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Blunted affect is the scientific term describing a lack of emotional reactivity (affect display) on the part of an individual. Blunted affect "can be symptomatic of schizophrenia, depression, Autism, Posttraumatic Stress Disorder, or brain damage".[1] "The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression".[2] Individuals with blunted or flat affect show different regional brain activity when compared with healthy individuals.


Definition[edit]

Blunted affect is the scientific term describing a lack of emotional reactivity (affect display) on the part of an individual. It is manifest as a failure to express feelings either verbally or non-verbally, especially when talking about issues that would normally be expected to engage the emotions. Expressive gestures are rare and there is little animation in facial expression or vocal inflection.[3]

Affective flattening[edit]

Affective flattening is a general category which includes diminishment of, or absence of, emotional expressiveness. It is sometimes inappropriately equated with blunted or restricted affect. "Blunted" is an affect that is present but only with minimal degrees of emotions evident. "Restriction" is a holding back as in alexithymia. "Restricted" is not as severe as in flattened or blunted affect.

Constricted affect is an affect type that represents mild reduction in the range and intensity of emotional expression. If the client is consistently euphoric and all intensity is congruent but is unaffected by content, this would be still considered constricted to a euphoric affect.

Labile affect refers to the pathological expression of laughter, crying, or smiling. It is also known as "pseudobulbar affect", "emotional lability", "pathological laughter and crying", or, historically, "emotional incontinence". An individual may find themselves laughing uncontrollably at something that is only moderately funny, being unable to stop themselves for several minutes.

Qualities describing the affective response include:

  • concordance (expressed emotion seems to fit what patient is saying, doing), appropriateness, responsiveness (expressed emotion sensibly follows from the precipitating stimuli)
  • full range/stable (normal variation of emotions during exam)
  • restricted, constricted range (limited variability of emotion during exam)
  • labile (type or intensity shifts suddenly, rapidly)
  • blunted (few emotions expressed, low intensity)
  • flat (affect is even less intense than blunted; patient may appear inanimate)
  • exaggerated intensity

Clinical diagnoses with symptom of blunted affect[edit]

Schizophrenia[edit]

Patients with schizophrenia have long been recognized as showing "flat or inappropriate affect, with splitting of feelings from events...feelings seem flat instead of being in contact with what is going on".[4] One study of flat affect in schizophrenia found that "flat affect was more common in men, and was associated with worse current quality of life" as well as having "an adverse effect on course of illness".[5]

The study also reported a "dissociation between reported experience of emotion and its display"[5] – supporting the suggestion made elsewhere that "blunted affect, including flattened facial expressiveness and lack of vocal inflection...often disguises an individual's true feelings':[6] thus feelings may merely be unexpressed, rather than totally lacking. On the other hand, "a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of 'queerness'...The remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness".[7] In the most extreme cases, there is a complete "dissociation from affective states" on the part of the patient: "not only has he hacked his intellect away from his feelings, but he has smashed his feelings and his capacity for judgment into smithereens".[8]


Assessments[edit]

In making assessments of such conditions, however, the specialist is cautioned that "it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors";[9] while the layman is warned to beware of applying the criterion lightly to "his friends, otherwise he is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our 'normal' population, and our [US] tendency to psychological hypochondriasis".[10]

R. D. Laing in particular stressed that "such 'clinical' categories as schizoid, autistic, 'impoverished' affect...all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person's relation to his actions. There are no such reliable or valid criteria".[11]


Post Traumatic Stress Disorder[edit]

Post-traumatic stress disorder (PTSD) was previously known to cause negative symptoms and negative emotional expressions, however, recently, psychologists have focused their attention on the blunted affects and also the decrease in the expression/feelings of positive emotions in PTSD patients[12] . Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it diminishes interest in activities that produce pleasure (anhedonia) and produce feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviorally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that they have which causes PTSD [13] Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. [14]. In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel [15]. In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex (which appears to be impaird in PTSD as well. [16][17]


Autism[edit]

Blunted affect is also present in autism. This may be due to the sensitivity to sensory stimuli, the deficiency in social interaction, inattention, and the focus on “random” objects that autistic individuals display. The sensory overload can play a major part in blunted affect in Autism because people who have it are constantly going through an array of sensory information coming in from all senses and sometimes the nervous system simply can’t process or make sense of all of the stimuli coming in all at once. This overload of sensory stimuli means that an autistic person may listen to noises coming from everywhere, and their vision is much brighter because of the sensitivity to light stimuli, and sensitivity to touch, smell etc. All of these incoming stimuli happens at once, thus the nervous system can’t process all of it and the person experience blunted affect, mostly because there is no final result from the processing of all the stimuli therefore there is very little reaction.

[18]

Related symptoms[edit]

Blunted affect is very similar to anhedonia, the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who "lack words for their feelings. Indeed, they seem to lack feelings altogether. although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether".[19] Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.[20]

"If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events; this condition is sometimes called 'affective blindness'".[21]

See also[edit]

References[edit]

  1. ^ D. and D. M. Sue, Foundations of Counselling and Psychotherapy (2007) p. 65
  2. ^ A. Tasman/W. K. Mohn, Fundamentals of Psychiatry (2011) Section 25.2.3
  3. ^ George Stein; Greg Wilkinson (1 January 2007). Seminars in General Adult Psychiatry. RCPsych Publications. pp. 174–. ISBN 978-1-904671-44-2. Retrieved 17 December 2010.
  4. ^ Eric Berne, A Layman's Guide to Psychiatry and Pscyhoanalysis (Penguin 1976) p. 207
  5. ^ a b "Flat Affect in Schizophrenia"
  6. ^ D. K. Snyder/M. A. Whisman, Treating Difficult Couples (2003) p. 154
  7. ^ Otto Fenichel, The Psychoanalytic Theory of Neurosis (London 1946) p. 445-6
  8. ^ Neville Symington, Narcissism: A New Theory (London 2003) p. 122
  9. ^ Sue, p. 65
  10. ^ Berne, p. 217
  11. ^ R. D. Laing, Self and Others (Penguin 1969) p. 128
  12. ^ name="Kashdan">Kashdan, Todd (12 March 2007). "Anhedonia, emotional numbing, and symptom overreporting in male veterans with PTSD". Fairfax, VA: Netherlands: Elsevier Science. doi:doi:10.1016/j.paid.2007.01.013. ISSN (Print) 0191-8869 (Print). {{cite journal}}: |access-date= requires |url= (help); Check |doi= value (help); Check |issn= value (help); Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ name="Kashdan">Kashdan, Todd (12 March 2007). "Anhedonia, emotional numbing, and symptom overreporting in male veterans with PTSD". Fairfax, VA: Netherlands: Elsevier Science. doi:doi:10.1016/j.paid.2007.01.013. ISSN (Print) 0191-8869 (Print). {{cite journal}}: |access-date= requires |url= (help); Check |doi= value (help); Check |issn= value (help); Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  14. ^ Amdur, R (2000). "Emotional processing in combat-related post traumatic stress disorder: a comparison with traumatized and normal controls". Journal of Anxiety Disorders. 14 (3). Elsevier Science: 219–238. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  15. ^ "Comorbid Posttraumatic stress disorder and schizophrenia". Psychiatric Annals. 35 (1). 2005. ISSN 1938-2456. OCLC 27724748.
  16. ^ Jaak Panksepp, ed. (2004). Textbook of Biological Psychiatry. New Jersey: John Wiley & Sons, INC. ISBN ISBN 0-471-43478-7 (cloth : alk. paper). {{cite book}}: Check |isbn= value: invalid character (help)
  17. ^ Shin, Lisa (2006). "Amygdala, Medial Prefrontal Cortex, and Hippocampal Function in PTSD". New York Academy of Sciences. doi:doi: 10.1196/annals.1364.007. {{cite journal}}: Check |doi= value (help); Cite journal requires |journal= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  18. ^ ""What is Sensory Overload"". Retrieved 21 March 2013.
  19. ^ Goleman, p. 50
  20. ^ Troisi A, Belsanti S, Bucci AR, Mosco C, Sinti F, Verucci M (2000). "Affect regulation in alexithymia: an ethological study of displacement behavior during psychiatric interviews". J. Nerv. Ment. Dis. 188 (1): 13–8. doi:10.1097/00005053-200001000-00003. PMID 10665455. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ Goleman, p. 15

External links[edit]


Category:Mood disorders



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