Flat Affect

Medically Reviewed by Shruthi N, MD on August 22, 2024
Written by Alyson Powell Key, Angela McPhillips
7 min read

In psychology, your "affect" refers to how you portray emotions – through gestures, your tone of voice, facial expressions, and the like. If you’re happy or upset, people usually can see it on your face and hear it in your voice. But sometimes the emotions you feel on the inside and your outward expressions don’t match up – there's a disconnect between the two.

Neurological and psychological conditions often cause affect problems. There are varying degrees of how much emotion you don't show. Flat affect – total or near absence of appropriate emotional responses to situations and events – is the highest level of intensity.

What is flat affect?

You may be extremely happy or very sad, but others can’t tell because your face, gestures, and body language don’t reflect those feelings. Because of this, you may seem uncaring and unresponsive. This total lack of emotional response is called flat affect. Flat affect isn’t a disorder on its own, but rather a symptom of a mental health condition or a medication side effect.

You may have heard the terms flat affect and blunted affect. They differ based on how much emotion you show. 

Flat affect is when you feel emotions but show practically nothing visually.

Blunted affect refers to feelingemotions but only showing some of what you're feeling. (It's a less intense form of the flat affect because you still show some response.)

 

 

Your affect can vary in the degree and appropriateness of how you show emotions. When dealing with affect challenges, you have no control over the outward expression of your feelings. You may experience constricted, labile, or inappropriate affects.  

Constricted affect

Constricted (or restricted) affect is when you feel emotions but have some degree of showing it. This is a lesser degree of flat and blunted affect.

Labile affect

Labile affect refers to sudden, exaggerated, and unpredictable shifts in how you express emotion. Often these emotional shifts are out of proportion to the situation or setting. 

Inappropriate affect

Inappropriate affect is when an emotional reaction doesn't fit the situation, like smiling when you hear someone died.

If you have flat affect, you may have:

  • Lack of body language and gestures
  • Minimalized or absent facial expressions
  • Lack of shifts in speech tone

See a mental health professional if you think you're experiencing flat or blunted affect. They can utilize different tools to see if you have it and what may be causing it.

 

If you're feeling emotionally numb -- whether you show it or not -- that's referred to as "emotional blunting." It's one of the most common side effects of taking antidepressants, which causes some people not to continue on them. Emotional blunting means you may not feel positive or negative emotions.

It occurs in people with depression, schizophrenia, and posttraumatic stress disorder.  

When we are numb to positive emotions but not negative ones, that's called anhedonia. It's a common symptom of depression and other mental health conditions.

Flat affect is primarily a symptom of mental health conditions related to disrupted brain chemistry. However, medication side effects, traumatic brain injury, muscle disorders, or facial paralysis can also cause a flat affect.

This is a serious, long-term mental illness. Some symptoms include:

  • Believing things that aren’t real (delusions)
  • Seeing or hearing things that don’t exist (hallucinations)
  • Disorganized thinking or speech
  • Sudden agitation, confusion, and other unusual behaviors

A flat affect can be a negative symptom of schizophrenia, meaning that your emotional expressions don’t show outwardly. You may speak in a dull, flat voice and your face may not change. You also may have trouble understanding emotions in other people. You might confuse happy and sad, or misjudge just how happy or sad the other person might be.

Schizophrenia is a lifelong illness. Even if your symptoms have gone away, you’ll need to stay on medication and get therapy. If your symptoms are severe, you may need to go to the hospital for your or other people’s safety.

Social skills training can help change a flat affect. This is when you work with a therapist or other mental health expert to learn how to communicate, interact with others, and manage everyday activities.

A flat affect can be one of the symptoms of this mood disorder. Researchers have used movie clips to study flat affect and depression. In one small study, they found that people who are depressed reacted less to positive scenes than people with schizophrenia did. Depressed people also reacted slightly more to negative clips.

Experts don’t exactly know why depression leads to a flat affect. They think it may be linked to things such as a problem with your brain chemistry, your genes, and physical changes to your brain.

Some people believe antidepressants lead to emotional blunting, specifically, but others say it's a symptom of depression caused by incomplete treatment. There's a lot that's still unknown about emotional blunting and antidepressants. Researchers have called for more studies to learn about the mechanisms of both and how they may impact one another. 

Flat affect and emotional blunting can have an impact on treatment, especially if people go off medication they can benefit from. In another study, nearly 75% of more than 750 people in the acute phase of depression (and about 25% of those in remission) said they had severe emotional blunting. About 56% thought depression caused the emotional blunting, while 45% said antidepressants had a negative effect on their emotions. More than one-third were thinking of stopping medication or had already done so.

This kind of brain damage can happen after a car crash, a fall, or any other injury that causes a hard hit to the head.

The impact bounces your brain back and forth inside your skull. The trauma causes bruising and bleeding and tears the nerve fibers.

TBI can hurt a part of your brain called the frontal lobe. That’s where emotional expressions start. A damaged frontal lobe may cost you your ability to recognize or feel different emotions. The result can be a flat affect. You also may miss cues in other people’s body language. A brain injury can even change your personality.

TBI can range from mild to severe. Your symptoms may go away after a few months, or they may last for the rest of your life. 

Your doctor will recommend a combination of treatments. A speech therapist or neuropsychologist can help you manage your flat affect and improve your relationships with family and friends.

 

A main symptom of this disease is having less facial expression. In the Parkinson's disease world, it's known as "masked face," "facial masking," or hypomimia. The lack of facial expression is a result of the symptoms of Parkinson's disease, which stiffens muscles in the face that can affect your eyebrows or smile, for example.

If you have Parkinson's disease, it can take longer to move. You may also have speech impairments. This can make it harder to communicate.

Treatments can help with facial masking if you or a loved one has Parkinson's disease. Speech therapy may be able to help, as can medications that ease rigidity.

Scientists know that autism and related disorders stem partly from genetics as well as differences in the brain.

People with ASD interact, behave, and communicate in different ways. They may experience flat affect. If you have autism and flat affect, your face often may appear blank. Your voice may not change tone or may sound robot-like. You may have a hard time reading other people’s voices and body language.

It can be difficult to diagnose conditions like anxiety or depression if you (or a loved one) has ASD because there may not be many outward signs. That’s why it’s important for caregivers and doctors to check for changes in sleep, appetite, and overall mood.

There’s no cure for ASD. But medication can help with energy level, focus, depression, and seizures. Working with a therapist can help you better relate to other people.

Treating the underlying disorder you have can help treat flat affect. That is, if you don't show emotion, trying to make yourself show emotion may not do the trick. But treating the underlying condition may help more. Some people may respond to treatment, but others may not.

Treatments for flat affect include treatments that address the causes (like depression, schizophrenia, and others mentioned above). These treatments can include medications. It can also include speech and physical therapies. Mental health treatments like cognitive behavioral therapy can also help with flat affect symptoms.

Flat affect, or the absence of an appropriate emotional response, can be a sign of a mental health issue, brain disorder, or medication side effect. This symptom can be unsettling or uncomfortable as your outward reactions don't match up with your inward emotions. Contact your doctor if you’re unable to display emotions or are exhibiting inappropriate and unpredictable emotional responses. The first step in dealing with flat affect is to identify the underlying cause. Your doctor can help. 

Do I have a blunted affect?

You may have a blunted affect if you feel like your emotional responses are muted. You feel emotions, but only show some of what you’re feeling. For example, you find a joke hilarious but barely crack a smile. 

What are the four types of flat affect?

The four types of affect are: blunted, constricted, labile, and inappropriate. 

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