For most of us, there is congruence between affect and circumstance; for example, if we are given the news that a friend has passed away, our reaction would be sadness. We may feel devastated and even cry at the news.
However, for a certain percentage of the population, their outward affect does not match the situation that they’re in. This is known as inappropriate affect and can have a variety of causes.
Emotions, actions, or overall demeanor that seem out of place in a situation all fall under the general umbrella term “inappropriate affect.”
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. Let’s dig into how and why this happens.
Causes of 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 reason.
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 the limbic system, anterior cingulate cortex, and prefrontal cortex.
Schizophrenia and Other Psychotic Disorders
A second main cause of inappropriate affect is mental disorders or conditions, including:
Neurological Conditions
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Brain damage
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Pseudobulbar affect
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Autism
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Dementia
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Alzheimer’s disease
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Head trauma
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Brain tumor
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Multiple sclerosis
Often, these individuals have not lost the capacity for emotional reactions but appear to have lost the ability to have them occur in an expected way. This is because their affect is a reaction to their hallucinations or delusions and 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 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 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
According to a study in the International Journal of Bipolar Disorders, emotional blunting can also be caused by certain medications used to treat schizophrenia and other psychotic disorders, including:
- Selective serotonin reuptake inhibitors (SSRIs) like Lexapro (escitalopram), Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine)
- Selective norepinephrine reuptake inhibitors (SNRIs) such as Cymbalta (duloxetine), Pristiq (desvenlafaxine), and Effexor XR (venlafaxine)
- Tricyclic and tetracyclic antidepressants like Elavil (amitriptyline) and Remeron (desvenlafaxine)
- Antipsychotics like Serentil (mesoridazine), Thorazine (chlorpromazine), and Truxal ( chlorprothixene)
- Lithium like Duralith, Eskalith, Lithobid, Lithotabs, Lithane, Lithizine, and Lithonate
- Antiepileptics (anticonvulsants) like Valproate (Depakote), Gabapentin (Neurontin), and Topiramate (Topamax)
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.
Warning
Stopping treatment abruptly may lead to a rebound of depression symptoms or trigger the opposite effect, including anxiety, agitation, and sleeplessness.
Psychological Factors
There can also be other causes of inappropriate affect that are not due to brain damage or a mental disorder. In most of these cases, the person is capable of responding normally but, for one reason or another, does not. For example, a person in therapy may laugh while describing a difficult situation to control their emotions in a self-protective way.
Diagnosis of Inappropriate Affect
If you are concerned that you or someone you know is living with inappropriate affect, it is important to get 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, 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.
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:
- Uncontrollable crying even when not feeling sad
- Recognizing that your reactions are inappropriate
- Emotions that do not match the reality of a situation
- Showing happiness during a tragedy
- Becoming angry without any outward provocation
- Flat affect or not showing expected emotional reactions (but not in the case of simply holding back emotions)
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 episodes during 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.”
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:
- Antipsychotics (in the case of schizophrenia or psychosis)
- Antidepressants or mood stabilizers (in the case of mood disorders or related issues)
- A specific medication approved by the U.S. Food and Drug Administration for treating pseudobulbar affect (a combination of dextromethorphan and quinidine)
If psychotherapy is used, it is usually as an add-on to medication because it alone often will not help to remediate the problem.
Helping Someone With Inappropriate Affect
If you are a caregiver to a person experiencing inappropriate affect, it can be hard on you too. You may react negatively or defensively to the other person’s behaviors, which can worsen the situation. You might also be confused by their behavior and not know how to react.
Things you can do include:
- Take time for yourself: It’s important as a caregiver that you take time to get help for yourself as well.
- Join a support group: Support groups or other avenues for connecting with other people going through the same issues may be helpful.
- Consider therapy: You could also consider talk therapy to learn how to manage the situation and your own needs and emotions.
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 seek social support, such as through a schizophrenia or PTSD support group.
Manage Stress
According to a study in Cardiovascular 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.
Recap
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.
Keep in Mind
While inappropriate affect can be a debilitating condition because it affects every area of life, it is possible to reduce its impact with the help of a healthcare professional. 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 treatment plan 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.
