Concrete thinking is a problem associated with various psychiatric disorders such as schizophrenia. It is defined as inability to think in abstract terms. Abstractions and symbols are interpreted superficially without fact, finesse or any awareness of nuance. The person is unable to free himself from what the words literally means. In the process, excludes more abstract ideas.
In addition to schizophrenia, concrete thinking can be seen in coarse brain disorders and learning disability.
This can be tested using proverbs. Person with concrete thinking would not be able to perform proverb testing tasks. However, testing should be done carefully, because people with poor educational background will not be able to perform proverb testing which results in a wrong impression.
However, concrete thinking in schizophrenia can be diagnosed easily because of other symptoms of it. In addition, concrete thinking seen in schizophrenia is incorporated into the diagnostic guidelines as part of formal thought disorder. But the weight given to it in practice is much less and usually schizophrenia should be diagnosed by other psychiatric symptoms of schizophrenia.
Sources
Symptoms of mind by Andrew sims
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Very interesting blog. I am always confused about these two terms, I mean abstract vs concrete thinking. Can you interpret abstract and concrete thinking as the two extremes of the thinking process of human being? Or to put it simply, is concrete thinking "abnormal"? BTW, thank you for writing the blog.:-)
ReplyDeleteBandaralk,
ReplyDeleteThanks for the comment,
According to my knowledge, concrete thinking can be abnormal, if it occurs persistently in adults.
One of our teachers used to ask during lectures "what is the matter at hand", while keeping the pen in his palm. Most of the students used to say " a pen", So that would be concrete thinking, But by saying something like "Understanding the a lecture or following a lecture" would be considered as abstract thinking.
Concrete thinking could occur in schizophrenia, organic brain disorders. In addition, it could be seen in children under 11 years age.
However, concrete thinking should be assessed carefully in a person who do not have a proper education, due to obvious reasons.
I like your example of concrete thinking, Dr Nanayakkara.
ReplyDeleteJust wanted to add that concrete thinking is also associate with Asperger's/Asperger's spectrum disorder. I interviewed once a person who I suspected of ASD. I wanted to ask about their ability to understand other people's emotions, feelings, points of view etc, and I asked if they found difficult to put themselves in somebody else's shoes. The person looked at my shoes and then at me and said 'I don't like your shoes. I wouldn't wear them.' This is another example of concrete thinking. And I've learnt my lesson re invterviewing people with ASD :)
In another example one of our examiners ask the candidate,
ReplyDeleteWhat is concrete thinking
Candidate answered,
Thinking as hard as concrete
Hello,
ReplyDeleteAccording to the following journal article, concrete thinking is common among "process schizophrenia". Also, it seems to be a diagnostic criteria as well. Doesn't the DSM use concrete thinking as one diagnostic criteria of schizophrenia?
Harrow, Martin PhD; Alder, David MD; Hanf Edif MSW. Abstract and Concrete Thinking in Schizophrenia During the Prechronic Phases, 1974. Arch Gen Psychiatry[online]. July 2012. vol. 31(1). pp. 27-33. Available from: http://archpsyc.jamanetwork.com/article.aspx?articleid=491163 doi:10.1001/archpsyc.1974.01760130013002
Dear Quidnunc
ReplyDeleteThank you for asking this question,
I went through the abstract of the article, It seems to be little old article and most of the diagnostic manuals do not use the word process schizophrenia term. Now it may have changed to Chronic/Negative/Simple schizophrenia.
DSM IV TR did not include concrete thinking as a diagnostic criteria for schizophrenia. It is due to the fact that concrete thinking occur in many cases of organic psychosis.
But it is very common among schizophrenia
patients.
Following are the exerpts of diagnostic criteria in DSM IV TR,
"Diagnostic criteria for Schizophrenia
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated): 1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behavior
5. negative symptoms, i.e., affective flattening, alogia, or avolition
Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.
B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
" Copyright DSM IV TR