A circumstantial thought process is also known as circumstantiality. It's when you include a lot of unneeded and unimportant details when you talk or write. This takes away from the main point that you're trying to get across. The extra details and information make it hard for people to follow.
There are lots of reasons why you might have circumstantial thinking. They range from developmental disorders to many different mental health conditions. You won't know for sure until you talk to a doctor.
Circumstantial vs. Tangential Thought Process
A similar, more extreme type of thought pattern is called tangentiality. People who have it go very far from the main point they're trying to make. They don't ever reach their main point or give a direct answer to a question.
With circumstantiality, your speech rambles and goes off-topic, too. But there are often connections between everything you bring up. And while it can be hard for someone to follow your train of thought, you'll eventually answer their question or provide a main point.
Here's an example. If you ask a stranger if you can pet their dog, you'll probably expect a "yes" or "no" answer. Someone with a tangential thought process may say many different things that have nothing to do with their dog. Your question will go unanswered.
If you ask "Can I pet your dog?" to someone with a circumstantial thought process, they could also bring up many different topics. But what they say may feel more connected to your question. For instance, the person may explain the kind of dog they have, recount a story about how they never liked dogs as a kid but now they do, tell you which type of dog food they buy and why, and so on, before saying whether or not you can pet their dog.
Symptoms of a Circumstantial Thought Process
Circumstantiality can cause you to:
- Include a lot of unwanted details.
- Talk about things that are related to the subject but not important.
- Tell stories that are only slightly related to the subject.
- Answer questions with a lot more detail than is needed.
- Return to the main point only after talking about a lot of other things.
Causes of a Circumstantial Thought Process
What makes a thought process circumstantial? Doctors don't know exactly. It can happen for many different reasons, including when you have a mood or thought disorder, such as schizoaffective or bipolar disorder.
Schizoaffective disorder affects how you think, feel, and act. You have symptoms of schizophrenia, such as hallucinations, along with very high or very low moods.
Bipolar disorder used to be called manic depression. It's a mood disorder that can also cause you to have extreme mood swings.
Usually, your brain filters and prioritizes information to help you pay attention to what's important. But that filter can get turned off when you have the type of mania that happens with schizoaffective and bipolar disorders. This can make everything seem important.
Mania happens when you have extremely high energy. It's not just being in a good mood. It's very different from the way you usually think or act. Some other symptoms of mania include:
- Feeling high
- Feeling unstoppable
- Not being able to sleep
- Being impulsive
- Acting strange
- Feeling extremely anxious
- Getting easily annoyed
- Feeling like the people and things around you aren't real
Many other conditions can also lead to a circumstantial thought process. They include:
- Obsessive-compulsive disorder (OCD)
- Attention deficit hyperactivity disorder (ADHD)
- Autism
- Epilepsy
- Complex partial seizures
- Traumatic brain injury (TBI)
- Anxiety disorders
- Psychosis
- Developmental disorder
It's also possible to have circumstantiality without being diagnosed with another condition. A lot of people have unusual language patterns. Rambling speech alone isn't enough to diagnose any disorder. It could just be the way you naturally talk.
Circumstantial Thought Process Diagnosis
There are different types of thought disorders. To figure out which one you have, your doctor will talk to you about your symptoms and your medical history. To get a sense of your current health and rule out any physical conditions, they may start with the basics, such as:
- A physical exam
- Blood work
To assess your mental health, your doctor will take the following into account:
Appearance. For instance, many people who have developmental delays look much younger than their actual age.
Behavior. With your doctor's help, can the conversation get back on track? If you're in a manic phase because of a mental health condition, that's unlikely.
Motor activity. Your movements can reveal a lot about your mental health. For example, moving faster than normal can be a sign of mania. If you have ADHD, you may struggle to sit still.
Speech. Talking more and faster than usual can also be a sign of mania. If you're anxious, you may also be what doctors call "hyperverbal."
Mood. Your doctor may ask you to describe how you feel in your own words.
Affect. Your "affect" is how you present yourself to the world. For instance, do you seem happy, sad, anxious, or irritated?
Thought processes. How do you organize your thoughts? Can you go from point A to point B when you talk, or not?
Thought content. Your doctor will take note if you seem preoccupied with a certain topic and keep returning to it. They'll consider whether your thought is about something real, or about something that doesn't exist but feels real to you.
Perceptions. If you hear voices or see things that other people can't, it's important to tell your doctor.
Cognition. How alert are you? Can you focus on the task at hand? Do you know who you are and where you are?
Insight. How aware are you of your symptoms? For instance, do you feel like you ramble when you talk?
Judgment. How sound are your decisions right now? For instance, maybe you're not taking a prescribed drug that's supposed to manage your mood disorder.
Your doctor may refer you to a mental health expert if they suspect you have a thought disorder such as schizophrenia. If so, more tests may be done. Two of the most common are:
Rorschach test. This is also called the inkblot test. You'll look at 10 different inkblots and describe what you see. Your doctor will analyze your answers to help understand your thought processes.
Thought Disorder Index (TDI). The person who rates the test will look at a word-for-word transcript of a conversation you've had and score each instance of disordered thinking on a scale of 0 to 1 that ranges from "mild" to "severe".
For instance, if you misuse a word, like people often do when they're anxious or tired, that might rate "0.25." Getting off-base from the topic or saying something that's distinctly odd is usually considered "0.5." A score of "1" applies to a complete break from reality.
The TDI can be used with the Rorschach test or an open-ended conversation.
Treatment for Circumstantial Thought Process
The treatment for circumstantiality depends on:
- What's causing it
- How severe it is
- What works for you
Your treatment options could include:
Medicines. Psychiatric medicines may help improve your symptoms and help other kinds of treatments work better. Your doctor will work with you to figure out the best type of medicine for your condition. Some types of psychiatric medications include:
- Anti-anxiety medicines, which can help slow down your nervous system, control your "fight or flight" response, or increase different "feel good" chemicals in your brain
- Antidepressants, which alter different brain chemicals to better manage your mood and behavior
- Antipsychotic medicines, which treat symptoms of psychosis by adjusting how your brain uses different neurotransmitters
- Mood stabilizers, which can help level out the extreme highs and lows that happen with bipolar disorder and some other mental health conditions
Psychotherapy. This is also called talk therapy. Several different kinds can help improve how you feel from day to day. The therapy can be short-term or long-term. Some types of psychotherapy can teach you to manage negative thought patterns and behaviors you might not even be aware of.
Residential treatment. In some cases, your doctor may suggest more intense treatment. This can be a good choice if you can't take care of yourself or you're in danger of harming yourself or others. Being in a psychiatric hospital or residential treatment program can provide round-the-clock support and more intense care until you get better.
Other types of therapy. If your thought process is caused by autism or a cognitive disability, you may benefit from other types of therapy. These can include:
- Behavioral therapy, which can help reinforce behaviors you want to see more of and reduce others that you don't
- Occupational therapy, to help you overcome social, emotional, and physical challenges in your daily life
- Speech therapy, to help you learn better ways to speak and communicate with others
Lifestyle Changes to Help Circumstantiality
In most cases, you'll need a doctor's help if you have a thought disorder. But there are some things that you can do to help yourself feel better and help your treatment work better. For instance, you can:
Follow your treatment plan. That includes taking all medications exactly as prescribed and going to all follow-up visits with your doctor.
Stay physically active. Not only is exercise good for your overall health, but it also helps keep your stress levels in check. If you're not sure how to start, ask your doctor for some tips.
Stay away from tobacco, recreational drugs, and alcohol. They can worsen your symptoms or interfere with medications that are trying to treat your condition.
Keep a regular schedule. Knowing what you're doing each day and at what time can help prevent you from feeling overwhelmed.
Eat a healthy diet. Try to eat lots of fruits and vegetables, lean protein such as chicken, healthy fats (such as olive oil), and omega-3 fatty acids. When you can, cut back on processed foods that you buy in boxes and packages.
Find support. Know people you can confide in when you start to feel overwhelmed. Besides friends and family members, you may also want to join a support group. Ask your doctor if they can suggest one.
Manage your stress. You can't get rid of all the stress in your life, but you can learn to manage it better. That could mean learning how to meditate, taking yoga classes, or trying deep breathing exercises. Also, try to regularly make time for activities and people that make you happy.
Takeaways
Circumstantiality means that you have a rambling way of talking, writing, and thinking that is hard for people to follow. It can happen because of many different conditions, including a traumatic brain injury, ADHD, or schizophrenia, but you could also talk this way naturally. Your doctor can help you determine the cause and suggest a treatment if needed.
Circumstantial Thought Process FAQs
What is an example of an incoherent thought process?
Thought disorders occur on a spectrum. An incoherent thought process is on the severe part of the spectrum. Someone who thinks this way may string unrelated words together in a way that doesn't make sense to others. Experts sometimes describe this as "word salad." It's often seen in people with schizophrenia. Another term for it is "schizaphasia."
Treatment can help make your speech more coherent, but everyone is different. Your symptoms may return from time to time or not go away completely. Finding a doctor you trust and see regularly will be key.
