Emotion › Morbid Expression of Emotion

Constriction of Affect

Constriction of affect is a narrowing in the range of emotions a person is able to display, so that fewer distinct emotional states are shown than would ordinarily be expected, even though the emotions that are still displayed may register with roughly normal intensity. It sits on a spectrum with blunting of affect, sharing the same basic direction of restricted emotional display but generally understood as a somewhat milder or narrower version of that restriction.

This has traditionally been described as closely related to blunting of affect, the two terms sometimes used with overlapping meaning, though constriction more specifically emphasises a narrowed range of emotional states available to the person rather than a uniform reduction in the intensity of whatever is displayed.

Also known as

Flattening of affect

Sometimes used interchangeably with constriction, though flattening is also sometimes reserved for the most severe end of the spectrum, bordering on a complete absence of emotional display.

Recognition features

• A narrower range of emotional states displayed than would be expected, with fewer distinct feelings shown across a conversation
• The emotions that are displayed may still register with something close to normal intensity, distinguishing this from a uniform flattening
• Best appreciated by observing the person across a range of topics and noting how many distinct emotional shifts occur
• Typically not recognised by the patient as a change in themselves

Eliciting it at interview

• Track the variety of emotional states displayed across a conversation covering several different topics, rather than judging from a single moment
• Compare the range of feeling shown with what the topics discussed would normally be expected to elicit
• Ask family or carers whether the person seems to show a narrower range of emotion than they used to

Distinguishing features

• Differs from affect blunting mainly in degree and in which dimension is most affected: constriction emphasises a narrowed range of emotions, while blunting emphasises reduced intensity across the board
• Differs from apathy, which is a reduction in interest and motivation rather than specifically in the range of emotional display
• Sits at a milder point on the same spectrum as blunting, with the two sometimes overlapping in practice

Common misconceptions

• That constriction and blunting of affect are entirely separate phenomena; they are closely related and often described together, differing mainly in emphasis and degree
• That a narrow emotional range always means low mood; a person with constricted affect may not describe themselves as depressed even though their outward emotional range is limited

Related phenomena

Morbid Expression of Emotion · Blunting of Affect

Practice this

Across a long conversation covering many different topics, a patient displays only a narrow range of emotional reactions, though the few emotions she does show, such as brief irritation or mild amusement, register with roughly normal intensity each time. What is this? · A patient shows almost no interest in activities he previously enjoyed, rarely initiating anything on his own, and appears outwardly indifferent even when told genuinely significant news about his own health. Before revealing the answer: is this constriction of affect? · A patient shows a limited emotional display. Before revealing the answer, decide what distinguishes constriction of affect from apathy. · You suspect a patient shows constriction of affect. Before revealing the answer, decide how you would assess for this. · Explain why constriction of affect and blunting of affect are described as sitting on the same spectrum rather than being entirely separate signs.

Illustration

Across a long conversation touching on his hobbies, his family, and a recent disappointment at work, a 50-year-old man shows only mild, muted variations of the same faintly weary expression throughout, with none of the sharper shifts into enthusiasm, irritation, or amusement that the range of topics would ordinarily be expected to bring out.

References

• Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 6, 'Disorders of Emotion'.