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Speech patterns offer window into psychiatric disorders

Speech patterns offer window into psychiatric disorders

It's a scene typical of daytime talk shows, America's showcase for dysfunctional living. The woman who fell for her jailed pen pal is talking at length with no obvious purpose. The host prods for details of the romance, but every answer is exasperatingly vague. "I just love him. He's so nice to me. I like to get his letters. I like to see the mailman."

Shows like this might not seem intellectually stimulating, but listen closely to those arguments, taunts and teary confessions and you might hear a perfect illustration of a breakthrough in psychiatry. School of Medicine researchers have discovered that people with certain psychiatric disorders also have distinctive language patterns that seem to reflect fundamental problems in thinking. The speakers use vague words and usually meander through conversations as if unable to focus on the main point.

These odd speech patterns, common on daytime talk shows, provide direct evidence that many people with antisocial personality disorder and somatization disorder (once called hysteria) also have imbalances in the brain.

"Psychiatrists suspect these disorders are linked to brain chemistry, but it hasn't been proven," said Carol North, M.D., an associate professor of psychiatry and lead author of a paper in a recent issue of Comprehensive Psychiatry. "This study is one of the first to link the disorders to the functioning of the brain."

People with somatization disorder, almost always women, have never-ending complaints -- ranging from vomiting to paralysis --that can't be linked to physical illness. People with antisocial personality disorder might lie, steal and commit vandalism in childhood and progress to more serious offenses such as burglary and dealing drugs. Both disorders also seem to encourage poor decisions in friends, mates and lifestyles. A woman who marries a known wife-beater may well have one of the disorders, North said.

One or both of these disorders afflict about 8 million Americans -- 3 percent of the population. Both tend to run in families, and men with antisocial personality disorder often have female relatives with somatization disorder and vice versa.

Researchers compared the speech of 15 men and women diagnosed with one or both disorders with 10 men and women of similar ages and backgrounds who worked at a medical clinic. All of the subjects were interviewed about topics such as the weather and news of the day. North played audiotapes of the interviews to psychiatrists who didn't know the subjects or their mental-health status.

She trained the psychiatrists to keep score of different speech patterns, including vagueness and meandering sentences. A subject would earn "vague points" by saying something like "Clinton's a good guy. He does good things." If asked about the weather, a meanderer might mention his dog, his breakfast and his dentist before getting to the humidity.

The scorekeepers were able to see many real-life examples of these speech patterns before the study began. They all watched and listened to daytime talk shows as part of their preparation.

Women in the study showed strong differences in speech. Those with either antisocial disorder or somatization disorder were much more likely to use vague or meandering language. These language patterns were even more pronounced in women with both disorders.

The scorekeepers found no difference in speech patterns among the men in the study, and there was a good reason why. The men in the control group showed strong signs of antisocial personality disorder themselves, and two out of the five were actually diagnosed. "We still suspect that men with antisocial personality disorder do speak differently than other men," North said.

Malfunctioning mind

Researchers have long known that brain imbalances can alter language. People with psychoses such as schizophrenia may sound as though their sentences have been run through a blender. The jumbled speech, sometimes called "word salad" at its most extreme, clearly reflects problems with brain chemistry and thinking. North believes vague, wandering speech also indicates a malfunctioning mind, and she coined the term "nonpsychotic thought disorder" to describe the distinct language patterns of people with antisocial personality and somatization disorders. It is the first time that anyone has formally linked unusual thought processes to nonpsychotic psychiatric disorders.

"Dr. North has made a real contribution to the field," said Richard Wetzel, Ph.D., professor of neurology, of neurological surgery and of psychiatry and co-author of the study. "These are people who think things through in ways that aren't very helpful to themselves or society, and Dr. North has found a way to identify the kinds of problems they have with their thinking."

North and Wetzel hope the recognition of distinct speech patterns will help mental health specialists diagnose personality and somatization disorders. Too many people with the disorders are either labeled psychotic or aren't diagnosed at all, North said.

Paying attention to the speech of these people might even lead to better treatment, she added.

-- Chris Woolston

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