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What is a blunted affect


Instruments Measuring Blunted Affect in Schizophrenia: A Systematic Review

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When Your Face Doesn’t Reveal Your Feelings

The way human beings express emotion varies dramatically from person to person. With some people, one glance at their face and you understand what they are feeling. With others, their face offers few if any clues as to what they’re feeling.

Sometimes an underlying psychological or neurological condition can affect your ability to show emotion in recognizable ways. This condition is called blunted affect.

If you have a blunted affect, it can affect your personal and professional relationships, so it’s important to understand what it does and doesn’t mean.

Read on to understand what it means when you have a blunted affect.

“Affect” is a psychological term. It refers to the appearance of emotion through tone of voice, facial expressions, gestures, and body language. People with blunted affect don’t express emotions as obviously as most people do.

If you have a blunted affect, your outward appearance seems to suggest that you aren’t feeling strong emotions, even when you’re talking about emotional experiences. In other words, there’s a mismatch between what you’re feeling and what other people may think you’re feeling.

Blunted affect is different from emotional blunting. When you experience emotional blunting, you aren’t feeling your emotions very strongly. You may even feel emotionally numb. It’s possible to have blunted affect (little appearance of emotion) with or without emotional blunting (not feeling emotions).

How much emotion people display is on a continuum:

  • Flat affect. People who have a flat affect show virtually no outward evidence of any emotion.
  • Blunted affect. People who have a blunted affect show very little outward emotion.
  • Constricted affect. People who have a constricted affect show some emotion but less than most other people show.

People with blunted affect don’t appear to be feeling much emotion. When they communicate, others might notice:

  • the pitch of their voice doesn’t rise or fall very much when they talk about something emotional
  • their facial expressions don’t change when they talk about emotional matters
  • they don’t move their hands and arms a lot as they communicate
  • their posture and body language doesn’t reveal very much about what they’re feeling
  • they might avoid making eye contact

Blunted affect is a symptom of several disorders. To prevent blunted affect, you must prevent or seek treatment for the underlying disorder that causes it.

If the disorder is successfully treated, it may be possible to increase your emotional expressiveness. For some people, however, the difference in emotional expressiveness may be permanent.

Blunted affect is a symptom of several disorders. That means the disorder prevents or reduces your ability to function the same way other people do. In the case of blunted affect, these disorders may decrease your ability to express emotion:

Schizophrenia

Schizophrenia is a mental health disorder that can cause people to experience hallucinations, delusions, and thought patterns that distort reality. One of the possible symptoms of schizophrenia is an inability to show or express emotion.

In a 1992 study, researchers showed emotional movie clips to three groups of people: some with no known mental illness, some with depression, and some with schizophrenia. They also prepared unpleasant drinks for them to taste. Their facial expressions were recorded.

All of the study participants reported having the same feelings, but many of the people with schizophrenia had facial expressions that didn’t match their emotions. Those with blunted affect only showed emotion during 2.7 seconds of the film, whereas others displayed emotional expressions for around 22.3 seconds.

Researchers think blunted affect might raise the risk of suicide for some people with schizophrenia, because it can interfere with social interactions and increase feelings of isolation.

Autism spectrum disorders

Autism spectrum disorders (ASD) are developmental disorders that make it difficult to interact and communicate with others. Autistic people often have limited interests, and they may repeat certain behaviors.

One of the most widely recognized symptoms of ASD is a mismatch between feelings and facial expressions, gestures, and body language. People with autism often speak in a tone of voice that doesn’t rise and fall with changing emotions.

Research indicates that these differences in emotional expressiveness can interfere with social relationships. This is because autistic people have a hard time recognizing and interpreting other people’s facial expressions and because people who are neurotypical have trouble interpreting the facial expressions of autistic people.

Parkinson’s disease

Parkinson’s disease is a neurological disorder that affects the ability to control physical movements. As the disease progresses, those affected may lose control of the muscles that enable them to smile, frown, or knit their brows together to show displeasure.

Parkinson’s can also affect speech, so that one’s voice no longer changes in tone to reflect shifts in their emotions.

A number of conditions can diminish your emotions — sometimes to the point that you may not feel very much at all. These conditions include:

  • traumatic brain injury
  • behavioral variant frontotemporal dementia
  • depression
  • post-traumatic stress disorder
  • bipolar disorder

These disorders don’t necessarily cause you to lose the ability to express emotion. They limit the range and intensity of the emotions you can feel at a given time. In other words, they cause emotional blunting, not blunted affect.

The decrease in emotions may come from the disorder itself or from the medications used to treat it. Antipsychotic and antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can both cause emotional blunting.

Diagnosing blunted affect can be tricky because how individuals express emotion can vary widely from culture to culture, family to family, and person to person.

Doctors, psychologists, and other health professionals use several tests to determine whether someone has blunted affect. Most of the tests take 15 to 30 minutes to administer and are based on interviews or questionnaires.

Finding help for blunted affect

If you need help finding information, resources, or assistance for yourself or someone else dealing with blunted affect, these organizations may be a good starting place:

  • RA1SE. This research project offers resources for individuals and families finding out about schizophrenia.
  • Parkinson’s Foundation. This foundation provides a helpline, webinars, podcasts, and local chapters to help people with Parkinson’s disease.
  • Centers for Disease Control and Prevention (CDC). The CDC curates a list of organizations that can help you with educational services, financial resources, assistive technology, and other information for people with autism spectrum disorders.

Because blunted affect is a symptom of an underlying disorder or of a medication for a disorder, doctors usually treat the disorder.

There’s some evidence that treating the disorder may improve the ability to express emotion somewhat, but blunted affect is sometimes permanent.

Blunted affect is a decreased ability to express emotion through your facial expressions, tone of voice, and physical movements. Schizophrenia, autism spectrum disorders, and Parkinson’s disease are all associated with blunted affect.

Blunted affect doesn’t mean you aren’t feeling emotions, it just means you don’t show what you’re feeling in ways other people can easily recognize.

Blunted affect is different from emotional blunting. If you’re experiencing emotional blunting, your ability to actually feel emotions is diminished, often by depression, PTSD, certain kinds of dementia, traumatic brain injury, bipolar disorder, or one of the medications you’re taking.

If you’re experiencing blunted affect or emotional blunting, it’s important to talk to a doctor or mental health professional because both of these conditions can make it more difficult to maintain healthy personal and professional relationships.

Treating the underlying disorder may help you express more of what you’re feeling.

Blunted affect (Part II) - PsyAndNeuro.ru

Blunted affect is a decrease in the ability to express emotions, in particular facial and vocal expression, as well as expressing emotions through gestures. This term is more preferred today and differs from the term flat affect, which is the extreme expression of blunt affect.

Blunted affect is included in the negative symptom scores of commonly used scales such as PANSS, SANS, and the Clinical Negative Symptom Inventory (CAINS)45,46 and the Brief Psychiatric Rating Scale (BNSS). Their analysis is based on the observation of spontaneous reactions during the course of a conversation or the expression of emotions in response to questions asked by the interviewer, and not on the subjective experience of a reduced emotional range. nine0003

In PANSS, facial expressions and communicative gestures are targeted for analysis. When assessing SANS, more aspects are taken into account: facial expressions, expressive gestures, eye contact, affective reaction and inflection. On the other hand, some of the features included in the analysis of SANS blunted affect are absent from recently developed methods for assessing negative symptoms: in particular, inappropriate affect is now considered as an aspect of disorganization, and a reduced level of spontaneity of movements is considered as non-specific and more relevant. to the assessment of depression symptom. In CAINS and SANS, facial expressions, voice expression, and expressive gestures are considered as symptoms inherent in blunted affect. nine0003

Mimicry is analyzed using measuring coding systems such as Facial Movement Coding System and its analogues, Facial Expression Coding System. Most studies state that treated and untreated patients with schizophrenia, compared with healthy controls, show little change in facial expression in response to any emotion, both in frequency and intensity, up to the complete absence of any changes throughout the conversation, and even in response to various stimuli used to evoke an emotional reaction. Overall, there was a significant correlation with blunted affect. nine0003

Electromyelography studies were based on objective criteria for evaluating facial expressions. Many of them found that in response to an emotional stimulus, people with schizophrenia had relatively little zygomatic activity (usually associated with positive emotions) and similar or greater activity of the wrinkling muscle (usually associated with negative emotions). Increased activity in the muscles that cause skin wrinkling is not necessarily indicative of greater emotional expression only in subjects with schizophrenia, as the movement of these muscles also signifies tension, concentration, or confusion. In addition, even if people with schizophrenia had no difficulty with these micro-muscle expressions, the inability to express emotions would still be noticeable to people in their environment, and this would still have an impact on their social interaction. Healeyet al. studied how well the general public, which does not include physicians and researchers, is able to recognize the facial expressions of people with schizophrenia compared to healthy people, and concluded that the facial expressions of patients with schizophrenia were recognized as weaker, and their facial expressions were most often characterized as neutral. nine0003

Most studies comparing the emotional voice changes of people with schizophrenia and healthy people note that the former have less emotionally correct and spontaneous speech. Violations affect all parameters of speech, noting the almost complete absence of intonation.

In studies aimed at objective voice assessment in subjects with schizophrenia and healthy people, the method of computerized acoustic analysis of speech was used. These studies confirmed the absence of emotional vocal expression in subjects with schizophrenia compared to healthy subjects; however, these changes were less pronounced than the scores on the Symptom Rating Scale. The reasons for this discrepancy are still unclear. Voice expression is a complex and likely multidimensional component, and more research is needed to determine the aspects of it that are inherent in schizophrenia. nine0003

Expressive gestures include movements of the arms, head (eg nodding), shoulders (shrugs), torso (leaning forward). In society, they help to understand who is talking to whom, who will speak next, to determine the level of mutual understanding, to maintain interest and attention during the conversation. In some studies describing two-way interaction between a psychiatrist and a patient, focused on the analysis of the latter's behavior, there was a general deterioration in non-verbal behavior, including head and body movements, eye contact and gesticulation. nine0003

Blunted affect is seen in both treated and untreated patients with schizophrenia, thus ruling out the possibility that this symptom could be the result of antipsychotics.

There is currently no evidence to support the possibility that reduced emotional expression may be associated with negative emotional experiences and negative emotions. The evidence for positive emotions is even more controversial and will be discussed in the anhedonia section. nine0003

The main hypothesis regarding the pathogenesis of blunted affect and its signs (reduced facial and vocal expressiveness, as well as expressive gestures) are associated with impairments in the recognition of emotions, and, with impaired perception of non-verbal signals in society as a whole (facial affect, intonation, language body), or with a lack of motor activity. Regarding the first hypothesis, some studies have described a deficit in the perception of non-verbal signals in society. However, an association between a deficit in the perception of social non-verbal cues and poor expression of emotions or negative symptoms has not been found. nine0003

With regard to the alternative hypothesis regarding the lack of motor activity, it should be noted that patients with motor disorders are prone to disorders in non-verbal communication. The underlying mechanisms may differ (for example, disturbances in the nucleus basalis or frontal lobe dysfunction) and may also differ in some of the components responsible for blunting affect. More recently, a hypothesis has been put forward about the atypical functioning of the mirror neuron system. The hypothesis may connect deficits in social perception with motor impairments, suggesting that dysfunction of mirror mechanisms for the use of gestures causes patients to have difficulty reproducing gestures demonstrated by an expert (imitation) or based on a verbal command (pantomime). However, we have no evidence that the mechanisms underlying imitation and pantomime also apply to spontaneous expressive behavior. nine0003

Translation into Russian is organized by the Council of Young Scientists of the Russian Society of Psychiatrists with the support of the World Psychiatric Association.

You can download the full Russian version of the issue from which this article is taken at

Source: Stephen R. Marder, Silvana Galderisi. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry. Feb 2017; 16(1): 14–24. nine0057

Editing: Ph.D. Fedotov I.A.

Dull affect: when your face does not reveal your feelings

The way people express emotions varies greatly from person to person. Some people have one look at their face and you understand how they feel. In others, their faces offer little to no clue as to what they are feeling.

Sometimes an underlying psychological or neurological condition can interfere with your ability to express emotions in a recognizable way. This state is called blunted affect.

If you have a blunted affect, it can affect your personal and professional relationships, so it's important to understand what it does and doesn't mean.

Read on to understand what it means when you have a blunted affect.

What is a blunted affect?

"Affect" is a psychological term. It refers to the expression of emotions through tone of voice, facial expressions, gestures and body language. People with blunted affect do not express emotions as clearly as most people. nine0003

If you have blunted affect, your appearance seems to suggest that you do not feel strong emotions, even when you talk about emotional experiences. In other words, there is a discrepancy between how you feel and what other people might think about your feelings.

Dull affect is different from emotional dullness. When you experience emotional dullness, you don't feel your emotions very much. You may even feel emotional numbness. There may be blunted affect (weak expression of emotions) with or without emotional blunting (no feeling of emotions). nine0003

The amount of emotion people show depends on a continuum:

  • Flat affect. People with a flat affect practically do not show external signs of any emotions.
  • Dull affect. People with blunt affect show very little outward emotion.
  • Limited affect. People with limited affect show some emotion, but less than most other people.

What are the symptoms of blunted affect? nine0097

People with blunted affect do not seem to experience much emotion. When they communicate, others may notice:

  • their voice does not rise or fall much when they talk about something emotional
  • their facial expression does not change when they talk about emotional things
  • they do not move their hands and arms when interacting
  • their posture and body language tell little about how they feel
  • they may avoid eye contact

Is it possible to prevent blunting of affect?

Dull affect is a symptom of several diseases. To prevent blunting, you must prevent or seek treatment for the underlying disorder that causes it.

If the disorder is successfully treated, it may be possible to increase your emotional expressiveness. However, for some people, the difference in emotional expressiveness can be permanent.

What are the common risk factors for blunting affect? nine0097

A dull affect is a symptom of several diseases. This means that the disorder interferes or reduces your ability to function in the same way as other people. If affect is blunted, the following disorders can reduce your ability to express emotions:

Schizophrenia

Schizophrenia is a mental health disorder that can cause people to experience hallucinations, delusions, and thought patterns that distort reality. One of the possible symptoms of schizophrenia is the inability to show or express emotions. nine0003

In a 1992 study, researchers showed emotional video clips to three groups of people: some with no known mental illness, some with depression, and some with schizophrenia. They also prepared unpleasant tasting drinks for them. Their facial expressions were recorded.

All participants in the study reported the same feelings, but many people with schizophrenia had facial expressions that did not match their emotions. Those with blunted affect showed emotions for only 2.7 seconds of the film, while others showed emotional expressions for about 22.3 seconds. nine0003

Researchers believe that blunting may increase the risk of suicide in some people with schizophrenia because it can interfere with social interaction and increase feelings of isolation.

Autism Spectrum Disorders

Autism Spectrum Disorders (ASDs) are developmental disorders that make it difficult to interact and communicate with other people. Autistic people often have limited interests and may repeat certain actions. nine0003

One of the most widely recognized symptoms of ASD is a mismatch between feelings and facial expressions, gestures and body language. People with autism often speak in a tone that doesn't rise or fall with changing emotions.

Research indicates that these differences in emotional expression may interfere with social relationships. This is because autistic people have difficulty recognizing and interpreting other people's facial expressions, and also because NT people have difficulty interpreting autistic people's facial expressions. nine0003

Parkinson's disease

Parkinson's disease is a neurological disorder that affects the ability to control physical movements. As the disease progresses, sufferers may lose control of the muscles that allow them to smile, frown, or furrow their brows to show displeasure.

Parkinson's disease can also affect speech so that the tone of voice no longer changes to reflect shifts in their emotions.

What causes emotional dullness? nine0097

A number of conditions can weaken your emotions, sometimes to the point where you may not feel at all. These conditions include:

  • traumatic brain injury
  • behavioral frontotemporal dementia
  • depression
  • post-traumatic stress disorder
  • bipolar disorder

These disorders do not necessarily lead to loss of the ability to express emotions. They limit the range and intensity of the emotions you can experience at the moment. In other words, they cause emotional dulling, not affective dulling. nine0003

Decreased emotions may be caused by the disorder itself or by the medications used to treat it. antipsychotics and antidepressants, including selective serotonin reuptake inhibitors (SSRIs), both can cause emotional dulling.

How is blunt affect diagnosed?

Diagnosing blunted affect can be tricky because the way people express emotions can vary greatly from culture to culture, family to family, and person to person. nine0003

Doctors, psychologists, and other health professionals use several tests to determine if someone has blunted affect. Most tests take between 15 and 30 minutes to complete and are based on surveys or surveys.

Finding Help for Blunted Affect

If you need help finding information, resources, or help for yourself or someone else dealing with blunted affect, these organizations can be a good starting point:

  • RA1SE. This meditation research project offers resources for individuals and families learning about schizophrenia.
  • Parkinson Foundation. This foundation provides a helpline, webinars, podcasts, and local chapters to help people with Parkinson's disease.
  • Centers for Disease Control and Prevention (CDC). The CDC maintains a list of organizations that can help you with educational services, financial resources, assistive technology, and other information for people with autism spectrum disorders. nine0110

How to treat blunt affect?

Because dullness is a symptom of an underlying illness or medication for a disorder, doctors usually treat the disorder.

Learn more