Blunted affect

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Blunted affect is the scientific term describing a lack of emotional reactivity on the part of an individual. The precise boundary between the generally positive personality trait "serious" and the generally pathological "blunted affect" is impossible to describe precisely because it is culture specific and relies on subjective values. For example, the Japanese are often described as "unemotional" (even to the point of "blunted in affect") by Americans, and so the same individual may be considered to display a blunted affect in one culture and be merely "serious" or "unemotional" in another. See culture-specific syndrome.

Victims of post-traumatic stress syndrome are often said to display blunted affect. Veterans of intense combat have been described as having the thousand-yard stare (or thousand-yard gaze). Some of these veterans clearly suffer from a grave disorder commonly known as shell shock and may suffer from recurring nightmares or otherwise experience psychological distress. Others have developed less emotional reactivity as an arguably natural reaction to stress. Those displaying on this end of the spectrum may self-report dissociation but no psychological distress per se. At least one analyst of military basic training has described one primary goal of said training to be inducing this state of being, considered desirable for maintaining calm and rational decision-making capability during combat situations.^{[How to reference and link to summary or text]}

Blunted affect should not be confused with anhedonia although the two share some characteristics. Anhedonia is 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. A person with anhedonia may be unable to laugh or smile, for example. Conversation will not be pleasurably stimulating for a person with extreme anhedonia, and thus that person may not be as responsive to conversation or its emotional subject matter. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. Other negative symptoms of schizophrenia include: alogia, lack of concentration, social withdrawal (sometimes called social anhedonia), etc. People with depression also sometimes experience anhedonia and it is a major component of the diagnosis for clinical depression.

One final consideration worth noting is that adults generally display less affection than children. This suggests blunting one's affect may be a normal part of maturation.

Affective flattening

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 affect that is present but only with minimal degrees of emotions evident. "Restriction" is a holding back or 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 are 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 (normal variation of emotions during exam)
• restricted, constricted range (limited variability of emotion during exam)
• stable (normal movement between emotions)
• 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

Affect and low-functioning schizophrenia

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". 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".

The study also reported a "dissociation between reported experience of emotion and its display" – supporting the suggestion made elsewhere that "blunted affect, including flattened facial expressiveness and lack of vocal inflection...often disguises an individual's true feelings': 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". 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".

Hoschel (2001) describes the responses of schizophrenia because "emotional information might be related to low social/emotional functioning of the individual with schizophrenia." Referring to clients who are considered "low functioning" (schizophrenics), manifestations of the internal stressors become apparent through displacement activities. Alexithymic patients provide clues via assessment presentation which may be indicative of emotional arousal (Trouisi, 2000) The displacement and lack of cognitive responses may be enough for descriptive clinical documentation, but more is usually required. "The Soul's Words (Psyche Logos) have much to say and even greater to reveal." (?) It communicates in ways that are beyond the 'normal' interpretive mechanics. Our description of the emotional component especially with alexithymia makes the therapist more like a detective. One must possess the tools of description and be fluent with its appropriate application.

Assessments

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"; 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".

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".

Stress

Victims of post-traumatic stress syndrome (PTSD) are often said to display blunted affect. Veterans of intense combat have been described as having the thousand-yard stare (or thousand-yard gaze). Some of these veterans suffer from a disorder once referred to as shell shock and may experience a number of symptoms, including recurring nightmares, hypervigilance, and avoidance of situations that may cause distress.

There are other, less severe "negative" psychological symptoms long noted in PTSD: anhedonia (the inability to feel pleasure) and a general emotional numbness. Such lesser emotional reactivity is an arguably natural reaction to stress. Those displaying on this end of the spectrum may self-report dissociation but no psychological distress per se. People diagnosed with this disorder often endure a chronic course of blunted affect with the onset being subtle yet considerable.

See also

• Affect display
• Alexithymia
• Antonio Damasio
• Narcissistic defences
• Negative symptoms
• Schizoid personality disorder

Further reading

• Hoschel K, Irle E. (2001) Emotional priming of facial affect identification in schizophrenia. Schizophr Bull. Volume:27(2):317-27). Sonnenberg Clinic, Department of Psychiatry, Saarbruken, Germany.
• TROISI, ALFONSO M.D.1; BELSANTI, SERGIO M.D.1; BUCCI, ANNA ROSARIA M.D.1; MOSCO, CRISTINA M.D.2; SINTI, FABIOLA M.D.1; VERUCCI, MONICA M.D.1.(2000), Affect Regulation in Alexithymia: An Ethological Study of Displacement Behavior during Psychiatric Interviews. J Nerv Ment Dis. 2000 Jan; 188(1): 13-8.

External links

• Mental health glossary