Expressive vs Receptive vs Nominal Aphasia

All three are language disturbances grouped under aphasia, but they break down at different points in the chain from understanding language to producing it. Expressive aphasia disrupts putting thoughts into words, receptive aphasia disrupts understanding language in the first place, and nominal aphasia is a narrower difficulty confined specifically to naming.

Distinguishing table

Dimension	Expressive Aphasia	Receptive Aphasia	Nominal Aphasia
Core deficit	Difficulty putting thoughts into words, despite knowing what one wants to say	Difficulty understanding language, spoken or written, rather than producing it	A specific difficulty naming objects, despite an otherwise full vocabulary
Comprehension of language	Typically intact — the person understands what is said to them	Impaired — this is the primary deficit	Intact, aside from the specific naming difficulty itself
Fluency of speech production	Reduced, ranging from mild word-finding trouble and mispronunciation to, in severe cases, speech restricted to a handful of fixed phrases	Can remain superficially fluent, since the disturbance lies in understanding rather than producing language	Otherwise fluent and grammatically intact, aside from the naming gaps themselves
Scope of the difficulty	Broad — affects the general production of spoken language	Broad — covers several specific forms (pure word deafness, agnostic alexia, visual asymbolia), each tied to a different pattern of brain injury	Narrow — the single dominant feature is a difficulty naming objects, more circumscribed than the other two
Typical example	A patient clearly wants to describe what happened to them but can only produce broken, halting fragments of the sentence	A patient speaks fluently but the content makes little sense, and they cannot follow simple spoken instructions	A patient describes the function of an everyday object in detail ("the thing you write with") but cannot supply its name, "pen"

Clarifying questions

Do you understand what I'm saying to you right now, even if it's hard to answer back?
Intact comprehension with impaired production points to expressive aphasia; impaired comprehension points to receptive aphasia.
When you're struggling for a word, is it mainly the names of specific objects, or is putting any kind of sentence together difficult?
A difficulty confined specifically to naming objects, with otherwise fluent, grammatical speech, points to nominal aphasia rather than a broader expressive aphasia.
Can you follow a short spoken instruction, like picking up an object and putting it somewhere?
Directly tests comprehension, the defining deficit in receptive aphasia, separating it from the other two forms where comprehension is preserved.

Common student confusion

Students often assume any aphasia that involves 'trouble finding words' must be the same thing, without checking whether comprehension is also affected or whether the difficulty is confined to naming alone. The quickest sorting test is comprehension: intact comprehension plus effortful production is expressive aphasia (or, if the trouble is narrowly confined to naming, nominal aphasia); impaired comprehension, however fluent the speech sounds, is receptive aphasia.

Read each in full

Expressive Aphasia · Receptive Aphasia · Nominal Aphasia

References

Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.