“What was it like… that thing we use to eat soups or creams, so round at the tip?” The word that comes to most people’s mind is “spoon”.

It is a name, a label that refers to a certain concept that the person who has asked the question knows, but cannot access. And although it is usually a momentary lapse, sometimes we are faced with a frequent event in which the individual does not remember the name of things. This is the language disorder called anomie .

Anomie: description and symptoms

The concept of anomie refers to the presence of difficulties in naming an object or concept , that is, in accessing or producing the name or label with which we designate it. It is a problem that can appear in many circumstances, being in some cases something normal as it happens before a lapse or during the aging while in others it can be a symptom of a more or less important alteration. The difficulty is mainly found in the use of nouns, being more uncommon that there are problems with verbs, adjectives or adverbs.

Usually the person with anomie tends to use circumlocutions to make the receiver of his message understand what he intends to say, using for example semantic keys such as what the object in question is used for, its form or what happens during such situation or phenomenon. It is also common to use crutches and expressions to gain time, or more general categories that include the concept with which they have difficulty (if they are not able to access the name “dog” they can say for example “animal”).

Patients and subjects who frequently present anomie tend to live it with discomfort or even concern , since most are fully aware of what they want to say despite not finding the way to represent it.

Types of anomie

Although anomie tends to be considered as a whole, the truth is that there are several aspects that may cause one not to remember or to be able to issue a specific name. There are three main types of anomie.

1. Lexical Anomie

The purest and best known form of anemia, is when the element that fails is the possibility to access the word despite knowing clearly what it refers to . It is not that I don’t know how to pronounce the word or what concept it refers to, but that I don’t know how to represent the label itself in my mind. This is the type of anomie corresponding to the example in the introduction.

2. Phonological Anomie

This type of anomie occurs when, despite knowing what concept he wants to refer to and what his name is , the subject is not able to find its representation at a phonetic level, not knowing what he must say to name it. It is frequent in the aphasias in which the production of language is altered, as in Broca’s.

3. Semantic Anomie

The problem in this type of anomie is at the moment of conceptualizing, there being cognitive and memoristic problems . It is not that he could not pronounce the words or that he could not find the right label for a concept, but that he is not able to identify it.

Anomie in aphasias

Anomie is a common symptom present in many aphasias, those alterations and losses of the ability to produce and/or understand language caused by brain injury.

However, while it is usually one of many symptoms that occur in different types of aphasia, if it appears without other language impairment it may constitute so-called anomic aphasia. This type of aphasia is characterised by the fact that the person’s language is fluent , there are no difficulties in understanding the language and if the person is asked to repeat the same words he or she does so without difficulty. Thus, the only perceptible alteration is anomie.

The anomic aphasia also corresponds to the semantic aphasia of the classification proposed by Luria, although there are nuances that separate them. In this case the ability to name and find the word in question is altered because the subject is not able to choose between different options, presenting other problems such as the difficulty to understand complex relationships at a logical level.

Another type of aphasia especially linked to anomie is the semantic acoustic-amnestic aphasia, in which the subject does not remember the phonetic form of the word in question that he wants to use. He knows what it is but not how it is said, presenting also problems when storing and replicating series of words.

Contexts and causes of appearance

Anomie can appear in multiple contexts, not all of which are clinical. For example, in the phenomenon of the tip of the tongue there is a difficulty in remembering a word, although the problem is more one of memory than one of language (we would be dealing with a case of lexical anomie). Likewise, with age it is common to suffer a certain degree of anomie due to the aging of the brain

On a clinical level, anomie can appear in a large number of mental and organic disorders. Of particular relevance is the presence of lesions in different areas of the brain linked to language. The most related to anomie are Broca’s areas from 37 to 39 (including the angular gyrus) and other areas of tertiary association of the parieto-temporal-occipital zone. Likewise, if the problem is found in the formulation or choice of the concept, there is also a great influence of the frontal lobe.

Such injuries and alterations are frequent in head injuries and strokes . Their appearance is also very frequent in dementias, such as Alzheimer’s or some frontotemporal ones such as semantic dementia.

Treatment

In cases where the problem is not a slight lapse but a truly anomic subject , the treatment to be applied will depend largely on where the problem is. In any case, rehabilitation tends to be required from a multidisciplinary perspective, in which the role of speech therapy will be highlighted through the use of speech therapy. In other cases, especially those derived from dementia, occupational therapy can be very useful.

Among the activities to be applied, the use of matching tasks between drawings and words or tasks in which they must judge whether or not different words are synonymous in cases of semantic anomie has been shown to be successful, and in the case of pure or lexical anomie, the use of tasks in which phonetic clues can be used, as well as priming (first the word is presented and then the drawing of the concept or element), tasks of completing words and/or sentences or generating rhymes. In cases of phonological anomie, reading aloud and imitation and repetition tasks are usually useful .

Bibliographic references:

  • Castejón, L. and Cuetos, F. (2006). The rehabilitation of anomie from a multidimensional perspective. Journal of Speech Therapy, Phoniatrics and Audiology 26 (2); 101-114.
  • Cuetos, F. (2003). Anomia: The difficulty of remembering words. Madrid: TEA Ediciones.
  • Santos, J.L. (2012). Psychopathology. CEDE PIR Preparation Manual, 01. Madrid.