What is the Brief Psychiatric Rating Scale?

Introduction

The Brief Psychiatric Rating Scale (BPRS) is a rating scale which a clinician or researcher may use to measure psychiatric symptoms such as depression, anxiety, hallucinations and unusual behaviour.

The scale is one of the oldest, most widely used scales to measure psychotic symptoms and was first published in 1962.

Brief History

The BPRS was initially developed by John E. Overall and Donald R. Gorham. It was created for the purpose of being able to quickly assess the patient’s psychiatric symptoms prior, during, or following a treatment. The items of the test were generated from conducting factor analysis on the Multidimensional Scale for Rating Psychiatric Patients and the Inpatient Multidimensional Psychiatric Scale. Sixteen factors were found from the analysis, which served as the building blocks for the BPRS. Later research in 1968 added two more factors to the BPRS, which were excitement and disorientation.

Test Format

The BPRS consists of 18 items measuring the following factors:

  1. Anxiety.
  2. Emotional withdrawal.
  3. Conceptual disorganisation.
  4. Guilt feelings.
  5. Tension.
  6. Mannerisms and posturing.
  7. Grandiosity.
  8. Depressive moods.
  9. Hostility.
  10. Suspiciousness.
  11. Hallucinatory behaviour.
  12. Motor hyperactivity.
  13. Uncooperativeness.
  14. Unusual thought content.
  15. Blunted affect.
  16. Somatic concern.
  17. Excitement.
  18. Disorientation.

It uses a seven-item Likert scale with the following values:

  • 1 = “not present”.
  • 2 = “very mild”.
  • 3 = “mild”.
  • 4 = “moderate”.
  • 5 = “moderately severe”.
  • 6 = “severe”.
  • 7 = “extremely severe”.

The test is administered in tandem with a series of interviews conducted by at least two clinicians to ensure interrater reliability of the assessment.

Usage

The BPRS is intended for use on adult psychiatric patients and has been validated for use in elderly populations. A version designed for children called the Brief Psychiatric Rating Scale Children was also developed by Overall and Betty Pfeifferbaum, with different scale structures and factors.

Further Development

An expanded version of the test was created in 1993 by D. Lukoff, Keith H. Nuechterlein, and Joseph Ventura.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Brief_Psychiatric_Rating_Scale&gt;; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Scale for the Assessment of Negative Symptoms?

Introduction

The Scale for the Assessment of Negative Symptoms (SANS) is a rating scale that mental health professionals use to measure negative symptoms in schizophrenia.

Negative symptoms are those conspicuous by their absence – lack of concern for one’s appearance, and lack of language and communication skills, for example. Nancy Andreasen developed the scale and first published it in 1984. SANS splits assessment into five domains. Within each domain it rates separate symptoms from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Positive Symptoms (SAPS), which was published a few years later. These tools are available for clinicians and for research.

Background

Schizophrenia is a severe mental illness characterised by a range of behaviours, including hallucinations and delusions. Hallucinations refer to disorders involving the sensory systems, and are most often manifested as seeing or hearing things (e.g. voices) that do not exist. Delusions include odd or unusual beliefs such as grandiosity or paranoia. Both hallucinations and delusions are inconsistent with reality. Other symptoms of schizophrenia include bizarre behaviour, odd posture or movements, facial grimacing, loss of, or indifference to self-help skills (grooming, washing, toileting, feeding, etc.). Schizophrenia may also be marked by a host of social and communication deficits, such as social withdrawal, odd use of language, including excessive use of made up words (neologisms), incomprehensible combinations of words (word salad) or overall poverty of speech. The symptoms are often classified into two broad categories: positive and negative symptoms. Positive symptoms refer to those behaviours or condition that are present in schizophrenia but that are not present under typical conditions (hallucinations, delusions). Negative symptoms refer to those behaviours that are conspicuous because of their absence (grooming, language, communication). Several measures or rating scales have been developed to assess the positive and negative aspects of schizophrenia.

Items

  • Affective Flattening or Blunting:
    • Unchanging Facial Expression.
    • Decreased Spontaneous Movements.
    • Paucity of Expressive Gestures.
    • Poor Eye Contact.
    • Affective Non-responsivity.
    • Lack of Vocal Inflections.
    • Global Rating of Affective Flattening.
    • Inappropriate Affect.
  • Alogia:
    • Poverty of Speech.
    • Poverty of Content of Speech.
    • Blocking.
    • Increased Latency of Response.
    • Global Rating of Alogia.
  • Avolition – Apathy:
    • Grooming and Hygiene.
    • Impersistence at Work or School.
    • Physical Anergia.
    • Global Rating of Avolition – Apathy.
  • Anhedonia – Asociality:
    • Recreational Interests and Activities.
    • Sexual Interest and Activity.
    • Ability to Feel Intimacy and Closeness.
    • Relationships with Friends and Peers.
    • Global Rating of Anhedonia-Asociality.
  • Attention:
    • Social Inattentiveness.
    • Inattentiveness During Mental Status Testing.
    • Global Rating of Attention.
    • Scale for the Assessment of Positive Symptoms (SAPS).

What is Reduced Effect Display?

Introduction

Reduced affect display, sometimes referred to as emotional blunting, is a condition of reduced emotional reactivity in an individual.

It manifests as a failure to express feelings (affect display) either verbally or nonverbally, especially when talking about issues that would normally be expected to engage the emotions. Expressive gestures are rare and there is little animation in facial expression or vocal inflection. Reduced affect can be symptomatic of autism, schizophrenia, depression, posttraumatic stress disorder, depersonalisation disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications (e.g. antipsychotics and antidepressants).

Reduced affect should be distinguished from apathy and anhedonia, which explicitly refer to a lack of emotion, whereas reduced affect is a lack of emotional expression (affect display) regardless of whether emotion (underlying affect) is actually reduced or not.

Types

Constricted Affect

A restricted or constricted affect is a reduction in an individual’s expressive range and the intensity of emotional responses.

Blunted and Flat Affect

Blunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. “The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. They may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression”.

Shallow Affect

Shallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy.

Brain structures

Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex.

Limbic Structures

Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques; neonatal damage produces the same effect as damage that occurs later in life. The macaques’ brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion.

Brainstem

Parts of the brainstem are responsible for passive emotional coping strategies that are characterised by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown “sad” film excerpts. The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results.

Prefrontal Cortex

Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behaviour. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus.

Anterior Cingulate Cortex

A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect.

Diagnoses

Schizophrenia

Flat and blunted affect is a defining characteristic in the presentation of schizophrenia. To reiterate, these individuals have a decrease in observed vocal and facial expression as well as the use of gestures. One study of flat affect in schizophrenia found that “flat affect was more common in men, and was associated with worse current quality of life” as well as having “an adverse effect on course of illness”.

The study also reported a “dissociation between reported experience of emotion and its display” – supporting the suggestion made elsewhere that “blunted affect, including flattened facial expressiveness and lack of vocal inflection … often disguises an individual’s true feelings.” Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, “a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of ‘queerness’ … the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness”. In the most extreme cases, there is a complete “dissociation from affective states”. To further support this idea, a study examining emotion dysregulation found that individuals with schizophrenia could not exaggerate their emotional expression as healthy controls could. Participants were asked to express whatever emotions they had during a clip of a film, and the participants with schizophrenia showed deficits in behavioural expression of their emotions.

There is still some debate regarding the source of flat affect in schizophrenia. However, some literature indicates abnormalities in the dorsal executive and ventral affective systems; it is argued that dorsal hypoactivation and ventral hyperactivation may be the source of flat affect. Further, the authors found deficits in the mirror neuron system may also contribute to flat affect in that the deficits may cause disruptions in the control of facial expression.

Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals’ use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviourally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex.

Assessment

In making assessments of mood and affect the clinician is cautioned that “it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors”; while the layperson is warned to beware of applying the criterion lightly to “friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our ‘normal’ population, and our [US] tendency to psychological hypochondriasis”.

R.D. Laing in particular stressed that “such ‘clinical’ categories as schizoid, autistic, ‘impoverished’ affect … all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person’s relation to [his or her] actions. There are no such reliable or valid criteria”.

Differential Diagnosis

Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who “lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether”. Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.

“If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events; this condition is sometimes called ‘affective blindness'”. In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.

What is Reduced Affect Display?

Introduction

Reduced affect display, sometimes referred to as emotional blunting, is a condition of reduced emotional reactivity in an individual.

It manifests as a failure to express feelings (affect display) either verbally or nonverbally, especially when talking about issues that would normally be expected to engage the emotions. Expressive gestures are rare and there is little animation in facial expression or vocal inflection. Reduced affect can be symptomatic of autism, schizophrenia, depression, posttraumatic stress disorder, depersonalisation disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications (e.g. antipsychotics and antidepressants).

Reduced affect should be distinguished from apathy and anhedonia, which explicitly refer to a lack of emotion, whereas reduced affect is a lack of emotional expression (affect display) regardless of whether emotion (underlying affect) is actually reduced or not.

Types

Constricted Affect

A restricted or constricted affect is a reduction in an individual’s expressive range and the intensity of emotional responses.

Blunted and Flat Affect

Blunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. “The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression”.

Shallow Affect

Shallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy.

Brain Structures

Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex.

Limbic Structures

Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques; neonatal damage produces the same effect as damage that occurs later in life. The macaques’ brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion.

Brainstem

Parts of the brainstem are responsible for passive emotional coping strategies that are characterized by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown “sad” film excerpts. The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results.

Prefrontal Cortex

Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behaviour. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus.

Anterior Cingulate Cortex

A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect.

Diagnoses

Schizophrenia

Patients with schizophrenia have long been recognized as showing “flat or inappropriate affect, with splitting of feelings from events … feelings seem flat instead of being in contact with what is going on”. One study of flat affect in schizophrenia found that “flat affect was more common in men, and was associated with worse current quality of life” as well as having “an adverse effect on course of illness”.

The study also reported a “dissociation between reported experience of emotion and its display” – supporting the suggestion made elsewhere that “blunted affect, including flattened facial expressiveness and lack of vocal inflection … often disguises an individual’s true feelings.” Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, “a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of ‘queerness’ … the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness”. In the most extreme cases, there is a complete “dissociation from affective states”.

Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals’ use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviourally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex.

Assessment

In making assessments of mood and affect the clinician is cautioned that “it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors”; while the layperson is warned to beware of applying the criterion lightly to “friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our ‘normal’ population, and our [US] tendency to psychological hypochondriasis”.

R.D. Laing in particular stressed that “such ‘clinical’ categories as schizoid, autistic, ‘impoverished’ affect … all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person’s relation to [his or her] actions. There are no such reliable or valid criteria”.

Differential Diagnosis

Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who “lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether”. Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.

“If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events; this condition is sometimes called ‘affective blindness'”. In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.

What is Reduced Affect Display?

Introduction

Reduced affect display, sometimes referred to as emotional blunting, is a condition of reduced emotional reactivity in an individual.

It manifests as a failure to express feelings (affect display) either verbally or nonverbally, especially when talking about issues that would normally be expected to engage the emotions. Expressive gestures are rare and there is little animation in facial expression or vocal inflection. Reduced affect can be symptomatic of autism, schizophrenia, depression, posttraumatic stress disorder, depersonalisation disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications (e.g. antipsychotics and antidepressants).

Reduced affect should be distinguished from apathy and anhedonia, which explicitly refer to a lack of emotion, whereas reduced affect is a lack of emotional expression (affect display) regardless of whether emotion (underlying affect) is actually reduced or not.

Refer to Affective Science and Affect Display.

Types

Constricted AffectA restricted or constricted affect is a reduction in an individual’s expressive range and the intensity of emotional responses.
Blunted and Flat AffectBlunted affect is a lack of affect more severe than restricted or constricted affect, but less severe than flat or flattened affect. “The difference between flat and blunted affect is in degree. A person with flat affect has no or nearly no emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others. A person with blunted affect, on the other hand, has a significantly reduced intensity in emotional expression”.
Shallow AffectShallow affect has equivalent meaning to blunted affect. Factor 1 of the Psychopathy Checklist identifies shallow affect as a common attribute of psychopathy.

Brain Structures

Individuals with schizophrenia with blunted affect show different regional brain activity in fMRI scans when presented with emotional stimuli compared to individuals with schizophrenia without blunted affect. Individuals with schizophrenia without blunted affect show activation in the following brain areas when shown emotionally negative pictures: midbrain, pons, anterior cingulate cortex, insula, ventrolateral orbitofrontal cortex, anterior temporal pole, amygdala, medial prefrontal cortex, and extrastriate visual cortex. Individuals with schizophrenia with blunted affect show activation in the following brain regions when shown emotionally negative pictures: midbrain, pons, anterior temporal pole, and extrastriate visual cortex.

Limbic Structures

Individuals with schizophrenia with flat affect show decreased activation in the limbic system when viewing emotional stimuli. In individuals with schizophrenia with blunted affect neural processes begin in the occipitotemporal region of the brain and go through the ventral visual pathway and the limbic structures until they reach the inferior frontal areas. Damage to the amygdala of adult rhesus macaques early in life can permanently alter affective processing. Lesioning the amygdala causes blunted affect responses to both positive and negative stimuli. This effect is irreversible in the rhesus macaques; neonatal damage produces the same effect as damage that occurs later in life. The macaques’ brain cannot compensate for early amygdala damage even though significant neuronal growth may occur. There is some evidence that blunted affect symptoms in schizophrenia patients are not a result of just amygdala responsiveness, but a result of the amygdala not being integrated with other areas of the brain associated with emotional processing, particularly in amygdala-prefrontal cortex coupling. Damage in the limbic region prevents the amygdala from correctly interpreting emotional stimuli in individuals with schizophrenia by compromising the link between the amygdala and other brain regions associated with emotion.

Brainstem

Parts of the brainstem are responsible for passive emotional coping strategies that are characterized by disengagement or withdrawal from the external environment (quiescence, immobility, hyporeactivity), similar to what is seen in blunted affect. Individuals with schizophrenia with blunted affect show activation of the brainstem during fMRI scans, particularly the right medulla and the left pons, when shown “sad” film excerpts. The bilateral midbrain is also activated in individuals with schizophrenia diagnosed with blunted affect. Activation of the midbrain is thought to be related to autonomic responses associated with perceptual processing of emotional stimuli. This region usually becomes activated in diverse emotional states. When the connectivity between the midbrain and the medial prefrontal cortex is compromised in individuals with schizophrenia with blunted affect an absence of emotional reaction to external stimuli results.

Prefrontal Cortex

Individuals with schizophrenia, as well as patients being successfully reconditioned with quetiapine for blunted affect, show activation of the prefrontal cortex (PFC). Failure to activate the PFC is possibly involved in impaired emotional processing in individuals with schizophrenia with blunted affect. The mesial PFC is activated in aver individuals in response to external emotional stimuli. This structure possibly receives information from the limbic structures to regulate emotional experiences and behaviour. Individuals being reconditioned with quetiapine, who show reduced symptoms, show activation in other areas of the PFC as well, including the right medial prefrontal gyrus and the left orbitofrontal gyrus.

Anterior Cingulate Cortex

A positive correlation has been found between activation of the anterior cingulate cortex and the reported magnitude of sad feelings evoked by viewing sad film excerpts. The rostral subdivision of this region is possibly involved in detecting emotional signals. This region is different in individuals with schizophrenia with blunted affect.

Diagnoses

Schizophrenia

Patients with schizophrenia have long been recognized as showing “flat or inappropriate affect, with splitting of feelings from events … feelings seem flat instead of being in contact with what is going on”. One study of flat affect in schizophrenia found that “flat affect was more common in men, and was associated with worse current quality of life” as well as having “an adverse effect on course of illness”.

The study also reported a “dissociation between reported experience of emotion and its display” – supporting the suggestion made elsewhere that “blunted affect, including flattened facial expressiveness and lack of vocal inflection … often disguises an individual’s true feelings.” Thus, feelings may merely be unexpressed, rather than totally lacking. On the other hand, “a lack of emotions which is due not to mere repression but to a real loss of contact with the objective world gives the observer a specific impression of ‘queerness’ … the remainders of emotions or the substitutes for emotions usually refer to rage and aggressiveness”. In the most extreme cases, there is a complete “dissociation from affective states”.

Another study found that when speaking, individuals with schizophrenia with flat affect demonstrate less inflection than normal controls and appear to be less fluent. Normal subjects appear to express themselves using more complex syntax, whereas flat affect subjects speak with fewer words, and fewer words per sentence. Flat affect individuals’ use of context-appropriate words in both sad and happy narratives are similar to that of controls. It is very likely that flat affect is a result of deficits in motor expression as opposed to emotional processing. The moods of display are compromised, but subjective, autonomic, and contextual aspects of emotion are left intact.

Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) was previously known to cause negative feelings, such as depressed mood, re-experiencing and hyperarousal. However, recently, psychologists have started to focus their attention on the blunted affects and also the decrease in feeling and expressing positive emotions in PTSD patients. Blunted affect, or emotional numbness, is considered one of the consequences of PTSD because it causes a diminished interest in activities that produce pleasure (anhedonia) and produces feelings of detachment from others, restricted emotional expression and a reduced tendency to express emotions behaviourally. Blunted affect is often seen in veterans as a consequence of the psychological stressful experiences that caused PTSD. Blunted affect is a response to PTSD, it is considered one of the central symptoms in post-traumatic stress disorders and it is often seen in veterans who served in combat zones. In PTSD, blunted affect can be considered a psychological response to PTSD as a way to combat overwhelming anxiety that the patients feel. In blunted affect, there are abnormalities in circuits that also include the prefrontal cortex.

Assessment

In making assessments of mood and affect the clinician is cautioned that “it is important to keep in mind that demonstrative expression can be influenced by cultural differences, medication, or situational factors”; while the layperson is warned to beware of applying the criterion lightly to “friends, otherwise [he or she] is likely to make false judgments, in view of the prevalence of schizoid and cyclothymic personalities in our ‘normal’ population, and our [US] tendency to psychological hypochondriasis”.

R.D. Laing in particular stressed that “such ‘clinical’ categories as schizoid, autistic, ‘impoverished’ affect … all presuppose that there are reliable, valid impersonal criteria for making attributions about the other person’s relation to [his or her] actions. There are no such reliable or valid criteria”.

Differential Diagnosis

Blunted affect is very similar to anhedonia, which is the decrease or cessation of all feelings of pleasure (which thus affects enjoyment, happiness, fun, interest, and satisfaction). In the case of anhedonia, emotions relating to pleasure will not be expressed as much or at all because they are literally not experienced or are decreased. Both blunted affect and anhedonia are considered negative symptoms of schizophrenia, meaning that they are indicative of a lack of something. There are some other negative symptoms of schizophrenia which include avolition, alogia and catatonic behaviour.

Closely related is alexithymia – a condition describing people who “lack words for their feelings. They seem to lack feelings altogether, although this may actually be because of their inability to express emotion rather than from an absence of emotion altogether”. Alexithymic patients however can provide clues via assessment presentation which may be indicative of emotional arousal.

“If the amygdala is severed from the rest of the brain, the result is a striking inability to gauge the emotional significance of events; this condition is sometimes called ‘affective blindness'”. In some cases, blunted affect can fade, but there is no conclusive evidence of why this can occur.

What is Affect Display?

Introduction

Affect displays are the verbal and non-verbal displays of affect (emotion).

These displays can be through facial expressions, gestures and body language, volume and tone of voice, laughing, crying, etc. Affect displays can be altered or faked so one may appear one way, when they feel another (i.e. smiling when sad). Affect can be conscious or non-conscious and can be discreet or obvious. The display of positive emotions, such as smiling, laughing, etc., is termed “positive affect”, while the displays of more negative emotions, such as crying and tense gestures, is respectively termed “negative affect”.

Affect is important in psychology as well as in communication, mostly when it comes to interpersonal communication and non-verbal communication. In both psychology and communication, there are a multitude of theories that explain affect and its impact on humans and quality of life.

Refer to Affective Science and Reduced Affect Display.

Theoretical Perspective

Affect can be taken to indicate an instinctual reaction to stimulation occurring before the typical cognitive processes considered necessary for the formation of a more complex emotion. Robert B. Zajonc asserts that this reaction to stimuli is primary for human beings and is the dominant reaction for lower organisms. Zajonc suggests affective reactions can occur without extensive perceptual and cognitive encoding, and can be made sooner and with greater confidence than cognitive judgments.

Lazarus on the other hand considers affect to be post-cognitive. That is, affect is elicited only after a certain amount of cognitive processing of information has been accomplished. In this view, an affective reaction, such as liking, disliking, evaluation, or the experience of pleasure or displeasure, is based on a prior cognitive process in which a variety of content discriminations are made and features are identified, examined for their value, and weighted for their contributions.

A divergence from a narrow reinforcement model for emotion allows for other perspectives on how affect influences emotional development. Thus, temperament, cognitive development, socialization patterns, and the idiosyncrasies of one’s family or subculture are mutually interactive in non-linear ways. As an example, the temperament of a highly reactive, low self-soothing infant may “disproportionately” affect the process of emotion regulation in the early months of life.

Non-Conscious Affect and Perception

In relation to perception, a type of non-conscious affect may be separate from the cognitive processing of environmental stimuli. A monohierarchy of perception, affect and cognition considers the roles of arousal, attentional tendencies, affective primacy, evolutionary constraints, and covert perception within the sensing and processing of preferences and discrimination. Emotions are complex chains of events triggered by certain stimuli. There is no way to completely describe an emotion by knowing only some of its components. Verbal reports of feelings are often inaccurate because people may not know exactly what they feel, or they may feel several different emotions at the same time. There are also situations that arise in which individuals attempt to hide their feelings, and there are some who believe that public and private events seldom coincide exactly, and that words for feelings are generally more ambiguous than are words for objects or events.

Affective responses, on the other hand, are more basic and may be less problematic in terms of assessment. Brewin has proposed two experiential processes that frame non-cognitive relations between various affective experiences: those that are prewired dispositions (i.e., non-conscious processes), able to “select from the total stimulus array those stimuli that are casually relevant, using such criteria as perceptual salience, spatiotemporal cues, and predictive value in relation to data stored in memory”, and those that are automatic (i.e. subconscious processes), characterized as “rapid, relatively inflexible and difficult to modify… (requiring) minimal attention to occur and… (capable of being) activated without intention or awareness”.

Arousal

Arousal is a basic physiological response to the presentation of stimuli. When this occurs, a non-conscious affective process takes the form of two control mechanisms; one mobilisation, and the other immobilisation. Within the human brain, the amygdala regulates an instinctual reaction initiating this arousal process, either freezing the individual or accelerating mobilisation.

The arousal response is illustrated in studies focused on reward systems that control food-seeking behaviour. Researchers focused on learning processes and modulatory processes that are present while encoding and retrieving goal values. When an organism seeks food, the anticipation of reward based on environmental events becomes another influence on food seeking that is separate from the reward of food itself. Therefore, earning the reward and anticipating the reward are separate processes and both create an excitatory influence of reward-related cues. Both processes are dissociated at the level of the amygdala and are functionally integrated within larger neural systems.

Affect and Mood

Mood, like emotion, is an affective state. However, an emotion tends to have a clear focus (i.e., a self-evident cause), while mood tends to be more unfocused and diffused. Mood, according to Batson, Shaw, and Oleson (1992), involves tone and intensity and a structured set of beliefs about general expectations of a future experience of pleasure or pain, or of positive or negative affect in the future. Unlike instant reactions that produce affect or emotion, and that change with expectations of future pleasure or pain, moods, being diffused and unfocused, and thus harder to cope with, can last for days, weeks, months, or even years. Moods are hypothetical constructs depicting an individual’s emotional state. Researchers typically infer the existence of moods from a variety of behavioural referents.

Positive affect and negative affect represent independent domains of emotion in the general population, and positive affect is strongly linked to social interaction. Positive and negative daily events show independent relationships to subjective well-being, and positive affect is strongly linked to social activity. Recent research suggests that “high functional support is related to higher levels of positive affect”. The exact process through which social support is linked to positive affect remains unclear. The process could derive from predictable, regularized social interaction, from leisure activities where the focus is on relaxation and positive mood, or from the enjoyment of shared activities.

Gender

Research has indicated many differences in affective displays due to gender. Gender, as opposed to sex, is one’s self-perception of being masculine or feminine (i.e. a male can perceive himself to be more feminine or a female can perceive herself to be more masculine). It can also be argued, however, that hormones (typically determined by sex) greatly affect affective displays and mood.

Affect and Child Development

According to studies done in the late ’80s and early ’90s, infants within their first year of life are not only able to begin recognising affect displays but can begin mimicking the displays and also begin developing empathy. A study in 2011 followed up on these earlier studies by testing fifteen 6-12 month old infants’ arousal, via pupil dilation, when looking at both positive and negative displays. Results showed that when presented with negative affect, an infant’s pupil will dilate and stay dilated for a longer period of time when compared to neutral affect. When presented with positive affect however, the pupil dilation is much larger, but stays dilated for shorter amount of time. While this study does not prove an infant’s ability to empathise with others, it does show that infants do recognise and acknowledge both positive and negative displays of emotion.

In the early 2000s over the period of about seven years, a study was done on about 200 children whose mother had “a history of juvenile-onset unipolar depressive disorder” or simply, depression as children themselves. In the cases of unipolar depression, a person generally displays more negative affect and less positive affect than a person without depression. Or, they are more likely to show when they are sad or upset, than when they are excited or happy. This study that was published in 2010 discovered that the children of mothers that suffer from unipolar depression, had lower levels of positive affect when compared to the control group. Even as the children grew older, while the negative affect began to stay the same, the children still showed consistently lower positive affect. This study suggests that “Reduced PA [positive affect] may be one source of developmental vulnerability to familial depression…” meaning that while having family with depression, increases the risk of children developing depression, reduced positive affect increases the risk of this development. But knowing this aspect of depression, might also be able to help prevent the onset of depression in young children well into their adulthood.

Disorders and Physical Disabilities

Refer to Reduced Affect Display.

There are some diseases, physical disabilities and mental health disorders that can change the way a person’s affect displays are conveyed. Reduced affect is when a person’s emotions cannot be properly conveyed or displayed physically. There is no actual change in how intensely they truly feel emotions, there is simply a disparity between emotions felt and how intensely they are conveyed. These disorders can greatly affect a person’s quality of life, depending on how intense the disability is.

Flat, Blunted and Restricted Affect

These are symptoms in which an affected person feels an emotion, but does not or cannot display it. Flat being the most severe in where there is very little to absolutely no show of emotions. Restricted and blunted are, respectively, less severe. Disorders involving these reduced affect displays most commonly include schizophrenia, post traumatic stress disorder, depression, autism and persons with traumatic brain injuries. One study has shown that people with schizophrenia that experience flat affect, can also experience difficulty perceiving the emotions of a healthy individual.

Facial Paralysis and Surgery

People who suffer from deformities and facial paralysis are also physically incapable of displaying emotions. This is beginning to be corrected though, through “Facial Reanimation Surgery” which is proving not only to successfully improve a patient’s affect displays, but also bettering their psychological health. There are multiple types of surgeries that can help fix facial paralysis. Some more popular types include fixing the actual nerve damage, specifically any damage to the hypoglossal nerve; facial grafts where nerves taken from a donor’s leg are transplanted into the patient’s face; or if the damage is more muscular versus actual nerves, muscle may be transferred into the patient’s face.

Strategic Display

Refer to Psychological Manipulation.

Emotions can be displayed in order to elicit desired behaviours from others.

People have been known to display positive emotions in various settings. Service workers often engage in emotional labour, a strive to maintain positive emotional expressions despite difficulties in working conditions or rude customers, in order to conform to organisational rules. Such strategic displays are not always effective, since if they are detected, lower customer satisfaction results.

Perhaps the most notable attempt to feign negative emotion could be seen with Nixon’s madman theory. Nixon’s administration attempted to make the leaders of other countries think Nixon was mad, and that his behaviour was irrational and volatile. Fearing an unpredictable American response, leaders of hostile Communist Bloc nations would avoid provoking the United States. This diplomatic strategy was not ultimately successful.

The effectiveness of the strategic display depends on the ability of the expresser to remain undetected. It may be a risky strategy since if detected, the person’s original intent could be discovered, undermining the future relationship with the target.

According to the appraisal theory of emotions, the experience of emotions is preceded by an evaluation of an object of significance to that individual. When individuals are seen to display emotions, it serves as a signal to others of an event important to that individual. Thus, deliberately altering the emotion display toward an object could be used make the targets of the strategic emotion think and behave in ways that benefit the original expresser. For example, people attempt to hide their expressions during a poker game in order to avoid giving away information to the other players, i.e. keep a poker face.

What is Affective Science?

Introduction

Affective science is the scientific study of emotion or affect.

his includes the study of emotion elicitation, emotional experience and the recognition of emotions in others. Of particular relevance are the nature of feeling, mood, emotionally-driven behaviour, decision-making, attention and self-regulation, as well as the underlying physiology and neuroscience of the emotions.

Discussion

An increasing interest in emotion can be seen in the behavioural, biological and social sciences. Research over the last two decades suggests that many phenomena, ranging from individual cognitive processing to social and collective behaviour, cannot be understood without taking into account affective determinants (i.e. motives, attitudes, moods, and emotions). Just as the cognitive revolution of the 1960s spawned the cognitive sciences and linked the disciplines studying cognitive functioning from different vantage points, the emerging field of affective science seeks to bring together the disciplines which study the biological, psychological, and social dimensions of affect. In particular affective science includes psychology, affective neuroscience, sociology, psychiatry, anthropology, ethology, archaeology, economics, criminology, law, political science, history, geography, education and linguistics. Research is also informed by contemporary philosophical analysis and artistic explorations of emotions. Emotions developed in human history make organisms to react to environmental stimuli and challenges.

The major challenge for this interdisciplinary domain is to integrate research focusing on the same phenomenon, emotion and similar affective processes, starting from different perspectives, theoretical backgrounds, and levels of analysis. As a result, one of the first challenges of affective science is to reach consensus on the definition of emotions. Discussion is ongoing as to whether emotions are primarily bodily responses or whether cognitive processing is central. Controversy also concerns the most effective ways to measure emotions and conceptualise how one emotion differs from another. Examples of this include the dimensional models of Russell and others, Plutchik’s wheel of emotions, and the general distinction between basic and complex emotions.

Measuring Emotions

Whether scientific method is at all suited for the study of the subjective aspect of emotion, feelings, is a question for philosophy of science and epistemology. In practice, the use of self-report (i.e. questionnaires) has been widely adopted by researchers. Additionally, web-based research is being used to conduct large-scale studies on the components of happiness for example. (www.authentichappiness.com is a website run by the University of Pennsylvania, where questionnaires are routinely taken by thousands of people all over the world based on a well-being criteria devised in the book ‘Flourish.’ by Martin Seligman). Nevertheless, Seligman mentions in the book the poor reliability of using this method as it is often entirely subjective to how the individual is feeling at the time, as opposed to questionnaires which test for more long standing personal features that contribute to well-being such as meaning in life. Alongside this researchers also use functional magnetic resonance imaging, Electroencephalography and physiological measures of skin conductance, muscle tension and hormone secretion. This hybrid approach should allow researchers to gradually pinpoint the affective phenomenon. There are also a few commercial systems available that claim to measure emotions, for instance using automated video analysis or skin conductance (affectiva).

Affective Display

Refer to Affect Display and Reduced Affect Display.

A common way to measure the emotions of others is via their emotional expressions. These include facial expression, vocal expression and bodily posture. Much work has also gone into coding expressive behaviour computer programmes that can be used to read the subject’s emotion more reliably. The model used for facial expression is the Facial Action Coding System or ‘FACS’. An influential figure in the development of this system was Paul Ekman (For criticism, refer to the conceptual-act model of emotion).

These behavioural sources can be contrasted with language descriptive of emotions. In both respects one may observe the way that affective display differs from culture to culture.

Stanford

The Stanford University Psychology Department has an Affective Science area. It emphasizes basic research on emotion, culture, and psychopathology using a broad range of experimental, psychophysiological, neural, and genetic methods to test theory about psychological mechanisms underlying human behaviour. Topics include longevity, culture and emotion, reward processing, depression, social anxiety, risk for psychopathology, and emotion expression, suppression, and dysregulation.