Thought insertion

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Thought insertion is defined by the ICD-10 as feeling as if one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind. [1] [2] [3] [4] The person experiencing thought insertion will not necessarily know where the thought is coming from, but makes a distinction between their own thoughts and those inserted into their minds. [5] However, patients do not experience all thoughts as inserted; only certain ones, normally following a similar content or pattern. This phenomenon is classified as a delusion. [1] A person with this delusional belief is convinced of the veracity of their beliefs and is unwilling to accept such diagnosis. [6]

Contents

Thought insertion is a common symptom of psychosis and occurs in many mental disorders and other medical conditions. [1] However, thought insertion is most commonly associated with schizophrenia. Thought insertion, along with thought broadcasting, thought withdrawal, thought blocking and other first rank symptoms, is a primary symptom and should not be confused with the delusional explanation given by the respondent. Although normally associated with some form of psychopathology, thought insertion can also be experienced in those considered nonpathological, usually in spiritual contexts, but also in culturally influenced practices such as mediumship and automatic writing. [1] [2]

Some patients have also stated that at some point in time they were being manipulated by an exterior or interior force depending on the delusion that the patient faced and only later realized that thoughts weren't theirs, this is linked to patients "losing control" of what they do.

Examples of thought insertion:

She said that sometimes it seemed to be her own thought 'but I don't get the feeling that it is'. She said her 'own thoughts might say the same thing', 'but the feeling isn't the same', 'the feeling is that it is somebody else's.' [5]

I look out the window and I think that the garden looks nice and the grass looks cool, but the thoughts of Eamonn Andrews come into my mind. There are no other thoughts there, only his [sic]. He treats my mind like a screen and flashes thoughts onto it like you flash a picture. [5]

The subject has thoughts that she thinks are the thoughts of other people, somehow occurring in her own mind. It is not that the subject thinks that other people are making her think certain thoughts as if by hypnosis or psychokinesis, but that other people think the thoughts using the subject's mind as a psychological medium. [7]

Unbidden thoughts

Unbidden thoughts are thoughts that come to mind without the subject directly or consciously meaning to think them. Inserted thoughts, while sharing the characteristic of unconsciously or indirectly being conjured, are distinct from unbidden thoughts because of the author of the thoughts. During an experience of unbidden thinking, the subject knows that they are the author of the thought even though they may not have consciously meant to think it. During the feeling of thought insertion, however, the subject feels as though the thought belongs to another person and was inserted into their own mind, making the author of the thought someone other than themselves.

Auditory verbal hallucinations

Auditory hallucinations have two essential components: audibility and alienation. [8] While people who experience thought insertion do share the experience of alienation (they cannot recognize that the thoughts they are having are self-generated) with auditory hallucinations, they lack the sense of audibility (experiencing the thoughts as occurring outside of their mind or spoken to them). The person experiencing thought insertion recognizes that the thought is being thought of inside their mind, but they fail to recognize they are the one thinking it.

Theories

Standard approach

The "standard approach" is characterized by a lack of sense of agency. Most philosophers define a sense of agency as a subject's awareness that they are initiating or controlling one's own actions. According to standard approach theory, the subject does not have an awareness that they are the initiators of a thought, but they do recognize that they own the thought in that it exists within their own mind. Many have argued that the standard approach does not explain the details and the unusual pathology behind thought insertion. [5] [9] Typically, critiques argue that this account fails to provide a reason that distinguishes inserted thoughts from either ordinary thoughts that the subject did not deliberately try to conjure (unbidden thoughts) or other thoughts that are thought to be controlled by forces outside of the subject. [9] As a result, other theories of thought insertion have been proposed in order to try to explain the complexities behind the phenomenon.

Causal-contextual

The causal-contextual theory of thought insertion focuses on a lack of a feeling of ownership. This theory differs from the standard approach because rather than explaining thought insertion by saying the subject lacks a sense of agency, this model explains thought insertion by theorizing that the subject lacks a sense of ownership, which in turn creates a lack of agency. [5] Patients with schizophrenia are hypothesized to have a generalized deficit in their integration of information, illustrated through the many other symptoms of schizophrenia and psychosis. [5] According to causal-contextual theory, sense of ownership depends on integrating causal-contextual information and a deficit in this process account for the abnormal experience of thought insertion. This model has come under criticism due to its definition of sense of ownership. In philosophy, a sense of ownership is defined as a thought that occurs within the space of one's own mind. However, in the causal-contextual model of thought insertion, sense of ownership is defined as feeling as if a thought belongs to the person thinking it. [10] Because of this distinction, many (e.g. Seeger, Coliva, etc.) argue that the causal-contextual model is not a separate model of thought insertion, but rather a corollary of the standard approach. [3] [10]

Mind-to-mind paradigm

Swiney and Sousa (2013) conducted an experiment to investigate thought insertion in a normal population. [11] They attempted to create situations in which nonpathological populations would have the ability to make sense of agency misattributions in their thoughts. Participants were told that they were attached to a machine that could "transfer thoughts" from one person to another. They were then told a target word, and were to click a mouse every time they thought about the target word. However, they were only to click the mouse when they believed the target word they were thinking of was not generated by their own mind. It was stressed that the paradigm did not always work and that it was okay to not experience another person's thoughts. The vast majority (72%) of participants made at least one misattribution of agency, meaning they attributed a thought they experienced as belonging to the other participant and believed the machine had transferred the thought into their mind through the machine. This occurred after only 5 minutes. These misattributions were more frequent when the target thought was an arousing negative thought as compared to a neutral control.

Neurology

Identifying brain regions associated with thought insertion has proven difficult. First, it is difficult to find subjects who experience thought insertion frequently. Second, it is difficult to do brain imaging techniques on these subjects while they are experiencing thought insertion. Therefore, most of the findings in this field come from cases of normal people under hypnosis, as evidenced in an experiment by Walsh and colleges (2015). [2] The supplementary motor area is thought to be involved in the phenomenon of thought insertion. Thought insertion is associated with reduced activation of networks that support language, movement, and self-related processing. [2] Specifically, thought insertion is associated with a reduction in the activity of the left supplementary motor area, basal ganglia, striatal areas, right superior occipital cortex and thalamus. An altered functional connectivity between the supplementary motor area and brain regions involved in language processing and movement implementation was also found. [2]

Theory of misattributed inner speech

According to the model of misattributed inner speech, during the generation of inner speech, speech production areas fail to inhibit the speech perception area and this leads to a misattribution of one's thoughts to an external source. [8]

Comparator-model (forward model)

The comparator-model, also known as the forward model, is an elaboration of theory of misattributed inner speech. This theory relies on a model involved in inner speech known as the forward model. Specifically, the comparator-model of thought insertion describes processing of movement-related sensory feedback involving a parietal-cerebellar network as subject to feedforward inhibition during voluntary movements and this is thought to contribute to the subject feeling as though thoughts are inserted into his or her mind. It has been proposed that the loss of sense of agency results from a disruption of feedforward inhibition of somatosensory processing for self-generated movements. Frith (2012) argues that delusions and hallucination are associated with a failure in the predictive component of the model. [12] Critics of this model argue that it makes the unsupported claim that a model for movement can be transferred to account for thoughts. [13] These critics argue that this jump cannot be made because it is not known that movements and thoughts are processed in the same way. Support for the comparator-model has also been spotty. In an experiment done by Walsh and colleges (2015), the theory behind the forward model of thought insertion was not supported. [2] They found that thought insertion was not associated with overactivation of somatosensory or other self-monitoring networks that occurs in movement. They argue that this provides evidence that a model for motor agency cannot explain thought agency.

Executive control model

The executive control model argues that thought insertion may be mediated by altered activity in motor planning regions, specifically the supplementary motor area. In one experiment, reduced connectivity between the supplementary motor area and motor implementation regions during suggested involuntary compared to voluntary movements was observed. [2]

Treatment

Most of the treatments for thought insertion are not specific to the symptom, but rather the symptom is treated through treatment of the psychopathology that causes it. However, one case report considers a way to manage thought insertion through performing thoughts as motor actions of speech. [14] In other words, the patient would speak his thoughts out loud in order to re-give himself the feeling of agency as he could hear himself speaking and then contributing the thought to himself.

Related Research Articles

Psychosis Condition of the mind that involves a loss of contact with reality

Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not. Symptoms may include false beliefs (delusions) and seeing or hearing things that others do not see or hear (hallucinations). Other symptoms may include incoherent speech and behavior that is inappropriate for the situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities.

Paranoia is an instinct or thought process which is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory, or beliefs of conspiracy concerning a perceived threat towards oneself. Paranoia is distinct from phobias, which also involve irrational fear, but usually no blame. Making false accusations and the general distrust of other people also frequently accompany paranoia. For example, an incident most people would view as an accident or coincidence, a paranoid person might believe was intentional. Paranoia is a central symptom of psychosis.

Schizophrenia Mental illness characterized by abnormal behavior and misinterpretation of reality

Schizophrenia is a mental illness characterized by relapsing episodes of psychosis. Major symptoms include hallucinations, delusions, and disordered thinking. Other symptoms may include social withdrawal, decreased emotional expression, and lack of motivation. Symptoms typically come on gradually, begin in young adulthood, and in many cases never resolve. There is no objective diagnostic test; diagnosis is based on observed behavior, a history that includes the person's reported experiences, and reports of others familiar with the person. To be diagnosed with schizophrenia, symptoms and functional impairment need to be present for six months. Many people with schizophrenia have other mental disorders that may include an anxiety disorder such as panic disorder, obsessive-compulsive disorder, depressive disorder, or a substance use disorder.

Paranoid schizophrenia schizophrenia that involves delusions or auditory hallucinations of persecution or being plotted against without thought disorder, disorganized behavior, or affective flattening

Paranoid schizophrenia was long diagnosed as the most common type of schizophrenia, but this sub-type is no longer used in the United States since the 2013 change in the DSM-V that classifies the range of symptoms of former sub-types all under "schizophrenia". Schizophrenia is defined as “a chronic mental disorder in which a person is withdrawn from reality." Prior to 2013 schizophrenia had been divided into subtypes based on the “predominant symptomatology at the time of evaluation." The subtypes were classified as: paranoid, disorganized, catatonic, undifferentiated, and residual type. However, they are not completely separate diagnoses, and cannot predict the progression of the mental illness.

A delusion is a firm and fixed belief based on inadequate grounds not amenable to rational argument or evidence to contrary, not in sync with regional, cultural and educational background. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or some other misleading effects of perception.

Thought disorder Disorder of thought form, content or stream

Thought disorder (TD) refers to disorganized thinking as evidenced by disorganized speech. Specific thought disorders include derailment, poverty of speech, tangentiality, illogicality, perseveration, and thought blocking. TD is a hallmark feature of schizophrenia, but is also associated with other conditions including mood disorders, dementia, mania, and neurological diseases.

Capgras delusion is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), a French psychiatrist.

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.

In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia. The continuum of personality proposed in schizotypy is in contrast to a categorical view of psychosis, wherein psychosis is considered a particular state of mind, which the person either has or does not have.

Psychopathology is the scientific study of mental disorders, including efforts to understand their genetic, biological, psychological, and social causes; develop classification schemes (nosology) which can improve treatment planning and treatment outcomes; understand the course of psychiatric illnesses across all stages of development; more fully understand the manifestations of mental disorders; and investigate potentially effective treatments.

Mental status examination way of observing and describing a patients current state of mind

The mental status examination or mental state 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.

The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the "golden standard" that all assessments of psychotic behavioral disorders should follow.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

The trauma model of mental disorders, or trauma model of psychopathology, emphasises the effects of physical, sexual and psychological trauma as key causal factors in the development of psychiatric disorders, including depression and anxiety as well as psychosis, whether the trauma is experienced in childhood or adulthood. It conceptualises victims as having understandable reactions to traumatic events rather than suffering from mental illness.

Grandiose delusions psychopathological condition (that is, when an individual believes that he has exceptional abilities, fame, wealth, or omnipotence)

Grandiose delusions (GD), delusions of grandeur, expansive delusions are a subtype of delusion that occur in patients suffering from a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. About 10% of healthy people experience grandiose thoughts but do not meet full criteria for a diagnosis of GD.

The sense of agency (SA), or sense of control, is the subjective awareness of initiating, executing, and controlling one's own volitional actions in the world. It is the pre-reflective awareness or implicit sense that it is I who is executing bodily movement(s) or thinking thoughts. In normal, non-pathological experience, the SA is tightly integrated with one's "sense of ownership" (SO), which is the pre-reflective awareness or implicit sense that one is the owner of an action, movement or thought. If someone else were to move your arm you would certainly have sensed that it were your arm that moved and thus a sense of ownership (SO) for that movement. However, you would not have felt that you were the author of the movement; you would not have a sense of agency (SA).

Childhood schizophrenia is a schizophrenia spectrum disorder that is characterized by hallucinations, disorganized speech, delusions, catatonic behavior and "negative symptoms", such as inappropriate or blunted affect and avolition with onset before 13 years of age. The term "childhood-onset schizophrenia" and "very early-onset schizophrenia" are used to identify patients in whom the disorder manifests before the age of 13.

A religious delusion is any delusion involving religious themes or subject matter. Though some psychologists have characterized all or nearly all religion as delusion, others focus solely on a denial of any spiritual cause of symptoms exhibited by a patient and look for other answers relating to a chemical imbalance in the brain.

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 auditory and/or visual hallucinations, and those with schizophrenia commonly report similar hallucinations, along with a variety of beliefs that are commonly recognized by modern medical practitioners as delusional. In general, religion has been found to have "both a protective and a risk increasing effect" for schizophrenia.

A self-disorder, also called ipseity disturbance, is a psychological phenomenon of disruption or diminishing of a person's sense of minimal self. The sense of minimal self refers to the very basic sense of having experiences that are one's own; it has no properties, unlike the more extended sense of self, the narrative self, which is characterized by the person's reflections on themselves as a person, things they like, their identity, and other aspects that are the result of reflection on one's self. Disturbances in the sense of minimal self, as measured by the Examination of Anomalous Self-Experience (EASE), aggregate in the schizophrenia spectrum disorders, to include schizotypal personality disorder, and distinguish them from other conditions such as psychotic bipolar disorder and borderline personality disorder.

References

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