Thought & Speech

Neologism

A neologism is a new word, either entirely invented or an ordinary word used with a new and idiosyncratic meaning. In psychiatric usage the term is applied particularly to new word formations produced by people with schizophrenia, and the underlying reason for a given neologism can vary — from an attempt to name a genuinely indescribable private experience, to a word blend produced by disordered thought, to influence from hallucinatory voices.

This has traditionally been carefully distinguished from paraphasia, in which a person with aphasia uses a wrong word, invents a superficially similar new one, or distorts a word's sound as a result of a language disorder, even though the surface appearance of both can look similar.

Also known as

Technical neologism

A newly invented word coined specifically to describe a private, unusual experience that has no adequate word in ordinary language.

Recognition features

• A word that is either wholly new or an existing word used with an idiosyncratic, non-standard meaning
• The person may or may not be able to explain what the new word means
• Can arise for several different underlying reasons: naming a private experience, a blend produced by disordered thought, or the influence of hallucinatory voices
• May also occur as a distorted-pronunciation mannerism in catatonic presentations, alongside other stereotyped speech and movement

Eliciting it at interview

• When an unfamiliar word is used, ask directly what it means and where it came from, since the explanation itself is clinically informative
• Ask whether voices or other unusual experiences played any part in the word's origin, given the recognised link between neologisms and hallucinatory content in some patients
• Note whether the new word appears to be a garbled version of an existing word (suggesting a link to formal thought disorder) or an entirely original coinage for an indescribable experience

Distinguishing features

• Differs from paraphasia, which arises from a language disorder such as aphasia rather than from psychotic thought content
• Differs from a malapropism, which is a conspicuously misused but ordinary word, generally without particular psychiatric significance
• A technical neologism, coined for a private, otherwise indescribable experience, differs from other neologisms in having a specific, functional purpose for the person using it

Common misconceptions

• That any unfamiliar or invented-sounding word is clinically significant; ordinary slang, invented pet names, and playful wordplay are common in everyday speech and are not neologisms in the psychiatric sense
• That all neologisms in psychiatric illness mean the same thing; the underlying process generating the new word varies and is worth exploring rather than assuming

Related phenomena

Paraphasia · Formal Thought Disorder

Diagnostically relevant to

Schizophrenia (links open the DSM-5 Learning Lab)

Practice this

A patient with a longstanding psychotic illness repeatedly uses the word 'plimtosis' to describe a private, hard-to-put-into-words inner experience, using it consistently across several conversations. When asked, he offers an explanation of what he means by it, though the word itself is not a real one. What is this? · A man with a known stroke affecting language areas produces the word 'spron' when trying to say 'spoon', consistently substituting similar-sounding but incorrect words throughout the interview, with no evidence of psychotic symptoms and clear frustration at his own errors. Before revealing the answer: is this a neologism? · A patient uses an unusual, non-standard word. Before revealing the answer, decide what distinguishes a neologism from a paraphasia. · A patient has used an unfamiliar word during the interview and you want to establish whether it is a neologism. Before revealing the answer, decide how you would explore this. · Explain why a technical neologism, coined to name a private experience, is considered clinically distinct from other neologisms arising from disordered thought.

Illustration

A young man with schizophrenia repeatedly refers to a specific, distressing bodily sensation he experiences as "grellification," a word he insists he had to invent himself because, in his words, "there isn't a real word for what it feels like," and he uses the term consistently across multiple conversations to describe the same experience.

References

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