Flat Affect in Schizophrenia

Table of ContentsView AllTable of ContentsWhat Is Flat Affect?CausesSymptoms and ImpactTreatmentCoping and SupportFrequently Asked Questions

Table of ContentsView All

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Table of Contents

What Is Flat Affect?

Causes

Symptoms and Impact

Treatment

Coping and Support

Frequently Asked Questions

Close

Flat affect indicates the diminished expression of emotion. While people with flat affect still experience emotion, they are unable to express emotions in typical and expected physical ways. They exhibit a lack of response to emotional stimuli such as reduced or absent facial expressions, monotone voice, and difficulty understanding the emotions of other people.

This extremely limited range of expressions occurs even in situations that would normally seem very exciting or very sad. For instance, upon hearing the great news, someone withschizophreniamay not smile, laugh, or have any joy in their response.

Flat affect is more common among men than women and is often present during the onset of schizophrenia.

Causes of Flat Affect

More often than not, flat affect is an underlying symptom of several conditions—not just schizophrenia. It may even be a side-effect of certain medications, includingantidepressants. Muscle disorders or facial paralysis, such ascatalepsyand Bell’s palsy,can also make it difficult to express emotions.

Thinking Process Abnormalities in Schizophrenia

Other Conditions Associated With Flat Affect

In addition to schizophrenia, there are several other conditions related to flat affect. These include:

Understanding Inappropriate Affect

Signs of Flat AffectMonotone or flat voice with no modulation or expressionLack of eye contactLack of discernible interest in the topic at handNo changes in facial expression regardless of the circumstance (neutral expression)Lack of verbal response to emotional stimuliBody language or non-verbal responses that are not typical to the experience, conversation, or situation at hand

Signs of Flat Affect

Monotone or flat voice with no modulation or expressionLack of eye contactLack of discernible interest in the topic at handNo changes in facial expression regardless of the circumstance (neutral expression)Lack of verbal response to emotional stimuliBody language or non-verbal responses that are not typical to the experience, conversation, or situation at hand

It’s important to note that while you may have trouble displayingemotion, many people with schizophrenia have no difficulty recognizing emotional responses in others. This is an important factor in working with your doctor to define a treatment plan, as it gives you a foundation to build on to create appropriate social exchanges.

Negative Symptoms in Schizophrenia

Treatment for Flat Affect

Flat affect can be treated to some degree. It often requires comprehensive therapy, including working with a healthcare provider and taking medication. While it often cannot be completely eliminated, therapy and intervention can help you interact with others more warmly and naturally and get your other symptoms of schizophrenia under control.

Therapy and Intervention

Cognitive behavioral therapy, or CBT, is one of the most researched models of therapy used in the treatment of schizophrenia. CBT can help people with flat affect begin to recognize how their emotionless response does not match what is required in a specific situation.

Your therapist may have you practice appropriate reactions to different stimuli (like grief or celebration) so that you can learn how to react as other people do.

How Behavioral Therapy Works

Medication

The newer “atypical” antipsychotics also influence other neurotransmitters in the brain and may help with a flat affect. Clozaril (clozapine) is one of these agents shown to help combat flat affect in people with schizophrenia and other mental illnesses for which this is a concern.

Atypical Antipsychotics for Schizophrenia

Coping and Support for Caregivers

Caring for a loved one who is suffering from flat affect is challenging. It’s much more than dealing with a loved one who tends to be “cold.” It’s not a personality trait. This symptom of schizophrenia makes it impossible for your loved one to translate emotion into a verbal or physical expression. The brain and body are not connecting.

While they may be unable to express their emotions, your emotions are likely in overdrive as you struggle to come to terms with this symptom of schizophrenia. Continuing to educate yourself on the condition and the experiences your loved one will face is one of the most important ways to cope.

Gathering information can help you better understand what to expect and what you can do to help.

Although your primary focus is on supporting your loved one, it’s also important to remember to help yourself. This means seeking support from local or online groups, a mental health provider, or a trusted friend or family member.

Sharing your experiences and challenges can help you process your emotions and give you encouragement and hope. You may also gain helpful information about new or progressive treatment methods as well as other resources to help your loved one.

Frequently Asked QuestionsMany of the conditions that cause flat affect can be treated. For some people, this can mean that their ability to express emotions can be restored. In other cases, treatment can help improve symptoms of flat affect or even prevent it from occurring. Treatments for conditions that cause flat affect vary, so talk to your healthcare practitioner or a mental health provider about which options are right for your needs.The difference between contristed, blunted, and flat affect lies in the degree to which a person’s emotional expression is affected. Constricted affect causes a diminished level of intensity and variability in how emotions are displayed. Blunted affect involves a more significant reduction in emotional expression.In flat affect, a person has minimal or absent emotional expression.Schizophrenia is a brain disorder that causes problems in a person’s ability to think, behave, and feel. In addition to flat affect, other symptoms of schizophrenia include delusions, hallucinations, reduced speech, disorganized speech, and lack of initiative.

Many of the conditions that cause flat affect can be treated. For some people, this can mean that their ability to express emotions can be restored. In other cases, treatment can help improve symptoms of flat affect or even prevent it from occurring. Treatments for conditions that cause flat affect vary, so talk to your healthcare practitioner or a mental health provider about which options are right for your needs.

The difference between contristed, blunted, and flat affect lies in the degree to which a person’s emotional expression is affected. Constricted affect causes a diminished level of intensity and variability in how emotions are displayed. Blunted affect involves a more significant reduction in emotional expression.In flat affect, a person has minimal or absent emotional expression.

Schizophrenia is a brain disorder that causes problems in a person’s ability to think, behave, and feel. In addition to flat affect, other symptoms of schizophrenia include delusions, hallucinations, reduced speech, disorganized speech, and lack of initiative.

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Li R, Ma X, Wang G, Yang J, Wang C.Why sex differences in schizophrenia?.J Transl Neurosci (Beijing). 2016;1(1):37-42.National Institute of Mental Health.Schizophrenia.Anttila V, Bulik-sullivan B, Finucane HK, et al.Analysis of shared heritability in common disorders of the brain.Science. 2018;360(6395). doi: 10.1126/science.aap8757Evensen J, Røssberg JI, Barder H, et al.Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.Schizophr Res. 2012;139(1-3):99-104. doi: 10.1016/j.schres.2012.04.019Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-45.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. doi:10.1371/journal.pone.0127740Additional ReadingAmerican Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Gur, R. E., Kohler, C. G.Flat Affect in Schizophrenia: Relation to Emotion Processing and Neurocognitive Measures.Schizophrenia Bulletin. 2006. 32(2), 279–287. doi: 10.1093/schbul/sbj041.

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Li R, Ma X, Wang G, Yang J, Wang C.Why sex differences in schizophrenia?.J Transl Neurosci (Beijing). 2016;1(1):37-42.National Institute of Mental Health.Schizophrenia.Anttila V, Bulik-sullivan B, Finucane HK, et al.Analysis of shared heritability in common disorders of the brain.Science. 2018;360(6395). doi: 10.1126/science.aap8757Evensen J, Røssberg JI, Barder H, et al.Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.Schizophr Res. 2012;139(1-3):99-104. doi: 10.1016/j.schres.2012.04.019Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-45.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. doi:10.1371/journal.pone.0127740Additional ReadingAmerican Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Gur, R. E., Kohler, C. G.Flat Affect in Schizophrenia: Relation to Emotion Processing and Neurocognitive Measures.Schizophrenia Bulletin. 2006. 32(2), 279–287. doi: 10.1093/schbul/sbj041.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Li R, Ma X, Wang G, Yang J, Wang C.Why sex differences in schizophrenia?.J Transl Neurosci (Beijing). 2016;1(1):37-42.National Institute of Mental Health.Schizophrenia.Anttila V, Bulik-sullivan B, Finucane HK, et al.Analysis of shared heritability in common disorders of the brain.Science. 2018;360(6395). doi: 10.1126/science.aap8757Evensen J, Røssberg JI, Barder H, et al.Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.Schizophr Res. 2012;139(1-3):99-104. doi: 10.1016/j.schres.2012.04.019Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-45.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. doi:10.1371/journal.pone.0127740

Li R, Ma X, Wang G, Yang J, Wang C.Why sex differences in schizophrenia?.J Transl Neurosci (Beijing). 2016;1(1):37-42.

National Institute of Mental Health.Schizophrenia.

Anttila V, Bulik-sullivan B, Finucane HK, et al.Analysis of shared heritability in common disorders of the brain.Science. 2018;360(6395). doi: 10.1126/science.aap8757

Evensen J, Røssberg JI, Barder H, et al.Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.Schizophr Res. 2012;139(1-3):99-104. doi: 10.1016/j.schres.2012.04.019

Patel KR, Cherian J, Gohil K, Atkinson D.Schizophrenia: overview and treatment options.P T. 2014;39(9):638-45.

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. doi:10.1371/journal.pone.0127740

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.Gur, R. E., Kohler, C. G.Flat Affect in Schizophrenia: Relation to Emotion Processing and Neurocognitive Measures.Schizophrenia Bulletin. 2006. 32(2), 279–287. doi: 10.1093/schbul/sbj041.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Gur, R. E., Kohler, C. G.Flat Affect in Schizophrenia: Relation to Emotion Processing and Neurocognitive Measures.Schizophrenia Bulletin. 2006. 32(2), 279–287. doi: 10.1093/schbul/sbj041.

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