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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 1. 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 8.

There are many factors that should be considered when assessing blunted affect. For example, blunted affect can co-vary with the negative symptom alogia 9, 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 3. In schizophrenia, blunted affect closely resembles symptoms of depression making it difficult to distinguish between the two in the absence of appropriate instruments 10. 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 9. It is therefore suggested by Kirkpatrick 3 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 3.

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
References
  1. Kilian S, Asmal L, Goosen A, Chiliza B, Phahladira L, Emsley R. Instruments measuring blunted affect in schizophrenia: a systematic review. PLoS One. 2015;10(6):e0127740. Published 2015 Jun 2. doi:10.1371/journal.pone.0127740 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4452733
  2. Moller H-J. Clinical evaluation of negative symptoms in schizophrenia. European Psychiatry. 2007; 22: 380–386.
  3. Kirkpatrick B. Progress in the Study of Negative Symptoms. Schizophrenia Bulletin. 2014; 40(2):101–106.
  4. Henry JD, Green MJ, De Lucia A, Restuccia C, McDonald S, & O’Donnell M. Emotion dysregulation in schizophrenia: Reduced amplification of emotional expression is associated with emotional blunting. Schizophrenia Research. 2007; 95:197–204.
  5. Myin-Qermeys I, Delespaul PAEQ, & deVries MW. Schizophrenia patients are more emotionally active than is assumed based on their behavior. Schizophrenia Bulletin. 2000; 26(4): 847–854.
  6. Sweet LH, Primeau M, Fichtner CG, Lutz G. Dissociation of affect recognition and mood state from blunting in patients with schizophrenia. Psychiatry Research. 1998;81: 301–308.
  7. Stip E, Fahim C, Mancini-MarRe A, Bentaleb LA, Mensour B, Mendrek A, et al. Restoration of frontal activation during a treatment with quetiapine: an fMRI study of blunted affect in schizophrenia. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2005; 29: 21–26.
  8. Levy R, Dubois B. Apathy and the functional anatomy of the prefrontal cortex-basal ganglia circuits. Cerebral Cortex. 2006; 16(7): 916–928.
  9. Kirkpatrick B. Developing concepts in negative symptoms: primary vs secondary and apathy vs expression. Journal of Clinical Psychiatry. 2014;75(1): 3–7.
  10. Müller MJ, Kienzle B, & Dahmen N. Depression, emotional blunting, and akinesia in schizophrenia. Overlap and differentiation. Eur J Health Econom. 2002;;3: S 99–S 103.
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