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Clanging, sometimes known as clang association, association chaining or glossomania, is a term used in psychiatry. It describes an unusual mode of speech associated with what are called thought disorders. Thought disorders are found in people with conditions such as schizophrenia and mania, and they reveal themselves in a person's speech. Clanging occurs when a person makes connections between words because of the way they sound and it can involve the use of puns and rhymes. It is usually associated with a type of thought disorder known as flight of ideas, in which a person's speech can be hard to follow as it moves quickly from one idea to the next.
Flight of ideas is sometimes described as a continuous and rapid form of derailment, where speech suddenly swerves in a new direction like a train leaving its track. Clanging can be part of this, with the connections made between words helping to shift speech off topic. As well as puns and rhymes, clanging can involve alliteration, where words begin with the same consonants, such as hungry and horse. It can also use what is called assonance, where words have the same vowel sounds, and an example of this could be use of the words fake and plate. The presence of clanging can be associated with the condition known as mania.
Mania is one phase of an illness called bipolar I disorder, where severe manic or depressive episodes can occur which disrupt normal life. During manic episodes, people may become euphoric and driven, forgetting to eat or sleep, and psychosis may occur, where people lose touch with reality. Bipolar disorder can be treated with medication and psychotherapy. A stay in the hospital may be required if a person has developed psychosis.
Clanging is also associated with schizophrenia. This is another disease in which psychosis occurs, causing people to have abnormal beliefs and see and hear things which are not there. Like bipolar disorder, schizophrenia may be treated using drugs and psychological talking therapies.
There are numerous speech abnormalities found in mania and schizophrenia, but clanging may be the only one for which researchers have found an explanation. It is thought that people begin to speak but become distracted by both the meaning and sound of the words they are using. This means that they repeatedly lose the thread of what they are saying, and shift off the topic to follow the new connections they are making between words. It is as if patients are compelled to consider every association for a word and are unable to edit out what is irrelevant.
Because clanging and other symptoms can be present in both bipolar disorders and schizophrenia, so sometimes bipolar is misdiagnosed. Other symptoms in common include hallucinations and delusions.
The best way to tell the difference is to remember that bipolar psychosis is temporary, and schizophrenia is often ongoing. For both condition emergency medical treatment is necessary.