Table of ContentsView AllTable of ContentsWhat Is Inappropriate Affect?CausesSchizophrenia and Other Psychotic DisordersDiagnosisSymptomsTypesTreatmentCoping
Table of ContentsView All
View All
Table of Contents
What Is Inappropriate Affect?
Causes
Schizophrenia and Other Psychotic Disorders
Diagnosis
Symptoms
Types
Treatment
Coping
Close
Affect refers to the outward expression of a person’s internal emotions. It includes a range of emotional experiences, often described as either positive or negative, and encompasses both moods and emotions.
For most people, there is congruence between affect and circumstance; for example, if you are given the news that a friend has passed away, your reaction would be sadness and tears.
However, for a certain percentage of the population, outward affect does not match the situation that they are in. This is known as inappropriate affect and can have a variety of causes.
If you know someone who smiles during a tragedy or who does not show emotion when it would be expected, they may be experiencing inappropriate affect.
To fully understand all the ramifications of inappropriate affect, we will consider in detail symptoms, causes, related conditions, diagnosis, coping, treatment, and related issues.
What Does Inappropriate Affect Mean?
As noted, inappropriate affect involves the display of reactions that do not match the situation that you are in or possibly even your internal state.
Emotions, actions, or overall demeanor that seem out of place in a situation all fall under the general umbrella term “inappropriate affect.”
Inappropriate affect can be a symptom of different underlying physical or mental problems, but it can also be a disorder itself. Psychiatrists and other professionals have recognized inappropriate affect as a problem among patients for over 100 years, reporting events such as laughter or tears without any cause.
In studying what we now know as schizophrenia in 1909, Stransky referred to “intrapsychic ataxia” as a condition involving a disturbance between thoughts and affect.In 1950, Bleuler noted that the clinical prognosis of schizophrenic patients displaying inappropriate affect was much poorer than those who did not.
The 6 Types of Basic Emotions and Their Effect on Human Behavior
Causes of Inappropriate Affect
There are a number of different potential causes of inappropriate affect, but they fall under the categories described below.
Brain Damage or Neurological Dysfunction
Inappropriate affect can result from physical damage to the brain, such as that happening due to a brain tumor, brain damage, dementia, brain injury, and head trauma.
When inappropriate affect results from a structural brain problem, areas commonly involved include thelimbic system, anterior cingulate cortex, and prefrontal cortex.
A second main cause of inappropriate affect is mental disorders, including:
Often, these individuals have not lost the capacity for emotional reactions, but appear to have lost the ability to have them occur in a normal and expected way. This is because their affect is a reaction to theirhallucinationsordelusionsand their assumptions about the reasons for other people’s actions.
Instead, they may have strange reactions that don’t seem to make sense to the outside observer. In this way, they show emotions and behavior that do not seem consistent with the reality of the situation. However, they are, in fact, consistent with their internal experience of the situation.
In schizophrenia, a type of inappropriate affect is sometimes called “flat affect” when it presents as a reduced expression of emotion.
Medications to Treat Mental Disorders
If you think your medication is causing emotional blunting, do not stop treatment without first speaking with your doctor, who can work with you to lower your dose or switch you to a different medication.
Stopping abruptly may lead to a rebound of depression symptoms or trigger the opposite effect, including anxiety, agitation, and sleeplessness.
Emotional Blunting: Causes, Symptoms & Treatment
Psychological Factors
There can also be other causes of inappropriate affect that is not due to brain damage or a mental disorder. In most of these cases, the person is capable of responding in a normal way, but for one reason or another does not. For example, a person in therapy may laugh while describing a difficult situation so as to control their emotions in a self protective way.
Diagnosis of Inappropriate Affect
If you are concerned that you are or someone you know is living with inappropriate affect, it is important to obtain a diagnosis from a licensed mental health professional. Your doctor can refer you to the necessary professionals, such as a neurologist, psychologist, or psychiatrist
The first step would generally be to rule out any physical or neurological condition causing the inappropriate affect. Your mental health professional might use a mental status examination, which is a structured way of observing and evaluating a person’s psychological function from the perspective of attitude, behavior, cognition, judgment, mood, perception, and thought processes.
Often, inappropriate affect is a symptom of another disorder rather than a syndrome itself, so an assessment would be conducted for mental disorders that could be a potential cause. Doctors will also assess the severity of the symptoms.
Psychiatric Evaluation: A Checkup for the Brain
Conditions Involving Inappropriate Affect
Various conditions may be associated with inappropriate affect:
Mental DisordersMajor depressive disorderSchizophreniaSchizoid personality disorderPost-traumatic stress disorderSchizoaffective disorderPsychopathyDepersonalizationBorderline personality disorderNeurological ConditionsBrain damagePseudobulbar affectAutismDementiaAlzheimer’s diseaseHead traumaBrain tumorMultiple sclerosis
Mental DisordersMajor depressive disorderSchizophreniaSchizoid personality disorderPost-traumatic stress disorderSchizoaffective disorderPsychopathyDepersonalizationBorderline personality disorder
Major depressive disorder
Schizophrenia
Schizoid personality disorder
Post-traumatic stress disorder
Schizoaffective disorder
Psychopathy
Depersonalization
Borderline personality disorder
Neurological ConditionsBrain damagePseudobulbar affectAutismDementiaAlzheimer’s diseaseHead traumaBrain tumorMultiple sclerosis
Brain damage
Pseudobulbar affect
Autism
Dementia
Alzheimer’s disease
Head trauma
Brain tumor
Multiple sclerosis
Symptoms of Inappropriate Affect
The specific symptoms of inappropriate affect will depend on the underlying cause and show up in terms of facial expressions, the tone of your voice, and the content of what you say. Below are some potential symptoms:
The specific types of symptoms experienced will depend on the underlying cause of the inappropriate affect.
Types of Affect
In addition to the broad symptoms of inappropriate affect, there are several specific categories within which symptoms can be grouped.Remember that inappropriate affect is simply that which does not match the situation or the internal emotional state of the person.
Blunted Affect
Blunted affect is a common symptom in schizophrenia and related disorders, and refers to a lowered level of the intensity of emotional expression. A person with blunted affect will show little feeling even in emotional situations.
As an example, a person with blunted affect may tell a story about being in a car crash but talk little about how it made them feel, speak in a monotone, and not have many facial expressions.
Restricted Affect
Restricted affect is a reduction in one’s expressive range. So, the person describing the car accident may show some feeling and emotion, but it is less than would be expected based on the content of what is being said.
Flat Affect
Flat affect refers to displaying absolutely no feeling or emotion regardless of the circumstances. This is a step below blunted affect in that it is completely devoid of emotional expression.
Labile Affect
A person with labile affect shows rapid changes in their emotions that don’t seem to relate to outside situations or seem inappropriate for the situation. In other words, if you have labile affect, you would display rapid and repeating shifts in mood or affect. A person with labile affect appears as though they do not control their emotions.
This type of affect is often seen in neurological disorders such as pseudobulbar affect,manic episodesduring bipolar disorder, and borderline personality disorder. Labile affect can also result from fatigue, stress/anxiety, and overstimulation.
Shallow Affect
Shallow affect has a similar meaning to blunted affect, but it is often used to describe the emotional experience of persons with psychopathy. A person with shallow affect will feel little emotion about situations that would expect to elicit specific feelings.
This means that things that cause most people to experience negative emotions do not have the same impact for psychopaths.
As an example, American serial killer Richard Ramirez, also known as the Night Stalker, when sentenced to death, responded with, “Big deal. Death always went with the territory. See you in Disneyland.”
RecapThere are several different type of inappropriate affect, including blunted, restricted, flat, labile, and shallow affect.
Recap
There are several different type of inappropriate affect, including blunted, restricted, flat, labile, and shallow affect.
Treatment for Inappropriate Affect
The treatment for inappropriate affect depends on the underlying cause. Receiving proper treatment depends on an accurate diagnosis, which is why it is so important to visit a healthcare professional if you or someone you know is living with these types of symptoms.
Most types of inappropriate affect will be treated with some form of medication depending on the severity of the symptoms.
Medications that may be used include:
If psychotherapy is used, it is usually as an add-on to medication because therapy alone often will not help to remediate the problem.
Helping Someone With Inappropriate Affect
Things you can do include:
Coping With Inappropriate Affect
If you are living with inappropriate affect, it may be hard to know how to cope. Below are some suggestions on ways to minimize the impact of inappropriate affect on your life.
Seek Professional Help
Visit a healthcare professional to determine the underlying cause of your inappropriate affect. This person will be able to recommend the appropriate treatment for your situation.
Lean on Friends and Family
If you have a neurological condition that causes you to react in inappropriate ways, it may be helpful to share this with those who are closest to you so that they can understand better what is happening.
Seek Social Support
If you have schizophrenia or a related condition, it’s important to seeksocial support, such as through a schizophrenia or PTSD support group.
Manage Stress
According to a study inCardiovascular Psychiatry and Neurology,reducing daily stress and depression can help lessen the onset of inappropriate effect. To manage stress and help balance your moods, get regular exercise, prioritize sleep, avoid using substances such as alcohol, and eat healthy foods.
RecapIf you are experiencing inappropriate affect, it is important to seek professional help. Asking friends and family for help, joining a support group, and finding ways to manage stress are also helpful.
If you are experiencing inappropriate affect, it is important to seek professional help. Asking friends and family for help, joining a support group, and finding ways to manage stress are also helpful.
A Word From Verywell
Are you or someone you know living with inappropriate affect? While this can be a debilitating condition because it affects every area of your life from work to social relationships, with the help of a healthcare professional, it is possible to reduce the impact on your life. Once you have your symptoms under control, all areas of your life should improve and your sense of control will increase.
Whether you are prescribed medication and/or receive psychotherapy, it’s important to follow through with the prescribed protocol to ensure the best chance of success.
Remember that even if you are feeling better, most conditions that require medication will involve taking this medication for the long-term. For this reason, you should always follow your doctor’s advice and never make treatment decisions on your own.
Emotions and Types of Emotional Responses
10 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.Naragon-Gainey K, McMahon TP, Park J.The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges.Am Psychol. 2018;73(9):1175-1186. doi:10.1037/amp0000371Hirjak D, Breyer T, Thomann PA, Fuchs T.Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia. Zhang XY, ed.PLoS ONE. 2013;8(9):e73662. doi:10.1371/journal.pone.0073662Arantes-Gonçalves F, Gama Marques J, Telles-Correia D.Bleuler’s psychopathological perspective on schizophrenia delusions: towards new tools in psychotherapy treatment.Front Psychiatry. 2018;9:306. doi:10.3389/fpsyt.2018.00306Lindner C, Dannlowski U, Bauer J, et al.Affective flattening in patients with schizophrenia: differential association with amygdala response to rhreat-related facial expression under automatic and controlled processing conditions.Psychiatry Investig. 2016;13(1):102-111. doi:10.4306/pi.2016.13.1.102Szmulewicz A, Samamé C, Caravotta P, et al.Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications.Int J Bipolar Disord. 2016;4(1):6. doi:10.1186/s40345-016-0047-3Goodwin GM, Price J, De bodinat C, Laredo J.Emotional blunting with antidepressant treatments: A survey among depressed patients.J Affect Disord. 2017;221:31-35. doi:10.1016/j.jad.2017.05.048Anttila 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.aap8757Marder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14-24. doi:10.1002/wps.20385Gooding DC, Zahn-Waxler C, Light SN, Kestenbaum CJ, Erlenmeyer-Kimling L.Childhood affective indicators of risk for adulthood psychopathology: The New York High-Risk Project Findings.J Psychiatr Brain Sci. 2018;3(3):4. doi:10.20900/jpbs.20180004Compare A, Zarbo C, Shonin E, Van gordon W, Marconi C.Emotional regulation and depression: a potential mediator between heart and mind.Cardiovasc Psychiatry Neurol. 2014;2014:324374. doi:10.1155/2014/324374Additional ReadingAhmed A, Simmons Z.Pseudobulbar affect: prevalence and management.Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/tcrm.s53906Harris A, Metcalfe M.Inappropriate affect.J Neurol Neurosurg Psychiatry. 1956;19(4):308-13. doi:10.1136/jnnp.19.4.308
10 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.Naragon-Gainey K, McMahon TP, Park J.The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges.Am Psychol. 2018;73(9):1175-1186. doi:10.1037/amp0000371Hirjak D, Breyer T, Thomann PA, Fuchs T.Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia. Zhang XY, ed.PLoS ONE. 2013;8(9):e73662. doi:10.1371/journal.pone.0073662Arantes-Gonçalves F, Gama Marques J, Telles-Correia D.Bleuler’s psychopathological perspective on schizophrenia delusions: towards new tools in psychotherapy treatment.Front Psychiatry. 2018;9:306. doi:10.3389/fpsyt.2018.00306Lindner C, Dannlowski U, Bauer J, et al.Affective flattening in patients with schizophrenia: differential association with amygdala response to rhreat-related facial expression under automatic and controlled processing conditions.Psychiatry Investig. 2016;13(1):102-111. doi:10.4306/pi.2016.13.1.102Szmulewicz A, Samamé C, Caravotta P, et al.Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications.Int J Bipolar Disord. 2016;4(1):6. doi:10.1186/s40345-016-0047-3Goodwin GM, Price J, De bodinat C, Laredo J.Emotional blunting with antidepressant treatments: A survey among depressed patients.J Affect Disord. 2017;221:31-35. doi:10.1016/j.jad.2017.05.048Anttila 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.aap8757Marder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14-24. doi:10.1002/wps.20385Gooding DC, Zahn-Waxler C, Light SN, Kestenbaum CJ, Erlenmeyer-Kimling L.Childhood affective indicators of risk for adulthood psychopathology: The New York High-Risk Project Findings.J Psychiatr Brain Sci. 2018;3(3):4. doi:10.20900/jpbs.20180004Compare A, Zarbo C, Shonin E, Van gordon W, Marconi C.Emotional regulation and depression: a potential mediator between heart and mind.Cardiovasc Psychiatry Neurol. 2014;2014:324374. doi:10.1155/2014/324374Additional ReadingAhmed A, Simmons Z.Pseudobulbar affect: prevalence and management.Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/tcrm.s53906Harris A, Metcalfe M.Inappropriate affect.J Neurol Neurosurg Psychiatry. 1956;19(4):308-13. doi:10.1136/jnnp.19.4.308
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.
Naragon-Gainey K, McMahon TP, Park J.The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges.Am Psychol. 2018;73(9):1175-1186. doi:10.1037/amp0000371Hirjak D, Breyer T, Thomann PA, Fuchs T.Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia. Zhang XY, ed.PLoS ONE. 2013;8(9):e73662. doi:10.1371/journal.pone.0073662Arantes-Gonçalves F, Gama Marques J, Telles-Correia D.Bleuler’s psychopathological perspective on schizophrenia delusions: towards new tools in psychotherapy treatment.Front Psychiatry. 2018;9:306. doi:10.3389/fpsyt.2018.00306Lindner C, Dannlowski U, Bauer J, et al.Affective flattening in patients with schizophrenia: differential association with amygdala response to rhreat-related facial expression under automatic and controlled processing conditions.Psychiatry Investig. 2016;13(1):102-111. doi:10.4306/pi.2016.13.1.102Szmulewicz A, Samamé C, Caravotta P, et al.Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications.Int J Bipolar Disord. 2016;4(1):6. doi:10.1186/s40345-016-0047-3Goodwin GM, Price J, De bodinat C, Laredo J.Emotional blunting with antidepressant treatments: A survey among depressed patients.J Affect Disord. 2017;221:31-35. doi:10.1016/j.jad.2017.05.048Anttila 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.aap8757Marder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14-24. doi:10.1002/wps.20385Gooding DC, Zahn-Waxler C, Light SN, Kestenbaum CJ, Erlenmeyer-Kimling L.Childhood affective indicators of risk for adulthood psychopathology: The New York High-Risk Project Findings.J Psychiatr Brain Sci. 2018;3(3):4. doi:10.20900/jpbs.20180004Compare A, Zarbo C, Shonin E, Van gordon W, Marconi C.Emotional regulation and depression: a potential mediator between heart and mind.Cardiovasc Psychiatry Neurol. 2014;2014:324374. doi:10.1155/2014/324374
Naragon-Gainey K, McMahon TP, Park J.The contributions of affective traits and emotion regulation to internalizing disorders: Current state of the literature and measurement challenges.Am Psychol. 2018;73(9):1175-1186. doi:10.1037/amp0000371
Hirjak D, Breyer T, Thomann PA, Fuchs T.Disturbance of intentionality: a phenomenological study of body-affecting first-rank symptoms in schizophrenia. Zhang XY, ed.PLoS ONE. 2013;8(9):e73662. doi:10.1371/journal.pone.0073662
Arantes-Gonçalves F, Gama Marques J, Telles-Correia D.Bleuler’s psychopathological perspective on schizophrenia delusions: towards new tools in psychotherapy treatment.Front Psychiatry. 2018;9:306. doi:10.3389/fpsyt.2018.00306
Lindner C, Dannlowski U, Bauer J, et al.Affective flattening in patients with schizophrenia: differential association with amygdala response to rhreat-related facial expression under automatic and controlled processing conditions.Psychiatry Investig. 2016;13(1):102-111. doi:10.4306/pi.2016.13.1.102
Szmulewicz A, Samamé C, Caravotta P, et al.Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications.Int J Bipolar Disord. 2016;4(1):6. doi:10.1186/s40345-016-0047-3
Goodwin GM, Price J, De bodinat C, Laredo J.Emotional blunting with antidepressant treatments: A survey among depressed patients.J Affect Disord. 2017;221:31-35. doi:10.1016/j.jad.2017.05.048
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
Marder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14-24. doi:10.1002/wps.20385
Gooding DC, Zahn-Waxler C, Light SN, Kestenbaum CJ, Erlenmeyer-Kimling L.Childhood affective indicators of risk for adulthood psychopathology: The New York High-Risk Project Findings.J Psychiatr Brain Sci. 2018;3(3):4. doi:10.20900/jpbs.20180004
Compare A, Zarbo C, Shonin E, Van gordon W, Marconi C.Emotional regulation and depression: a potential mediator between heart and mind.Cardiovasc Psychiatry Neurol. 2014;2014:324374. doi:10.1155/2014/324374
Ahmed A, Simmons Z.Pseudobulbar affect: prevalence and management.Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/tcrm.s53906Harris A, Metcalfe M.Inappropriate affect.J Neurol Neurosurg Psychiatry. 1956;19(4):308-13. doi:10.1136/jnnp.19.4.308
Ahmed A, Simmons Z.Pseudobulbar affect: prevalence and management.Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/tcrm.s53906
Harris A, Metcalfe M.Inappropriate affect.J Neurol Neurosurg Psychiatry. 1956;19(4):308-13. doi:10.1136/jnnp.19.4.308
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