Mental health professionals work to observe and document numerous signs of mental health and well-being, including affect. Affect is a person’s expression of their emotional state, and a person with a blunted affect is showing a significant reduction in the intensity of their emotion. Linked to several mental and neurological health issues, blunted affect is a symptom of a larger issue.
Blunted Affect Definition
Blunted affect is a state when the individual’s expressions are less reactive or responsive to situations and stimulation. They could hear wonderful news and barely crack a smile, or they experience tragedy without shedding a tear. Blunted affect is usually linked to a mental or physical health condition, but the use of alcohol and other drugs, as well as prescription medications, can also influence a person’s affect.
To readily grasp what blunted affect means, it is essential to understand what affect is and how mental health professionals use this information to make a more accurate assessment, diagnosis, and impactful treatment plan. Affect is a perceivable and noticeable reflection of one’s emotional state.
A mental health expert, medical professional, or loved one can evaluate and categorize a person’s affect by observing their:2
- Facial expressions
- Hand, body, and head movements
- Vocal expressions including rate, force, and tone of speech
- Energy levels
Affect vs. Mood
As a mental health symptom, affect stands in contrast to mood, because mood is the subjective, internal experience of the individual. Affect is an external expression, and one that can change rapidly. The American Psychiatric Association says affect is like “weather” because it is more prone to variability and frequent shifts. Mood is more like “climate” because it is more sustained and persistent, at least compared to affect.1
It is important to note that, depending on the person’s condition, their affect may not be an accurate reflection of their experience. Some mental or medical conditions will result in incongruent affects where a person could feel happy and content but display an affect that seems down or sad.2
Spectrum of Affect
Different types of levels of affect can be challenging to identify and label, and at times, the exact affect will be less important than noting the overall affect changes.
Terms used to describe the spectrum of affect include:1
- Full or broad affect: This describes someone whose emotional reaction changes in typical or expected ways. They appear happy when they feel happy and appear sad when they are sad. On the affective spectrum, full affect is a happy balance in the middle.
- Flat affect: Existing on one end of the spectrum, flat affect represents an absence of expression, no matter how happy or sad the experience.
- Labile affect: People with a labile affect will show their state with frequent, excessive, and unpredictable shifts in expression. A seemingly minor situational change could trigger a significant and disproportionate affect change.
- Inappropriate affect: This type of affect occurs when a person’s presentation does not match the content of their speech. A person who reports being sad and depressed while laughing uncontrollably would have an inappropriate affect.
- Constricted affect: Someone at this level of constricted or restricted affect will experience a mild reduction in affect. They will be closer to broad affect than to flat affect.
- Blunted affect: People with a blunted affect will display a significant reduction in emotional expression. Their presentation will not be flat, but they will show a major decrease in emotional range and responsiveness.
Signs of Blunted Affect
Affect itself is a symptom of a potentially larger issue and can be linked to certain physiological and psychological disorders. Unlike other mental health symptoms, the individual will not have the best insight into or explanation of their affect. Instead, a professional will utilize their education and experience to categorize the person’s affect.
Four signs of blunted affect are:1,2
- Diminished facial expressions: Rather than smiling, frowning, or showing other clear indicators of feelings through facial movements, someone with blunted affect could display only minimal movements.
- Decreased expressive gestures: Some people will use their whole bodies to communicate, but people with blunted affect will appear more still and subdued with their hands, arms, and other body parts moving only slightly.
- Limited vocal expression: As a person speaks, especially when excited or distressed, their voice will naturally change in volume, rate, or tone. When a person has a blunted affect, their voice will be more static, no matter the subject matter or the feeling normally connected to it.
- Lower energy levels: Blunted affect can spread throughout the entire body as a person will often appear with lower energy and a limited ability to feel motivated or energized.
Distinguishing flat, blunted, and restricted affect can be complicated and somewhat subjective. To best categorize the symptom, mental health experts will assess all facets impacted by changed affect and find the appropriate label. Like other psychological symptoms, affect can shift readily, so a person could have a blunted affect today and broad affect tomorrow. Tracking and documenting the changes over time will help offer a complete clinical picture.
Causes of Blunted Affect & Associated Conditions
With affect being a flexible and fluid expression of internal feelings, numerous situational and significant stressors can impact the state. Some people may note a shifted affect due to something minor like being overly tired, while others will be impacted by major concerns like serious medical or mental health issues.
Causes of blunted affect include:1,2,3
- Autism: Autism spectrum disorder (ASD) has the power to shift affect into all possible categories. Depending on the individual and the form of ASD, affect could be blunted.
- Schizophrenia and other psychotic disorders: Blunted affect is perhaps best known as being caused by schizophrenia and other psychotic disorders, like brief psychotic episodes. Often, a person with schizophrenia will show a blunted, restricted, or flat affect based on the degree of their condition.
- Depression: For people with depression, affect can be an appropriate way to measure symptom intensity. As depression increases, affect range tends to decrease so someone with blunted affect could be experiencing moderate or severe depression.
- Reactive attachment disorder (RAD): This is a condition caused by inconsistent, problematic, or limited parent/adult relationships during childhood. Since these interactions are so valuable, a person could struggle with desired affect later in life.
- Post-traumatic stress disorder (PTSD): With PTSD, symptoms tend to force people towards extremes with some being on edge and overly aroused, while other people will note lower responses to stimulation. Many of the second group could project blunted affect.
- Personality disorders like borderline, schizoid, and schizotypal personality disorders: These personality disorders are long-term conditions that drastically impact a person’s ability to relate to others and function in the world. A blunted affect is often the outcome of these conditions.
A number of medical and physical health issues can also influence the symptom. Some of these concerns may be a sign of new or progressing conditions or a problem connected to another treatment including:1,2,3
- Neurocognitive disorders like Parkinson’s and Alzheimer’s: As the brain physically changes due to these conditions, a person’s expression of emotions often changes as well. People could show a slow and gradual decline towards an inability to accurately display their feelings.
- Brain injury: Like with neurocognitive disorders, brain injuries can result in blunted affect. Depending on the accident or injury, the symptom may present suddenly, rather than the slow progression seen in neurocognitive issues.
- Medication side effects: Some medications, especially antipsychotic medications used to treat psychotic symptoms, could produce a blunted affect. At times, this symptom is indistinguishable from a blunted affect caused by another source.5
Medications and classes of medications shown to produce a blunted affect in people include:5
- Antidepressants like selective serotonin reuptake inhibitors (SSRIs)
- Antipsychotics
- Lithium
- Antiepileptics like lamotrigine (Lamictal)
Lastly, the interaction of alcohol and other drugs in the body could produce affective changes including blunted affect.
Blunted affect linked to substance use can occur with:1,4
- Marijuana/cannabis: The psychoactive ingredient in marijuana produces numerous symptoms, including blunted affect. When a person is intoxicated, they could display a constricted or blunted affect.
- Opioids: Similarly, a person highly intoxicated on opioids could display limited reactivity and affectual responses to the situation or stimulation. As the substance’s effects diminish, the expected affect will return.
- Stimulants: Rather than being a product of intoxication, blunted affect could be a result of stimulant withdrawal. The crash that often follows a stimulant binge may result in a blunted affect.
Treatment for Blunted Affect
Since blunted affect is a sign of an underlying condition, treatments that only focus on blunted affect can be limiting. Treatment professionals should target the underlying condition to produce the wanted influence on affect. Contact a trusted mental health provider to access a full assessment.
Blunted affect caused by substance abuse or medication side effects can begin to drastically improve as the person stops or modifies their use. In other cases, the signs of blunted affect will diminish when the body processes and eliminates the substance from the system.1,5 A person should always work to consult with their prescriber before making any adjustments to the recommended dose and usage, especially because some of the medications that may be associated with the side effect are also prescribed to treat the condition that is responsible for the blunting.
A person with blunted affect linked to severe depression may begin a regimen of therapy and medication management to address and improve their mood, energy, motivation, and optimism. As the overall clinical picture of depression changes to become less severe, their affect will gradually improve as a result.6
In some situations, a person’s blunted affect may need no treatment at all, like in the case of a person with ASD. The individual and their family may understand and accept the source of their symptom and view the attempt to change it as unnecessary or even negative. Here, the decision to treat or not treat their affect is a personal choice.
Final Thoughts on Blunted Affect
Although effectual changes may be difficult to understand and overcome, therapy, medication adjustments, and reaching out to your support network can help tremendously. Feeling well and having a broad affect you desire is within your reach.
Additional Resources
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
Are you ready to connect with a therapist but feel a little overwhelmed by all your options? Speak with one of Choosing Therapy’s Client Navigators. Client Navigators are mental health professionals who will listen to what you’re looking for in a therapist and help pair you with the best possible fit. Getting started is free, easy, and confidential.
