Do you think in words or pictures?

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Interesting. I can sometimes reach situations where if an extreme circumstance as happened, like I have just hurt myself I will not be able to speak. I will just stand there and have no words to say and only be able to make a noise. No words. Could not even cry or scream in pain (Though it is if I have just cut myself or something where it is before the pain has hit me but the shock has hit).

While it is probably not quite the same as you have said, and I assume most people will experience the moments where ones brain sort of stops like it has slammed the brakes on, it is interesting....

I think in both words and pictures. I'm good at visualising.

I think in almost anything but words.

'Words' to me, are mostly nested patterns of various auditory and visual stuff. But otherwise, unnatural to me.

Even something inexplicably non visual, nonverbal and abstract makes more sense to me.

The issue is translating it to any outward medium of expressions in context to any references, which includes and especially the verbal medium itself.

Both. My model of reality is primarily visual-spatial and my internal monologue is a commentary on the model.