Abnormal Expression of Emotion
An abnormal expression of emotion is a disturbance not in the underlying feeling itself but in how that feeling is shown, communicated, or acted upon. The emotion may be entirely present and even intense, but the person's outward display of it, or their coping response to it, is unusual in a way they can generally still recognise in themselves once it is pointed out. This sits a step further along the spectrum of disordered emotion than a simple abnormal reaction, since it concerns the relationship between feeling and its outward expression.
This has traditionally been distinguished from a morbid expression of emotion by the degree of the patient's own awareness of the mismatch between how they feel and how they are showing or handling it: an abnormal expression is usually still recognised by the person themselves as unusual, whereas a morbid expression is generally not.
Recognition features
- The underlying emotion is present, but its outward display or the person's manner of handling it is unusual
- The patient can often still recognise, at least when it is pointed out, that their way of showing or dealing with the feeling is atypical
- Encompasses a range of patterns: emotion held apart from awareness, feelings deliberately masked, distress pushed away from conscious acknowledgement, or profound difficulty processing what is happening
- Distinguished from a disturbance in the emotion itself, which is instead the territory of an abnormal emotional reaction or a morbid disorder of emotion
Eliciting it at interview
- Watch for a mismatch between what the person is describing and how they are outwardly presenting it, and ask directly about the discrepancy
- Ask how the person typically copes with or shows difficult feelings, since patterns here (bottling up, dismissing, or masking emotion) are often longstanding
- Where the presentation seems unusually calm, cheerful, or blank given the circumstances, explore gently what the person is actually feeling underneath
Distinguishing features
- Differs from an abnormal emotional reaction, which concerns the intensity or proportionality of the feeling itself rather than how it is expressed
- Differs from a morbid expression of emotion mainly by the degree of the patient's retained awareness of the unusual pattern
- Covers a specific, recognised set of patterns (dissociation of affect, smiling depression, denial, apathy, perplexity) rather than being a single uniform sign
Common misconceptions
- That how someone displays emotion always accurately reflects what they are feeling; a calm or even cheerful presentation can mask significant underlying distress
- That an abnormal expression of emotion means the feeling itself is not genuinely present; the feeling is usually real and sometimes intense, but its outward handling is what is unusual
Related phenomena
Dissociation of Affect · Smiling Depression · Denial · Apathy · Perplexity · Morbid Expression of Emotion · La Belle Indifférence
Practice this
A patient who is clearly deeply upset by a recent loss nonetheless deliberately maintains a composed, matter-of-fact manner in front of others, later admitting, when asked, that she is consciously suppressing any outward sign of how she feels. What is this? · A man involved in a minor car accident becomes intensely distressed and remains so, out of all proportion to the event, for several weeks afterward, describing his own reaction as clearly excessive but unable to shift it; how he outwardly shows this distress is unremarkable. Before revealing the answer: is this an abnormal expression of emotion? · A patient's emotional feeling seems to differ from how it is being shown. Before revealing the answer, decide what distinguishes an abnormal expression of emotion from an abnormal emotional reaction. · A patient's outward display of emotion has changed in a way others have noticed. Before revealing the answer, decide what distinguishes a morbid expression of emotion from an abnormal expression of emotion. · You suspect an abnormal expression of emotion in a patient. Before revealing the answer, decide how you would assess for this. · Explain why an abnormal expression of emotion is described as sitting a step further along the spectrum of disordered emotion than a simple abnormal emotional reaction.
Illustration
A 45-year-old man describes, in a flat and matter-of-fact tone with an almost pleasant half-smile, the recent breakdown of his marriage, and only when his clinician gently comments on the mismatch does he pause and admit, somewhat surprised at himself, that he has in fact been feeling devastated but has found it easier to talk about it as though it barely affects him.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 6, 'Disorders of Emotion'.