Verbal fluency in schizotypy

Less words, more words: psychometric schizotypy and verbal fluency1

Elias Tsakanikos and Cordon Claridge

Abstract
Positive and negative symptoms of schizophrenia have been differentially associated
with irregularities in verbal production, suggesting the involvement of different
underlying mechanisms in psychotic symptomatology. In view of that, the present
investigation examined whether the amount of verbal production would be also
differentially associated with negative and positive symptoms of psychometric
schizotypy in a sample of college students (N=190). The participants were tested on
a typical verbal fluency test and completed the O-LIFE schizotypy scales. The
analyses revealed that decreased verbal fluency was associated with increased levels
of negative schizotypy in participants who scored one standard deviation above the
mean on the Introvertive Anhedonia scale. In contrast, increased verbal fluency
was associated with increased levels of positive schizotypy in participants who
scored one standard deviation above the mean on the Unusual Experiences scale.
The obtained results are discussed in terms of the proposal that psychotic-like
unusual experiences, like hallucinations, may be the product of a higher automatic
spreading activation among stored lexical units, a mechanism which seems to
account for the previously reported link between positive schizotypy and creativity.
Key words: automatic spreading activation; creativity; executive functioning;
hallucinations; phonological (letter) fluency; positive/negative schizotypy; individual
differences in speech production

Abnormalities in verbal communication, such as irregularities in speech production,

are frequent in people with schizophrenia. Dramatic fluctuations between increase
(pressure of speech) and decrease (poverty of speech) in the amount of verbal
production have been related to linguistic impairments in schizophrenia, and have
been consistently associated with different aspects of the psychotic symptomatology
(Harvey, 2000). Despite the presence of a wide range of communication abnormalities
in schizophrenia, factor analytic studies have identified verbal productivity as a main
dimension of communication disorder (Harvey, Lenzenweger, Keefe, Pogge, Serper,
& Mohs, 1992).
Poor performance on verbal fluency, as assessed by the ability to generate word
lists under certain stimulus constraints, has been associated with negative symptoms
of schizophrenia, such as flat affect, anhedonia, and impoverished speech (Allen,
Liddle & Frith, 1993; Howanitz, Cicalese, & Harvey, 2000). Verbal fluency is
thought to reflect executive functioning, such as cognitive switching, rule monitoring,
and inhibition of inappropriate responses (Lezak, 1995). Impaired executive
functioning has not only been associated with deficient frontal lobe functioning in
schizophrenia (Crow, 1992), but also with frontal lobe dysfunction in other patient
1

Tsakanikos, E. & Claridge, G. (2004). Less words, more words: psychometric schizotypy and verbal
fluency. Manuscript submitted for publication.

Verbal fluency in schizotypy

groups (Beatty, Goodkin, & Beatty, 1989; Joyce & Robbins, 1991). Tests of verbal
fluency are generally considered to be sensitive to frontal lobe dysfunction (Lezak,
1995) as well.
Evidence suggests that verbal fluency is differentially affected in psychosis.
Although poor performance has been associated with negative symptomatology
(Allen et al., 1993; Howanitz et al., 2000), increased verbal fluency has been
associated with positive psychotic symptoms, such as hallucinations (Lindamer &
Whitman, 1997; Kerns, Berenbaum, Barch, Banich, & Stolar, 1999). This latter
finding is consistent with theoretical proposals that hallucinations are produced as a
result of an increased automatic spreading activation between stored lexical items
(David, 1994; Hoffman & McGlashan, 1997). People who experience hallucinations
may generate an increased amount of words during verbal fluency tests due to such an
enhanced lexical activation.
Are irregularities in verbal fluency primary or secondary features of psychosis?
Cognitive irregularities in schizophrenia can be either viewed as cognitive
endophenotypes (primary features), i.e. cognitive markers intermediating between a
putative genetic disposition and clinical symptoms, or as epiphenomena of the
psychotic symptoms, side effects due to medication, and/or effects of hospitalization
(secondary features). The presence of verbal fluency abnormalities in healthy
participants who score highly on psychometric measures of schizotypy would support
the possibility that these irregularities are primary features. On the contrary, a
negative result would suggest that these irregularities are secondary features.
Unfortunately, because of conflicting evidence in the recent literature, it is unclear
whether or not verbal fluency irregularities, akin to those associated with negative and
positive symptoms of schizophrenia, can be observed in positive and negative
schizotypy as well.
In some recent studies, positive schizotypy has been associated with increased
verbal fluency (OReilly, Dunbar, & Bentall, 2001; Weinstein & Graves, 2002).
Considering that fluency is typically regarded as a main facet of creativity, the authors
of these studies have interpreted this association as evidence of a biological link
between creativity and positive psychotic-like features (e.g. aberrant perceptual
experiences). This reported association between positive schizotypy and increased
verbal fluency (OReilly et al., 2001; Weinstein & Graves, 2002) seems to accord
with the hypothesis that hallucinations are the product of an increased automatic
spreading activation between related lexical units (David, 1994; Hoffman &
McGlashan, 1997). However, other studies have failed to demonstrate a similar
association between positive schizotypy and verbal fluency (Barrantes-Vidal,
Fananas, Rosa, Caparros, Riba, & Obiols, 2002; Dinn, Harris, Aycicegi, Greene, &
Andover, 2002). In addition, unlike the schizophrenia literature (Allen et al., 1993;
Howanitz et al., 2000), none of the above schizotypy studies (Barrantes-Vidal et al.,
2002; Dinn et al., 2002; OReilly et al., 2001; Weinstein & Graves, 2002) have
revealed any specific association between poor performance on verbal fluency and
negative schizotypy.
One possible explanation for the above inconsistent results might be related to
the sample size. With the exception of the Barrantes-Vidal et al study, which
employed a sample of adolescents with mean age = 13.4 years (a methodological
pitfall, considering that the schizotypy scales employed were designed for adults), in
studies with adults (Dinn et al., 2002; OReilly et al., 2001;Weinstein & Graves,
2002) the largest sample size was 103 participants. Therefore, the aim of the
investigation was to re-examine the relationship between verbal fluency and

Verbal fluency in schizotypy

positive/negative schizotypy in a larger adult sample. Moreover, any systematic
relationship between verbal fluency and schizotypy might not be necessarily linear.
For instance, a differential association between positive/negative schizotypy and
verbal fluency may be detectable only for the extreme scorers. Consequently, the
second aim was to look for evidence on possible non-linear markers. To evaluate the
above possibilities, 190 participants were tested on a typical verbal fluency test
(Lezak, 1995) and completed a multi-dimensional schizotypy inventory (O-LIFE;
Mason, Claridge, & Jackson, 1995).
Method
Participants
One hundred and ninety students, recruited from the University College London
(UCL) campus, took part in this study. Their mean age was 23.5 years, ninety-nine
were female, and were unpaid volunteers. English as a second language was an
exclusion criterion. Four participants were dropped from the analysis due to a large
number of unanswered questions in the O-LIFE.
Schizotypy measures
The OxfordLiverpool Inventory for Feelings and Experiences (O-LIFE) consists of
159 items selected on the basis of factor-analytic studies of older schizotypy scales
(Bentall, Claridge, & Slade, 1989; Mason et al., 1995). The inventory includes four
schizotypy measures: The Unusual Experiences (positive schizotypy) scale consists
of items assessing magical thinking, unusual perceptual aberrations, and hallucinatory
experiences. The Cognitive Disorganization (disorganized schizotypy) scale reflects
the disorganized aspect of psychosis, and consists of items assessing difficulties with
concentration, decision-making and social anxiety. The Introvertive Anhedonia
(negative schizotypy) scale reflects the negative symptoms of psychosis, and consists
of items assessing the lack of enjoyment from social contact, physical activities,
coupled with aversion to emotional and physical intimacy. Impulsive Nonconformity is largely based on the Psychoticism scale (Eysenck & Eysenck, 1975),
and consists of items assessing aggressive, anti-social and impulsive behaviour.
Attesting to the experimental validity of these scales, high-schizotypy scorers, as
identified by the O-LIFE sub-scales, demonstrate neuro-cognitive deficits akin to
those seen in schizophrenic patients (Steel, Hemsley, & Jones, 1996; Rawlings &
Goldberg, 2001; Tsakanikos & Reed, 2003).
Verbal fluency
A phonological (letter) fluency task, frequently used in neuropsychological research
(Lezak, 1995), was employed to assess verbal fluency. The task consisted of three 1
min trials. In each trial, the participants were asked to generate as many words as
possible that started with a certain letter (C, F, and L), avoiding names, non-English
words, and derivatives of the same word. The total number of correct responses
generated was the dependent measure.
Results
-------------------------Table 1 about here
--------------------------

Verbal fluency in schizotypy

Data from Table 1 presents the means, the standard deviations, and the intercorrelations between the O-LIFE scales, and verbal fluency. In terms of the O-LIFE
scales, the overall pattern (inter-correlation and descriptive statistics) appeared similar
to that reported in the original study (Mason et al., 1995), as well as to that reported in
later studies (e.g., Rawlings & Goldberg, 2001; Tsakanikos & Reed, 2003). It should
be noted that the only exception was the absence of a significant correlation between
Impulsivity Non-conformity and Introvertive Anhedonia (in the original study, r =
-0.10, p < 0.05). Considering that the correlation between the two scales was quite
low in both studies, this deviation was probably due sample size differences between
the Mason et al study (N = 508) and the present investigation (N = 186). Contrary to
what was expected, there was no significant correlation between schizotypy scales
and verbal fluency.
Despite the absence of a statistically significant correlation between schizotypy
scales and verbal fluency, it could be still argued that non-linear relationships between
these measures may exist. For example, particular trends between verbal fluency and
different schizotypy measures may exist only for participants with very high
schizotypy scores. To investigate the above possibility, verbal fluency performance
was plotted as a function of positive and negative schizotypy (Figure 1).
-------------------------Figure 1 about here
-------------------------Inspection of the upper graph (Figure 1 - panel A) suggests that, for participants
who scored one standard deviation above the mean on positive schizotypy (Unusual
Experiences > 15), verbal fluency appeared to increase as a function of their
schizotypy scores. For these extreme high scorers (N= 33), there was a statistically
significant positive correlation between Unusual Experiences and verbal fluency (r
= 0.35, P < 0.05). However, there was no significant correlation between Unusual
Experiences and verbal fluency (r = 0.03, P > 0.80) for participants scoring one
standard deviation below the mean (Unusual Experiences < 5).
Inspection of the lower graph (Figure 1 - panel B), suggested that verbal fluency
appeared to decrease as a function of negative schizotypy for participants who scored
one standard deviation above the mean (> 8) on Introvertive Anhedonia. For those
extreme scorers (N= 28), there was a statistically significant negative correlation
between Introvertive Anhedonia and verbal fluency (r = 0.46, P < 0.05). For
those participants who scored on negative schizotypy one standard deviation below
the mean (Introvertive Anhedonia < 3), there was no significant correlation between
Introvertive Anhedonia and verbal fluency (r = 0.01, P > 0.90). The obtained
results suggest that verbal fluency, at least for those who scored very high on
schizotypy, was positively associated with positive schizotypy, and negatively
associated with negative schizotypy2.

The same analyses run for extreme scorers on Cognitive Disorganization and Impulsivity Nonconformity, but no evidence for similar non-linear markers were found.

Verbal fluency in schizotypy

Discussion
In line with the schizophrenia literature (Allen et al., 1993; Howanitz et al., 2000;
Lindamer & Whitman, 1997; Kerns et al., 1999), the present data suggested that
different schizotypy dimensions were differentially associated with verbal
productivity, as assessed by a typical letter fluency task. However, the relationship
between verbal fluency and schizotypy was not linear; these associations were present
only for those participants who scored one standard deviation above the mean. It is
worth noting that this finding supports quasi-dimensional rather fully dimensional
views of schizotypy (see Claridge, 1997, for a discussion). In addition, the fact that
differentiated verbal fluency irregularities were observed in a student sample as a
function of psychometric schizotypy suggests that such irregularities are cognitive
markers (primary features) rather than epiphenomena (secondary features) of
psychosis.
During the phonological (letter) task, the participants were asked to generate as
many words as possible by following certain rules, i.e. the words should start with a
certain letter, and derivatives of the same words, names, and non-English words
should be avoided. Consequently, adequate word production in this task relied largely
on executive functions, such as maintaining on-line these rules and monitoring
performance accordingly, while inhibiting inappropriate responses (Lezak, 1995). In
the present study, negative schizotypy was found to be associated with decreased
verbal fluency, following the pattern of the negative symptoms of schizophrenia
(Allen et al., 1993; Howanitz et al., 2000). Given that negative symptoms of
schizophrenia have been associated with impaired executive functions (Crow, 1992),
it is possible that similar subtle impairments had a detrimental effect on verbal
influence in participants scoring highly on negative schizotypy.
However, apart from executive functions, another cognitive process that is highly
relevant to performance on a verbal fluency task is the speed of lexical retrieval. A
particularly increased activation of stored lexical units would, therefore, be expected
to enhance performance on a letter fluency task. Certain positive symptoms of
schizophrenia, such as hallucinations, have been attributed to such an increased
automatic spreading activation of related lexical items3 (David, 1994; Hoffman &
McGlashan, 1997). Given that positive symptoms of schizophrenia have been
associated with increased verbal fluency (Lindamer & Whitman, 1997; Kerns et al.,
1999), it is possible that both positive symptoms and increased verbal fluency may be
products of an enhanced automatic spreading activation. Such an account could also
accommodate the finding that high levels of positive schizotypy are associated with
increased verbal fluency, as has been shown in previous studies (OReilly et al.,
2001;Weinstein & Graves, 2002) and replicated in the present investigation.
It could be argued that the positive association between verbal fluency and
positive schizotypy is also predicted by the sheer inhibition hypothesis (Spitzer,
1993). According to this hypothesis, activation tends to spread more diffusely and
more rapidly due to inadequate mechanisms that control spreading activation and reactivation in the semantic networks. Unlike the automatic spreading activation
3

For instance, a neutral sound activates automatically a similar sounding word, which in turn activates
instantly and simultaneously other semantically or/and phonetically related words etc.

Verbal fluency in schizotypy

account, which seems limited to semantically and/or phonetically related lexical units
(David, 1994; Hoffman & McGlashan, 1997), the sheer inhibition hypothesis is not
limited to certain types of units (Spitzer, 1993). Nevertheless, the two accounts are
not necessarily incompatible; for example, an over-activation of phonetically related
lexical units, which has been proposed to be responsible for the production of acoustic
hallucinations (David, 1994; Hoffman & McGlashan, 1997), could be due to
inefficient control mechanisms of spreading activation and re-activation in the
semantic networks (Spitzer, 1993).
In summary, the present investigation showed that personality traits that
phenomenonologically resemble the negative and positive symptoms of schizophrenia
were differentially related to verbal fluency, suggesting different underlying
mechanisms. Enhanced performance on verbal fluency was associated with high
levels of positive schizotypy, i.e. increased reports of hallucination-like experiences,
delusional ideation, and perceptual aberrations, a pattern of results predicted by
theories of increased automatic spreading activation in the semantic networks (David,
1994; Hoffman & McGlashan, 1997; Spitzer, 1993). Given that verbal fluency is a
main facet of creativity, the obtained results reinforce the notion that the link between
pathological personality traits and creativity is likely due to common cognitive
features (Eysenck, 1993). This notion is consistent with the possibility of a healthy
schizotypy (McCreery & Claridge, 2002), which may account for the persistence of
schizophrenia-related genes in the population despite their many dysfunctional
aspects.

Verbal fluency in schizotypy

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Verbal fluency in schizotypy

Acknowledgements
Thanks are due to Carmen Chan, Emma Coakley, Helen Fisher, Suzanne Gage,
Jacqlin Iaccovou, Samaira Khan, James MacDonald, Hannah Pratt, Alexandra Suzuki,
Jessica Webb, and Grace Wong for their help with the data collection.

Verbal fluency in schizotypy

Table 1
Inter-correlations between schizotypy scales and performance on verbal fluency

SD

Unusual Experiences

9.72

5.92

Cognitive Disorganization

11.71

5.31

0.49**

Introvertive Anhedonia

4.83

3.69

0.15*

0.09

Impulsive Non-conformity

10.17

4.07

0.39**

0.27**

Verbal Fluency

41.64

9.57

0.02

* p < 0.05 (two-tailed)

** p < 0.01 (two-tailed)

10

-0.12

-0.04

-0.05

-0.09

Verbal fluency in schizotypy

Figure 1
60

verbaly fluency

panel A
50

40

30
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 22 23 24 25

positive schizotypy ('Unusual Experiences')

60

verbal fluency

panel B

50

40

30
0

10 11 12 13 14 15 17 20

negative schizotypy ('Introvertive Anhedonia')

11