blunted affect

What is blunted affect

Blunted affect also referred to as flat affect, emotional blunting or a decrease in the observed expression of emotion 1). Blunted affect is a prominent symptom of schizophrenia. Blunted affect is regarded as a negative symptom of schizophrenia and like other negative symptoms, the assessment, treatment and overall understanding of blunted affect remains limited 2). Patients with blunted affect have difficulty in expressing their emotions 3), characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli 4). However, patients’ reduced outward emotional expression may not mirror subjective internal emotional experiences 5) suggesting a disconnect in what patients experience, perceive and express when interpreting emotional stimuli 6) due to problems associated with emotional processing 7).

While blunted affect is an integral component of the symptom expression of the illness it is not unique to schizophrenia 8). In degenerative disorders such as Parkinson’s disease, blunted affect is frequently a prominent symptom. Also, antipsychotic-induced parkinsonism, which has a similar clinical presentation as Parkinson’s disease, may cause blunted affect which is clinically indistinguishable from blunted affect due to schizophrenia. In all of these disorders the fronto-striatal reward pathways are thought to play a role in producing blunted affect 9).

There are many factors that should be considered when assessing blunted affect. For example, blunted affect can co-vary with the negative symptom alogia 10), but whether these symptoms involve the same or a different neurobiological basis remains unanswered. Blunted affect can be a feature of both primary and secondary negative symptoms 11). In schizophrenia, blunted affect closely resembles symptoms of depression making it difficult to distinguish between the two in the absence of appropriate instruments 12). Symptoms such as lack of facial expression, apathy and psychomotor slowing are often associated with both. Also, antipsychotic medications as well as antidepressants can cause secondary blunted affect 13). It is therefore suggested by Kirkpatrick 14) that the Schedule for Deficit Syndrome be considered in conjunction with negative symptoms instruments in order to assist in determining whether blunted affect symptoms are primary or secondary. The reason being that patients who are diagnosed with deficit syndrome are more likely to experience primary enduring blunted affect symptoms 15).

Blunted affect vs flat affect

Flat affect is also called blunted affect, a condition that causes people to not express emotions in the same way other people might. A person with flat affect or blunted affect shows no facial expressions.

People who experience flat affect (blunted affect) show symptoms including:

  • no or low emotional expression on the face
  • no or low emotional reaction in both verbal and nonverbal ways
  • appearance of apathy
  • a monotone speaking voice
  • avoidance of eye contact with others
  • little to no change in facial expressions

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