Expressive vs Receptive vs Nominal Aphasia
Expressive Aphasia Receptive Aphasia Nominal Aphasia
Overview
All three are language disturbances grouped under aphasia, but they break down at different points in the chain from understanding language to producing it. Expressive aphasia disrupts putting thoughts into words, receptive aphasia disrupts understanding language in the first place, and nominal aphasia is a narrower difficulty confined specifically to naming.
| Dimension | expressive-aphasia | receptive-aphasia | nominal-aphasia |
|---|---|---|---|
| Core deficit | Difficulty putting thoughts into words, despite knowing what one wants to say | Difficulty understanding language, spoken or written, rather than producing it | A specific difficulty naming objects, despite an otherwise full vocabulary |
| Comprehension of language | Typically intact — the person understands what is said to them | Impaired — this is the primary deficit | Intact, aside from the specific naming difficulty itself |
| Fluency of speech production | Reduced, ranging from mild word-finding trouble and mispronunciation to, in severe cases, speech restricted to a handful of fixed phrases | Can remain superficially fluent, since the disturbance lies in understanding rather than producing language | Otherwise fluent and grammatically intact, aside from the naming gaps themselves |
| Scope of the difficulty | Broad — affects the general production of spoken language | Broad — covers several specific forms (pure word deafness, agnostic alexia, visual asymbolia), each tied to a different pattern of brain injury | Narrow — the single dominant feature is a difficulty naming objects, more circumscribed than the other two |
| Typical example | A patient clearly wants to describe what happened to them but can only produce broken, halting fragments of the sentence | A patient speaks fluently but the content makes little sense, and they cannot follow simple spoken instructions | A patient describes the function of an everyday object in detail ("the thing you write with") but cannot supply its name, "pen" |
Common confusion
Students often assume any aphasia that involves 'trouble finding words' must be the same thing, without checking whether comprehension is also affected or whether the difficulty is confined to naming alone. The quickest sorting test is comprehension: intact comprehension plus effortful production is expressive aphasia (or, if the trouble is narrowly confined to naming, nominal aphasia); impaired comprehension, however fluent the speech sounds, is receptive aphasia.
Clarifying questions
- Do you understand what I'm saying to you right now, even if it's hard to answer back?
- When you're struggling for a word, is it mainly the names of specific objects, or is putting any kind of sentence together difficult?
- Can you follow a short spoken instruction, like picking up an object and putting it somewhere?
Provenance
Class B · tier T1 · lifecycle migrated_candidate
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.