Flat Affect, or Emotional Indifference

What would it be like to be unable to express or even feel emotions? This is what we call flat affect. Imagine for a moment that a family member tells you they’ve won the lottery, and you can’t be happy for them. Instead of feeling joy, you’re apathetic. You don’t smile or congratulate them, and your face doesn’t change. Cognitively, you’re happy for them, but your feelings don’t reflect that thought.

To use another example, imagine someone getting fired for a completely unjust reason. Instead of feeling angry or sad, someone with flat affect would be incapable of feeling any emotion. It’s a phenomenon characterized by the inability to feel joy, sadness, fear, anger, or any other emotion that would make sense in the situation.

Before describing flat affect any further, we’re going to discuss what emotions are and the role they play in our lives. That way, we’ll be able to understand what occurs in people with flat affect.

What are emotions?

Emotions are reactions that we all experience – joy, sadness, fear, anger… Although we’re all familiar with emotions, this doesn’t make them any less complex when you stop for a second to analyze them. Even if we’ve felt nervous or anxious before, not everyone is aware that poor regulation of these emotions can lead to an emotional block or even an illness.

To simplify this a bit, emotions represent a biological tendency to react in a determined way to certain stimuli, which can also be learned from our environment. Today, most experts agree that with each emotion, a few  different responses occur.

First of all, a neurophysiological response occurs, triggered by hormones and neurotransmitters, which then manifests in a behavioral response (such as a gesture) and a cognitive response, which is what makes us aware of how we’re feeling. Behavioral and cognitive responses vary based on the individual’s environment and culture.

The degree of pleasantness or unpleasantness that you experience with each emotion is the salt of life. Emotions are essential for memory, decision-making, judgment, reasoning, behavior, social relationships, and well-being.

This is because the memories we keep are mostly emotional in nature. We also need emotional tension to make decisions. In fact, most of the decisions we make are based on emotions. But the most important thing about emotions is that they prepare, motivate, and guide us.

Emotions have two components – the subjective sensation that we feel inside, and the external manifestation of the emotion. Sometimes it’s possible to separate the two. For example, an actor can simulate all of the external manifestations of an emotion without really feeling it.

What function do emotions serve?

One of the most important functions of emotions is preparing us for action. They mobilize the energy necessary to respond effectively to the circumstances and direct our behavior towards a desired goal. Every emotion indicates and pushes us towards a different type of action.

Emotions also fulfill a social function. Communicating how you feel to the people around you facilitates and strengthens your relationship with them. Our emotions act as signals to others, giving them clues as to which attitude they should adopt and how they should act towards us.

Lastly, emotions fulfill a motivational function. For one thing, emotions push us to carry out motivated behaviors. For example, anger facilitates defensive reactions, joy facilitates interpersonal attraction, and surprise facilitates attention towards novel stimuli.

Emotions also guide our behavior, in the sense that we approach or avoid the execution of motivated behaviors depending on how we feel. It’s clear, then, that it’s important to feel and express emotions.

What does it mean to have flat affect?

Flat affect is not a disorder; it’s a symptom that indicates something isn’t working properly. Flat affect can be defined as the inability to experience and express emotions. It’s often referred to as emotional indifference or emotional bluntness. This is because the person appears distant or indifferent to both their own and other people’s emotions.

It’s important to emphasize the absence of both positive and negative emotions. For example, not only can they not experience joy, but they also can’t experience fear. It’s rare for someone’s affect to be totally flat – that is, they can experience emotions to a small degree, but only in exceptional situations. It’s more like a general emotional tone with a very small range.

How is flat affect related to depression?

Flat affect should not be confused with depression or the inability to experience pleasure. Depression is associated with apathy and feeling low.

The inability to experience pleasure, or anhedonia, is typical in depressive disorders. People with depression are unable to enjoy activities that they used to enjoy before. Therefore, they stop doing them, which makes it even harder for them to feel better.

People with flat affect experience emotions with little intensity, or don’t experience them at all. But in contrast to people with depression, this doesn’t distress them in any way. They don’t feel, but they also don’t suffer.

It can be difficult to distinguish anhedonia from flat affect. Both can occur at the same time, but to distinguish between the two, it’s helpful to remember that anhedonia is the inability to feel pleasure (a positive emotion), while flat affect is the absence of any emotion, or a reduced expression of them.

Why does flat affect develop?

Flat affect is a symptom or expression of an underlying illness, like we stated before. Therefore, it never occurs in isolation, but rather with other symptoms that together make up a particular disorder or syndrome.

Flat affect has always been associated with schizophrenia. There are two types of symptoms that occur in people with schizophrenia: positive and negative.

Positive symptoms are those that occur in excess compared to someone who doesn’t experience them. Negative symptoms are responses that are missing in these people. For example, a hallucination is a positive symptom because it’s an “excess” of perception, while apathy is a negative symptom because it’s a lack of motivation.

So, flat affect is among the negative symptoms of schizophrenia. However, schizophrenia is not the only disorder where flat affect can appear. It can also occur in autism spectrum disorder, in which the person has difficulty experiencing emotions intensely and expressing them properly. It can also manifest in people with certain types of dementia as a consequence of the changes that occur in the brain.

Because flat affect is part of a wider group of symptoms, in order to treat it the underlying illness or disorder must be addressed.

References

Díaz Marsá M, Afrontando la Esquizofrenia. Guía para pacientes y familiares. Enfoque Editorial S.C. 2013.

Cooper, David (1985). Psiquiatría y antipsiquiatría. Paidós Ibérica, Barcelona.