Patients with thought deprivation experience ego dysfunction. They think that their own thoughts are being brought to a halt by outside forces. Thought withdrawal is a common symptom of schizophrenia and is often accompanied by derealization.
What is thought withdrawal?
In the context of a psychotic state, patients often report what is called thought withdrawal. This thought withdrawal is considered a positive symptom in the context of various diseases of the psyche and is referred to as ego disorder. Those affected subjectively experience themselves as influenced by others in the context of various illnesses. They think they experience their own thoughts as absent in certain situations. They often also report that their thoughts simply stall or are brought to a halt by some force. From then on, what controls and drives them, they do not perceive as part of themselves. The subjectively felt thought deprivation can also be reflected in the language and cognitive behaviors of the affected person and only become apparent to the therapist as a result. Thus, thought deprivation is particularly often associated with erratic and systemless speech or manifests itself in communication repeatedly by an incoherent insertion. Like all positive symptoms, thought withdrawal should be seen as an excess over an objectively healthy state, close to a manifest hallucination.
Causes
Thought withdrawal usually occurs in the context of ego disorders. These are modes of experience of which the ego-environment boundary experiences a disturbance. The patient’s personal unit experience or ego experience is distorted. In addition to pure disorders of the ego-environment boundary, such as depersonalization, a lack of ability for isolated ego perception can also be described as an ego disorder. Furthermore, phenomena often occur that give one’s own experiential content the subjective flavor of manipulation at the level of thinking. In this context, the patients suffer from the experience of being influenced by others. If the ego disorder is purely an ego-perception disorder in the sense of experiencing external influence, the symptoms are usually associated with delusions or at least show a smooth transition to them. Disturbed behavior of the affected person is the consequence. Especially in the experience of being influenced by others, withdrawal of thoughts is a common symptom. Instead of being able to control oneself with one’s own thoughts, those affected experience themselves as if remote-controlled. Such ego disorders with thought withdrawal occur increasingly in the context of schizophrenia. Thought withdrawal is therefore referred to as a positive symptom of this disorder.
Symptoms, complaints, and signs
Even the thoughts of healthy people are not completed in certain situations. As an example, declining concentration may make it difficult to follow up on individual thoughts. Thought withdrawal has nothing to do with these physiologically normal forms. Rather, thought deprivation is a type of delusion that is necessarily accompanied by the idea of extraneous influence. The affected persons think that a power of whatever kind brings their thoughts to a standstill in order to control them in their behaviors and their ways of thinking. Often this power is concretized by the patients. Those affected often call it by other people’s names, describe it as Satan, interpret it as an alien or secret service. If there is no extraneous influence experience, we cannot definitely speak of the symptom of thought deprivation. In most cases, people with thought deprivation suffer from accompanying symptoms such as depersonalization or derealization. For example, they often generally experience their environment as distorted or distant. In some cases, they also experience their own body parts or their entire body as alienated. Thus, they often no longer experience the environment as reality. Outwardly, strong distrust and attempts to seal oneself off from the supposed mind-reading may indicate thought deprivation. Possibly the affected person confronts his environment directly with a corresponding reproach. In all cases, however, it is important to also consider alternative explanations for this behavior and not automatically assume thought withdrawal.
Diagnosis and course
The diagnosis of thought withdrawal is made by the psychologist or psychotherapist. In the larger context, the diagnosed symptom of thought withdrawal serves as evidence of ego disorder, so mostly as evidence of schizophrenia.The prognosis for people with thought withdrawal depends strongly on the primary cause. To the extent that schizophrenic delusions cause the symptom, a relatively unfavorable prognosis applies. Schizophrenia is difficult to treat because of the ego syntonia associated with it, as patients suffer from an inability to see their own delusions and illness.
When should you see a doctor?
If the affected person repeatedly exhibits abnormal behavior that is perceived by people in the environment as being off the norm, a doctor should be consulted. If delusions set in, if the affected person’s ways of thinking and acting cannot be understood by those close to him or her, or if the affected person makes confused statements, a doctor is needed. If thoughts are not thought through to the end in a continuous form in different situations, this is considered unusual and should be clarified medically. If there are strong fluctuations in concentration or if interruptions in attention occur, a visit to the doctor is necessary. As soon as the feeling sets in that one’s own thoughts are being controlled, interrupted or regulated by an external body, it is advisable to consult a doctor. The perception of an external influence on one’s own experience as well as cognitions is considered to be worrying and must be medically examined as well as treated. If the affected person lacks a connection to the immediate environment or if the own body is perceived as not belonging, a doctor is needed so that the cause can be clarified. In the case of derealization, the affected person needs help and must therefore be presented to a doctor. If further behavioral abnormalities can be observed, such as an aggressive demeanor, disturbed actions, as well as memory disorders, these should be examined by a physician.
Treatment and therapy
Treatment of patients with thought withdrawal is usually equivalent to treatment of the primary cause. Antipsychotics have been established for the treatment of schizophrenia patients. In cognitive therapy, the patient is ideally given a new perspective on his or her own thoughts, which are perceived as strange. The goal of therapy is to question opinions and judgments regarding the content of thoughts and their attribution to external sources. As soon as patients no longer perceive their thoughts as alien thoughts, an improvement in thought withdrawal sets in. Nevertheless, schizophrenia in particular is characterized by associative loosening. This means that the patient’s thought patterns and cognitive brain processes become alienated and gradually turn into manifest delusions, often without any discernible systemic context. Since patients usually refuse to accept their delusions as such, psychotherapies and all other forms of talk therapy often do not lead to the desired goal. Drug treatment thus often remains the only sensible therapeutic option. Cure from manifest schizophrenia is hardly achievable. However, the schizophrenic episodes including thought withdrawal can be mitigated and sometimes even delayed by antipsychotics.
Outlook and prognosis
The prognosis in the presence of imagined external thought withdrawal is relatively poor. Affected individuals usually suffer from impaired ego perception. Because the cause of imagined thought withdrawal is often found in schizophrenic delusions, treatment is difficult. Sufferers lack insight into the nature of their disorder. Thought withdrawal is not the sole feature of the disorder. A positive prognosis would be possible if the underlying disorder is successfully treated. Statistics state that about 60 to 80 percent of schizophrenia sufferers experience recurrent episodes of schizophrenia. This often means that the assumed thought withdrawal is re-established. It is true that in the clinical field, treatment options have improved considerably. Schizophrenia can be treated with antipsychotics or neuroleptics. The relapse rates that used to occur have been reduced by 40-50 percent. Nevertheless, the prognosis remains relatively unfavorable. Those affected commit suicide more frequently on average. Depressive symptomatology increases the feeling of thought deprivation in sufferers due to inexplicable external intervention. The younger and socially better off the sufferers are, the higher their risks of not being able to cope with the perceived thought withdrawal. However, a more favorable course is also possible.With early initiation of therapy, consolidated living arrangements, a supportive partner, and avoidance of stress to the extent possible, thought withdrawal as a symptom of schizophrenic disorder can be managed and successfully treated.
Prevention
Thought withdrawal can be prevented only to the extent that the causative ego disorders can be prevented. Comprehensive preventive measures are hardly available specifically for schizophrenia, since numerous individual factors play a role in the disorder in addition to genetic disposition and psychosocial factors.
Aftercare
Depending on what triggered the thought withdrawal as a result of psychosis, aftercare would have to be designed according to the symptomatology and the causative factor. For example, if drug addiction existed as the cause of the thought withdrawal, drug withdrawal is probably not sufficient. Psychiatric aftercare and admission to the methadone program would be recommended. Experience has shown that there is a high relapse rate and the thought withdrawal could therefore also recur. If there is a psychotic disorder or schizophrenia with a different cause, the treatment is different. Here, too, long-term treatment and monitoring of the affected person is advisable. However, a clearly defined diagnosis is important. The withdrawal of thoughts must be caused by external influence. Since such illnesses often occur in episodes, the chance of recovery is usually low. The insight into the illness is missing in schizophrenic delusions. Therefore, treatment is usually discontinued, not supported or undermined. Consequently, this also makes follow-up more difficult. Antipsychotics can make treatment possible. They alleviate the symptoms. But they can do nothing against the disease itself. Aftercare could be cognitive or behavioral therapy. But this would have to be long-term. It requires the patient to participate. In view of the clinical picture of schizophrenia, this is rather unlikely. Therefore, the patients see their delusions as real and lack any insight and willingness to cooperate.
