Paraphasias

Paraphasias are language production errors commonly observed in aphasia, a language disorder resulting from brain injury or disease. They involve substitutions, distortions, or unintended substitutions of words or sounds during speech. Paraphasias can affect spoken language more than comprehension and may also appear in writing.

Paraphasias are typically categorized by source and nature. Phonemic (or literal) paraphasias involve sound-level distortions within a word, such as substituting or rearranging phonemes (for example, producing “foon” for “spoon” or “bap” for “bath”). Semantic (or verbal) paraphasias involve substituting a related word with a similar meaning, such as saying “cat” for “dog” or “chair” for “sofa.” Neologistic paraphasias produce a nonword or invented term, like saying “glorp” instead of a familiar object. Some paraphasias are unrelated, meaning the substituted word bears little semantic relation to the target.

Paraphasias are most often observed in fluent aphasias, such as Wernicke’s-type aphasia, where speech may flow with errors that nonetheless resemble real language. They can also appear in nonfluent aphasia and conduction aphasia, though the pattern and frequency differ. Clinically, paraphasias help characterize language deficits and contribute to syndrome classification, differential diagnosis, and tracking of recovery or progression. Distinguishing paraphasias from circumlocutions, empty speech, or normal retrieval pauses is important in assessment.

Neuroanatomically, paraphasias reflect disruptions within the left hemisphere language network, particularly regions involved in lexical selection and phonological encoding. They can occur after stroke, traumatic brain injury, or within degenerative conditions such as primary progressive aphasia.