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I believe I roughly understand the difference in meaning between the two. However, as far as I can tell, they have the same pitch accent - 大辞林 lists them both as being [0], ie 平板. Would context always dictate which 「いじょう」 is being used?

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    うーん..? 質問は、How to differentiate between 異常 and 異状 in speech? they have the same pitch accent ... Would context always dictate which 「いじょう」 is being used? 「異常と異状を話し言葉でどう区別するか 」「ピッチアクセントはどちらも同じ。どちらが使われているかは 常にコンテクストで決まるのか ?」であって、「異常と異状はどう違いますか・どう使い分けますか」じゃないですよね・・・ – Chocolate Sep 22 at 12:38
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According to 「異常」と「異状」 | ことば(放送用語) - 放送現場の疑問・視聴者の疑問 | NHK放送文化研究所, the site explains

Q.「(健康診断で)イジョウがない」という場合、「異常」と「異状」のうち、どちらの漢字を使えばよいでしょうか。

In case, "there is nothing wrong in health check", which kanji「異常」or「異状」should I use to describe it?

A. 「診断結果は異常なし」など、「異常」を用います。

"There is nothing wrong in health check", etc. We use異常for it.

They follow

「異常」は「正常」の対をなすことば・対語です。「~な発達、~な執念、信号機の~」など「正常でない、普通でない」という意味で一般的に使います。

「異常」is a pair of words, antonym of「正常」. In general, it is used like「異常な発達 : unexpected development、異常な執念 : aberrant tenacity 、信号機の異常 : malfunction of traffic light」, etc.

For 「異状」,

一方、「異状」は「ふだんの状態と違った様子」を示す語で、医師法の「異状死体」(第21条[異状死体等の届出義務])や「西部戦線異状なし」(ドイツの小説家レマルクの作品名)など限定的に使います。また、警備員の巡回報告などの際に使われる「イジョーナシ!」は「異状なし!」を用います。

Whereas 「異状」is used to describe "The state different from as usual.". It is used restrictively like abnormal corpse, "All quiet on the western front" * or the expression「異状{イジョー}なし!」is used when guardsman describing the patrol report. *The literal translation of "Im Westen nichts Neues" is "In the West Nothing New," according to the wikipedia

The same site explains the pair of words is defined by "日本新聞協会の『新聞用語集 2007年版』「表記の原則」".

=異常[一般用語。正常の対語、アブノーマル。名詞・形容動詞]異常乾燥、異常気象、異常事態、異常な行動、異常に緊張、異常発生、エンジンに異常、診断結果は異常なし

=異状[限定用語。普通と違った状態。名詞]異状死(体)<医師法>、西部戦線異状なし(レマルクの作品名)

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As you already know, 異常 is abnormal and 異状 is closer to unusual, but the latter is a relatively uncommon word used in limited situations. Unless your job is related to military or security, you usually don't have to worry about 異状 in speech. In addition, the meanings of these words are close enough, and I doubt this pair can result in misunderstanding in speech.

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