Blunting of Affect
Blunting of affect is a marked reduction in the range and intensity of emotional expression, so that the person's face, voice, and gestures convey noticeably less feeling than would be expected, even in situations that would normally provoke a strong reaction. The person's inner emotional life may or may not be as reduced as their outward display suggests, but the display itself is flattened.
This has traditionally been recognised as one of the core negative features of chronic and severe psychiatric illness, and is distinguished by its pervasiveness across situations, in contrast to a more selective or specific reduction of feeling confined to one context.
Also known as
- Parathymia
- An older term sometimes used for a disturbance of the appropriateness or quality of emotional display.
- Inadequacy of affect
- Describes an emotional response that is present but insufficient in strength for the situation, a milder pattern closely related to blunting.
Recognition features
- A noticeably reduced range of facial expression, vocal tone, and gesture across the whole interview
- Reduced emotional reactivity even to content that would normally be expected to provoke a strong response, whether positive or negative
- The reduction is pervasive across situations and topics, rather than confined to one particular subject
- Typically not recognised by the patient themselves as a change, which distinguishes it from an abnormal expression of emotion
Eliciting it at interview
- Observe facial expression, vocal tone, and gesture systematically across the whole interview, including while discussing both neutral and emotionally significant topics
- Ask directly what the person is feeling in response to significant topics, and compare their reported feeling with what is actually displayed
- Ask family or carers whether they have noticed a change in how expressive the person is compared with before
Distinguishing features
- Differs from apathy, which concerns reduced interest and motivation, whereas blunting concerns specifically the outward range and intensity of emotional display
- Differs from affect constriction mainly by degree, with blunting representing a more marked and pervasive reduction
- Differs from dissociation of affect, which is a selective disconnection tied to particular content, whereas blunting is a general reduction across all situations
Common misconceptions
- That blunted affect always means the person feels nothing inside; the outward display may be reduced even where some degree of inner feeling persists
- That blunting is the same as low mood; a person can show blunted affect without describing themselves as sad, and blunting can occur without a primary mood disturbance
Related phenomena
Morbid Expression of Emotion · Constriction of Affect · Apathy · Incongruity of Affect
Diagnostically relevant to
Schizophrenia (links open the DSM-5 Learning Lab)
Practice this
Throughout a lengthy interview covering both distressing and positive topics, a man's facial expression, vocal tone, and gestures remain noticeably reduced and flat across every subject discussed. He does not appear to notice or comment on this himself. What is this? · A woman shows a flat, unreactive expression only when discussing one specific traumatic memory, but her expression, tone, and gesture are otherwise full and appropriately varied across every other topic in the interview. Before revealing the answer: is this affect blunting? · A patient seems to show less emotion and less drive than would be expected. Before revealing the answer, decide what distinguishes affect blunting from apathy. · A patient shows a reduced range of movement accompanying their emotional expression. Before revealing the answer, decide what distinguishes a disorder of expressive movement from blunting of affect. · A patient shows a mismatch between emotionally significant content and the feeling displayed. Before revealing the answer, decide what distinguishes dissociation of affect from affect blunting. · Two patients each seem to show 'the wrong amount' of emotion during an interview. Before revealing the answer, decide what would tell incongruity of affect apart from blunting of affect. · A patient describes a reduced emotional response. Before revealing the answer, decide what distinguishes loss of emotional resonance from affect blunting. · A patient's emotional display appears unusually resistant to change. Before revealing the answer, decide what distinguishes stiffening of affect from blunting of affect. · You are assessing a patient for affect blunting during a routine interview. Before revealing the answer, decide what you would specifically observe. · Explain why the fact that affect blunting is typically not recognised by the patient themselves is clinically significant.
Illustration
Throughout a lengthy interview covering both his recent wedding and the sudden death of a close friend, a 30-year-old man's face and voice remain almost entirely unchanged, conveying barely more feeling about the loss than about a routine administrative matter, though when asked he insists nothing about how he shows himself has changed.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 6, 'Disorders of Emotion'.