What Are Clang Associations in Bipolar Disorder?

Clang Associations
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Clang associations are groupings of words, usually rhyming words, that are based on similar-sounding sounds, even though the words themselves don't have any logical reason to be grouped together. A person who is speaking this way may be showing signs of psychosis in bipolar disorder or in schizophrenia.

In bipolar disorder, clang associations can appear in psychotic episodes in the manic phases of the illness, although they also can occur in psychoses linked to depression.

In schizophrenia, clang associations are closely linked with an inability to communicate.

"Clanging" also has been referred to as "glossomania" in medical literature relating to speech alterations in schizophrenia and bipolar disorder.

What Do Clang Associations Sound Like?

Clang associations generally sound a bit like rhyming poetry, except that the poems don't seem to make any sense (they don't make sense because there's no logical reason for those particular words to be grouped together into a poem).

For example, in the song "X Amount of Words" by Blue October's Justin Furstenfeld (who has bipolar disorder), the words "pathetic" and "sympathetic" are rhymed with "prosthetic" and "paramedic":

Imagine the worst
Systematic, sympathetic
Quite pathetic, apologetic, paramedic
Your heart is prosthetic

These words don't have much of a logical reason to be grouped together, but they create a catchy, clang-y sort of rhythm ...

hence the term "clang associations."

You can have a clang association with any words that don't make sense when grouped. Here's another:

Auto, tomorrow, swallow, Zoro, borrow

The words used in clang associations generally rhyme, although they may only rhyme partially. 

Clang Associations Part of 'Word Salad'

In bipolar disorder and schizophrenia, clang associations are considered to be part of a language disorder condition called schizophasia (popularly known as "word salad).

In fact, language disturbance is a major feature in schizophrenia.

A person is said to have schizophasia when his speech is jumbled, repetitious and simply doesn't make sense. This speech may feature neologisms, which are made-up words or expressions, or simply be mumbled and impossible to understand.

Schizophasia also seems to be related to thought disorder, in which a person's thoughts are similarly jumbled and don't make sense. It's not clear whether thought disorder and schizophasia are two separate conditions, or just features of the same condition.

People whose speech features clang associations and other symptoms of schizophasia may also have a flat-sounding voice or another unusual voice quality. They may seem to have problems with remembering words or using them correctly, as well.

Writing Associations in Schizophasia Disorder

Along with leading to clang associations, neologisms, and other jumbled spoken language, schizophasia may also affect written language.

In 2000, Université de Montréal researchers tested the writing and dictation ability of patients "suffering from paranoid ​schizophrenia with ​glossomanic schizophasia." They found that the patients weren't able to write down dictated words accurately — they replaced letters in words with similar-sounding, but not identical letters, for example.

This indicates that the language problems inherent in schizophrenia extend beyond spoken language in patients.

In fact, there's some speculation that language problems in schizophrenia, such as clang associations, may form part of a possible genetic basis for the condition: "Recent research has begun to relate schizophrenia, which is partly genetic, to the genetic endowment that makes human language possible," concluded one group of clinicians.


Covington MA et al. Schizophrenia and the structure of language: the linguist's view. Schizophrenia Research. 2005 Sep 1;77(1):85-98.

Coron AM et al. Writing impairment in schizophasia: two case studies. Brain and Cognition. 2000 Jun-Aug;43(1-3):121-4.

Marini A et al. The language of schizophrenia: an analysis of micro and macrolinguistic abilities and their neuropsychological correlates. Schizophrenia Research. 2008 Oct;105(1-3):144-55.

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