Thought & Speech › Thought Alienation

Thought Withdrawal

In thought withdrawal, the person finds that while they are thinking, their thoughts suddenly vanish, taken from their mind by an outside force, rather than simply trailing off or being forgotten. The felt cause is the crucial detail: the person attributes the disappearance to an external agency, not to their own distraction or a lapse of concentration.

This has traditionally been discussed as a possible subjective counterpart to thought blocking, in the sense that both involve an abrupt interruption in the flow of thought — but they are understood quite differently by the person having the experience, since thought withdrawal carries an explicit attribution of external interference that thought blocking does not.

Also known as

Thought deprivation

An alternative name for the same experience, emphasising the sense of thoughts being taken away rather than actively removed by an external force.

Recognition features

• A sudden disappearance of a thought while it is being thought, rather than a gradual fading or ordinary forgetting
• The person attributes the disappearance to an outside force actively removing the thought, rather than to their own distraction or lapse in concentration
• May be accompanied by a specific belief about who or what is responsible
• Often experienced as distressing, particularly when the person retains some insight into how unusual the experience is

Eliciting it at interview

• Ask specifically about the felt cause of any blank spells in thinking: "When your thoughts stop like that, does it feel like they've just gone, or does it feel like something has taken them away from you?"
• Compare carefully with the person's account of ordinary distraction or thought blocking, since the distinguishing feature is the attribution to an outside agency rather than the abruptness of the stop itself
• Explore whether a specific external cause is named, and record the account in the person's own words

Distinguishing features

• Differs from thought blocking in the attribution of cause: thought blocking is experienced as an unexplained blank, while thought withdrawal carries an explicit sense of active external removal
• Differs from thought insertion, which involves foreign thoughts being added rather than the person's own thoughts being taken away
• The presence or absence of a felt external agent is the single most useful distinguishing detail when the surface presentation (a sudden gap in thinking) looks similar across these related phenomena

Common misconceptions

• That thought withdrawal is simply a more dramatic way of describing thought blocking; the two are distinguished by whether an outside force is implicated, which is a meaningful clinical distinction
• That any report of 'losing my thoughts' indicates this specific symptom; careful, open questioning about the felt cause is needed before applying the label

Related phenomena

Thought Alienation · Thought Blocking · Thought Insertion

Diagnostically relevant to

Schizophrenia (links open the DSM-5 Learning Lab)

Practice this

A patient describes that, mid-thought, his thinking suddenly and completely vanishes, and he is certain this happened because an outside force actively took the thought out of his mind, rather than him simply losing his train of thought. What is this? · A patient describes his mind suddenly going blank mid-sentence, with no thought there at all where a moment before there had been one — but when asked what caused it, he simply says he doesn't know, it just happened, with no sense of anyone or anything taking it from him. Before revealing the answer: is this thought withdrawal? · A patient describes a disturbing sense that something is being taken away or controlled by an outside force. Before revealing the answer, decide what distinguishes a passivity phenomenon from thought withdrawal. · A patient stops speaking abruptly mid-sentence and cannot say what they were about to say. Before revealing the answer, decide: what single question would tell you whether this is thought blocking or thought withdrawal? · A patient describes a disturbance affecting the contents of his own mind, attributed to an outside force. Before revealing the answer, decide what distinguishes thought withdrawal from thought insertion. · A patient describes a sudden gap in his thinking. Before revealing the answer, decide how you would explore whether this is thought withdrawal. · Explain why the presence or absence of a felt external agent is described as the single most useful detail for distinguishing thought withdrawal from superficially similar experiences.

Illustration

A 29-year-old woman describes being halfway through a thought about her sister's visit when it was, in her words, "pulled straight out of my head" by a force she cannot name but is certain was not of her own doing, an experience quite different, she insists, from ordinary forgetfulness, which she also experiences from time to time and can easily tell apart from this.

References

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