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definition - BLUNTED AFFECT

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Blunted affect

                   

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.[1]

Blunt affect 'can be symptomatic of schizophrenia, depression, or brain damage'.[2] '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'.[3]

Contents

  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'.[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

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]

  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.[12] 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.[13]

  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 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

  Related symptoms

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'.[14] Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.[15]

'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"'.[16]

  Culture

Cultural critics frequently cite 'Frederic Jameson's idea of a flattened postmodern space linked to a flattened affect or a loss of psychological depth'[17] - stressing 'consumer capitalism's pervasive simulacra and flattened affect'.[18]

  See also

  References

  1. ^ George Stein; Greg Wilkinson (1 January 2007). Seminars in General Adult Psychiatry. RCPsych Publications. pp. 174–. ISBN 978-1-904671-44-2. http://books.google.com/books?id=6PGzHFuS1xkC&pg=PA174. Retrieved 17 December 2010. 
  2. ^ D. and D. M. Sue, Foundations of Counselling and Psychotherapy (2007) p. 65
  3. ^ A. Tasman/W. K. Mohn, Fundamentals of Psychiatry (2011) Section 25.2.3
  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. ^ Daniel Goleman, Emotional Intelligence (1996) p. 206
  13. ^ Irving B. Weiner; George Stricker; John A. Schinka; Thomas A. Widiger (2003). Handbook of Psychology: Clinical psychology. John Wiley and Sons. p. 66. ISBN 978-0-471-39263-7. http://books.google.com/books?id=dVauuLKZar4C&pg=PA66. Retrieved 12 December 2010. 
  14. ^ Goleman, p. 50
  15. ^ Troisi A, Belsanti S, Bucci AR, Mosco C, Sinti F, Verucci M (January 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. 
  16. ^ Goleman, p. 15
  17. ^ C. Bolton et al, Robot Ghosts and Wired Dreams (2007) p. 129
  18. ^ Marianne DeKoven, Utopia Ltd (2004) p. 10

  External links

   
               

 

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