Thought broadcasting | |
---|---|
Other names | Thought diffusion [1] |
Usual onset | Early adulthood (16-30 years) [2] |
Duration | Usually chronic among the elderly population [3] |
Differential diagnosis | Echo de la pensée , [4] thought withdrawal and thought insertion [5] |
Frequency | 6% among individuals with schizophrenia in one study |
Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.
Thought broadcasting is considered a severe delusion and it induces multiple complications, from lack of insight to social isolation. The delusion normally occurs along with other symptoms. Thought broadcasting is considered rare. In one study, for instance, it had a prevalence of 6% among individuals with schizophrenia.
Thought broadcasting is linked with problems of self-other control (the capacity to distinguish oneself from others). This type of delusion can be treated with the use of antipsychotic and psychotherapy. The delusion is part of the Schneider's first-rank symptoms of schizophrenia. The diagnosis of the condition can be made using the DSM-5 or the ICD-11.
Various interpretations of thought broadcasting exist in the literature, but three primary definitions have been recognized. Under the first definition, thought broadcasting occurs when an individual hears their own thoughts spoken aloud. This definition suggests an auditory hallucination is experienced by the individual. It was first noted in Kraepelin's book, Dementia Praecox and Paraphrenia. The second definition involves an individual sensing their thoughts silently escaping from their mind, without necessarily being audible to others. This contrasts with thought withdrawal, a similar phenomenon, as thoughts passively dissipate outwards rather than being actively removed. The third and final definition posits that thought broadcasting happens when others think in union with the individual, without the need for the thoughts to be audible. It was first described by Schneider in 1959 and is considered to be the most important definition. [1] [6]
Thought broadcasting is the persistent, distressing belief that one's thoughts are accessible by others, that continues even when evidence to the contrary is presented. [8] [9] [10] This condition is frequent among individuals with schizophrenia and is considered a positive symptom; however, it can also manifest during manic episodes of bipolar disorder, psychotic depression, brief psychotic disorder and schizoaffective disorder. [11] [12] [13] [14] Thought broadcasting is rare and there are no significant differences in occurrence between sexes. [15] [16] This type of delusion is also regarded as one of the most severe, due to its significant effect on mental well-being. [17] Within the population of individuals with schizophrenia, thought broadcasting has a prevalence of approximately 6%, according to one study. [18] This type of delusion rarely occurs in isolation; it frequently coexists with other symptoms, including auditory verbal hallucinations, somatic hallucinations, delusions of control, delusion of guilt, sexual delusions, and depersonalization. [19]
Thought broadcasting is often paired with lower functioning, quality of life, magical thinking and lack of insight and judgment. It can also contribute to symptoms of depression and anxiety. [2] [20] [note 1] Thought broadcasting recurrently leads to changes in mental privacy, location, and agency. It can also blur ego boundary. [21] It can be considered a manifestation of autonetic agnosia, that is, a deficit in the ability to identify self-generated mental events, along with thought insertion and others. [22]
This type of delusion influences both speech production and speech perception. Over time, thought broadcasting can shape how one thinks. If someone says a word or phrase similar to what the patient may have been thinking, it could catalyze the delusion, especially if it happens fairly frequently. [23]
There is a very high comorbidity between obsessive-compulsive disorder (OCD) and schizophrenia. [24] This may result from obsessive-compulsive symptoms that initially present or worsen with the use of atypical antipsychotics, a common treatment modality for schizophrenia. [25] Intrusive thoughts—involuntary and unwanted thoughts, ideas, and images—constitute a central symptom of OCD. [26] When these intrusive thoughts are coupled with thought broadcasting, it causes a special concern that these could be apprehended by others, resulting in increased anxiety and shame, leading to social isolation—a safety behavior. The relief given by isolation then reinforces the belief that the individual needs to stay away from others. [27] [28]
Auditory hallucinations are often depicted as malicious voices that possess knowledge about the person's private and shameful thoughts or actions, which the individual would prefer to keep hidden. In these situations, thought broadcasting arises as an inability to conceal one's own thoughts. [29] This type of delusion is also believed to be linked with problems in self-other control, that is, when an individual adjusts the representation of oneself and others in social interactions. [note 2] [30] Methamphetamine abuse can induce psychosis, including thought broadcasting. [31] One theory suggests that when the two hemispheres of the brain are not effectively integrated, the left hemisphere may fail to identify the source of feelings and thoughts originating in the right hemisphere. As a result, individuals may experience the mistaken belief that these thoughts and emotions are either being inserted into (thought insertion), removed from (thought withdrawal), or transmitted out of their own head (thought broadcasting). [32]
Individuals with thought broadcasting have a lower acceptance of treatment. [33] Both antipsychotic medication and psychotherapy, specially cognitive behavioral therapy, may be useful. [2] [5] In one case study, cognitive behavioral therapy and exposure therapy helped reduce significantly the conviction of thought broadcasting. [34] In another case study, where an individuals with schizophrenia also exhibited comorbid obsessive-compulsive symptoms (OCS), treating these symptoms helped to reduce thought broadcasting. [35] This delusion does not significantly affect the prognosis for patients with psychosis, [36] though is observed more often in schizophrenia with poor prognosis. [37]
Thought broadcasting was initially described by Emil Kraepelin in his 1913 work, Psychiatrie. In the mid-1900s, Kurt Schneider classified thought broadcasting as typical of schizophrenia, encompassing it as a first-rank symptom along with 7 others. From then, the delusion has been incorporated into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) diagnostic criteria. [1] The DSM-5 outlines eleven categories of delusions, among which thought broadcasting is included. The ICD-11 characterizes it as in experiences of influence, passivity, and control, along with thought insertion and withdrawal. The DSM-5 specifies thought broadcasting as a belief that one's thoughts are transmitted and consequently perceived by others. It also classifies it as bizarre—a delusion of implausible and incomprehensible nature. [26] [38] In contrast, the ICD-11 provides a broader description, stating that an individual's thoughts are accessible to others, enabling them to know the content of those thoughts. [8] [26] Furthermore, it includes thought broadcasting as one of the core symptoms for diagnosing schizophrenia. [39]
Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.
Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood disorders, anxiety disorders, and obsessive–compulsive disorder.
A hallucination is a perception in the absence of an external stimulus that has the compelling sense of reality. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and mental imagery, which does not mimic real perception, and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.
Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.
A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: a disruption of the form of thought. Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses. Disorganized speech leads to an inference of disorganized thought. Thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."
Kurt Schneider was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia, as well as personality disorders then known as psychopathic personalities.
Stimulant psychosis is a mental disorder characterized by psychotic symptoms. It involves and typically occurs following an overdose or several day binge on psychostimulants, although it can occur in the course of stimulant therapy, particularly at higher doses. One study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for some time.
The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.
Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.
Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.
A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".
An auditory hallucination, or paracusia, is a form of hallucination that involves perceiving sounds without auditory stimulus. While experiencing an auditory hallucination, the affected person hears a sound or sounds that did not come from the natural environment.
Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by the extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful or of a high status. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses fantastical talents, accomplishments, or superpowers.
A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.
Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.
The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.
A religious delusion is defined as a delusion, or fixed belief not amenable to change in light of conflicting evidence, involving religious themes or subject matter. Religious faith, meanwhile, is defined as a belief in a religious doctrine or higher power in the absence of evidence. Psychologists, scientists, and philosophers have debated the distinction between the two, which is subjective and cultural.
The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes. Religious experiences often involve reports of auditory and/or visual phenomena, which sounds seemingly similar to those with schizophrenia who also commonly report hallucinations and delusions. These symptoms may resemble the events found within a religious experience. However, the people who report these religious visual and audio hallucinations also claim to have not perceived them with their five senses, rather, they conclude these hallucinations were an entirely internal process.
Caffeine-induced psychosis is a relatively rare phenomenon that can occur in otherwise healthy people. Overuse of caffeine may also worsen psychosis in people suffering from schizophrenia. It is characterized by psychotic symptoms such as delusions, paranoia, and hallucinations. This can happen with ingestion of high doses of caffeine, or when caffeine is chronically abused, but the actual evidence is currently limited.
...thought broadcasting can occur at any time, but it most often emerges between the ages of 16 and 30 years.
thought broadcasting can occur at any time, but it most often emerges between the ages of 16 and 30 years....In elderly populations, positive symptoms such as thought broadcasting tend to be present as a more chronic form of the disorder developed earlier in life.
The experience that one's thoughts are accessible by others so that others know what one is thinking.
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: CS1 maint: bot: original URL status unknown (link)We have shown that thought broadcasting delusions are typical of paranoid schizophrenia...
These experiences [possession of thought] are usually indicative of a psychotic illness...
For example, the probability of patients with thought broadcast to be allocated to the three different diagnostic classes were as follows : 0.97 probability for schizophrenia, 0.02 for manic psychosis and 0.01 for depressive psychosis (WHO, 1973).
...when controlling for diagnosis, sex, and race we show that the diagnostic group and race are not key factors in explaining the occurrence of thought insertion, thought withdrawal, thought broadcasting...
Schneiderian first-rank symptoms (such as thought broadcasting and thought echo) are very rare...
...thought broadcasting are usually regarded as some of the most severe types of delusions due to their phenomenological features, and impact on mental health.
Thought broadcasting was recorded in 76 patients (6%)
The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought dissemination (mind-reading), fantastic delusions, sexual delusions, and depersonalization.
In particular, we found that thought-broadcasting delusions correlated with...lack of judgment and insight...
delusions...show fundamental changes in the way in which thoughts are experienced during psychosis...including alterations in their paradigmatic phenomenal character, sense of ego boundaries, mental privacy, mental location, and mental agency.
These symptoms are referred to as manifestations of autonoetic agnosia, meaning literally "the inability to identify self-generated mental events". These symptoms include poor insight, hallucinations, and various forms of delusions, such as thought insertion, thought withdrawal, thought broadcasting...
Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive Symptoms (OCS) are known to be highly comorbid with bipolar disorder and schizophrenia.
Reports of OCD induction or exacerbation were limited to individuals with a primary psychotic disorder taking atypical antipsychotics. It is possible that psychotic individuals who develop OCD symptoms on atypical antipsychotics have an underlying biologic predisposition to the co-occurrence of OCD and schizophrenia
Harm obsessions subsequently functioned as triggering events for TB beliefs. The client's belief that others could hear his obsessive violent thoughts triggered further intense anxiety and shame, which led to extreme isolation. Isolation functioned as a safety behavior and reinforced the belief that he needed to stay away from others due to the potential danger he posed. Relief from distress served to negatively reinforce continued isolative behavior.
Bizarre behaviour may also act to alienate the person and reduce opportunities for social support and potential disconfirmation through social contact; or form a safety behaviour, preventing testing out of concerns.
In about 70% of people with psychosis who hear voices, the voice(s) is commonly experienced as male and malevolent, as derogating and shaming, who typically issues commands is often experienced as powerful and omnipotent and 'knowing' i.e. knows of (can detect) shameful things and violations that the person would like to keep hidden. Indeed, attacking voices and experiences of thought broadcasting are often experienced as an inability to keep ' from view' (deception) one's own thoughts/experiences.
Characteristic symptoms of schizophrenia, such as thought broadcasting...suggest a failure in distinguishing between oneself and others.
The first several injections of methamphetamine induce hyperarousal and euphoria, but abuse may induce psychotic states consisting of paranoid delusions with auditory hallucination, bizarre ideas, thought broadcasting...
The left hemispheric consciousness is no longer inhibited from being aware that thoughts, feelings, and intentions are being imposed on it from an external source (the right hemisphere). The schizophrenic patient expresses (with his or her verbal left hemisphere) that thoughts are being inserted into, withdrawn from, or transmitted out of his or her head...
In particular, we found that thought-broadcasting delusions correlated with lower treatment acceptance...
The client endorsed considerable relief and receptivity to ERP and cognitive therapy in the context of CBT targeting psychotic and mood symptoms, including reduced distress associated with intrusive thoughts...and reduced conviction related to TB beliefs (from 95% to 25% by session 6 of ERP and 0% by the end of CBT)
The treatment of OCS resulted in the complete resolution of thought broadcasting.
...thought broadcast does not have a significant effect on outcome.
Taylor reported that the [first-rank] symptoms occur most commonly in [schizophrenic] patients with poor prognosis...
...the World Health Organization's International Classification of Diseases system includes thought broadcasting in a relatively short list of the "most important" phenomena or the diagnosis of schziphrenia.