variety of symptoms and behavioral characteristics. Clang association is a symptom related to disordered thoughts seen in bipolar disorder and schizophrenia. It is a reflection of disorganized thought processes. Instead of a person’s thinking and speech being directed based on meaning, in clang association, a person’s thinking and speech is driven by the sound of words. A person can associate words based on rhyming quality and punning.

Examples of clang association include:

• “I wrote the boat overload showed my goat float tote.”
• “He rained the train brain strain gain the crane.”

While the rhyming may have similar qualities to music such as rap, clang association is situationally inappropriate and interferes with the ability to clearly communicate.

Clang Associations in Bipolar Disorder

Cognitive dysfunction is a major component in serious mental health conditions and can include changes in thinking, memory, motivation, perception, skilled movements and language. Thought disorder is a key feature of cognitive dysfunction. Although bipolar is recognized as a mood disorder with cycling highs and lows, thought disorder is a symptom of bipolar as well.

Often seen during manic phases of bipolar disorder, the thought disorder can manifest as cognitive deficits prior to acute mood symptoms. Some thought disorder symptoms could include racing thoughts, difficulty with word retrieval, attention and retention problems, and accelerated thought processes. This acceleration of thought makes it difficult for a person with bipolar to focus on specific thoughts, and in a matter of minutes, they can lose clarity and awareness of their own thoughts. Processing such a rapid emergence of thoughts is nearly impossible and affects responses to situations and others.

During an acute manic episode in bipolar disorder, clang association can emerge as the person is trying to communicate but unable to make any sense. In addition to clang association, a person may speak in jumbled words or phrases, have speech that rapidly changes direction, use made-up words and be generally incoherent.

Clanging in Schizophrenia

Clang association was originally associated with schizophrenia, a mental health disorder characterized by psychotic symptoms including delusions, hallucinations and thought disorder. As previously discussed, the thought disorder can affect one’s thought processes, language, and ability to communicate. During a phase of acute psychosis in schizophrenia, a person may display several breaks in communication related to thought disorder, including, but not limited to:

• Poverty of speech: brief responses
• Pressure of speech: loud, fast-paced speech that is difficult to interrupt
• Loosening of associations: speech that is spontaneous with changing topics
• Schizophasia: severe lack of coherence and sentence structure
• Neologism: making up new words
• Echolalia: repeating words or phrases of another person during a conversation
• Clang association: speech governed by word sound rather than the meaning

Changes in language and speech are common symptoms of schizophrenia, and clang association can be seen during acute psychosis when a person is distracted by their own speech and subsequently uses similar sounding words that rhyme. Although not all individuals with schizophrenia will have impairments with language, many do experience these abnormalities in language. Researchers are unable to definitively determine whether these language deficits are related to language itself or deficits in cognition as a whole.

Managing Clang Associations

Since clang associations are symptoms of thought disorder seen in manic or acute episodes of bipolar disorder and schizophrenia, the best form of management includes consistent treatment of the disorder. Some people may be currently receiving treatment but experience psychosis because their medication needs adjustment, or other health and situational factors may worsen their symptoms. Acute psychosis in either disorder requires immediate treatment to prevent harm to self or others. Clang association can be a good indicator that a person is close to or already experiencing psychosis.

Mental health first aid can help those close to a person with bipolar disorder or schizophrenia get the help they need. Typical treatment for bipolar disorder or schizophrenia, including the symptom of clang association, can include:

• Psychotherapy
• Cognitive behavioral therapy
• Group or family therapy
• Cognitive enhancement therapy (specific to schizophrenia)
• Medications

If you or someone you know is struggling with bipolar disorder or schizophrenia and a co-occurring substance use disorder, contact The Recovery Village. One of our representatives can discuss a treatment plan suitable for you.

Editor – Renee Deveney

As a contributor for Advanced Recovery Systems, Renee Deveney is passionate about helping people struggling with substance use disorder. With a family history of addiction, Renee is committed to opening up a proactive dialogue about substance use and mental health. Read more

Medically Reviewed By – Dr. Karen Vieira, PhD

Dr. Karen Vieira has a PhD in Biomedical Sciences from the University of Florida College of Medicine Department of Biochemistry and Molecular Biology. Read more