Schizophrenia and Flat Affect

How to Recognize Impaired Emotional Functioning and Minimize Symptoms

expressionless woman sitting on sofa
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Flat affect (impaired emotional functioning) is a hallmark symptom of schizophrenia, although it may also affect those with other conditions. It is a lack of showing emotion characterized by an apathetic and unchanging facial expression and little or no change in the strength, tone, or pitch of the voice. This extremely limited range of expressions occurs even in situations that would normally seem very exciting or very sad. For instance, upon hearing great news, someone with schizophrenia may not smile, laugh, or have any joy in their response.

Causes

Although millions of people are affected by flat affect, scientists are not entirely sure of the exact cause. It is hypothesized that it is due to differences in brain functioning.

When shown emotional stimuli, those with schizophrenia show decreased activity in the limbic system, the part of the brain responsible for your mood, instincts, and drives. Because of this, some researchers suggest that there are chemical imbalances in the brain that blunt the limbic system's reaction to stimuli. Simply put, the brain has a hard time translating an emotion into a physical reaction.

Symptoms and Impact

If you have been affected by flat affect, you may find that it negatively impacts your social functioning. People can respond negatively to the way you react in a situation or conversation, leading to the assumption that you are cold or unfeeling when that's not true.

Those affected by flat affect may exhibit the following symptoms:

  • A monotone or flat voice with no modulation or expression
  • A lack of eye contact
  • A lack of discernible interest in the topic at hand
  • No changes in facial expression regardless of the circumstance (neutral expression)
  • A lack of verbal response to emotional stimuli
  • Body language or non-verbal responses that are not typical to the experience, conversation, or situation at hand

It's important to note that while you may have trouble displaying emotion, many people with schizophrenia have no difficulty recognizing emotional responses in others. This is an important factor in working with your doctor to define a treatment plan, as it gives you a foundation to build on to create appropriate social exchanges.

Treatment

More often than not, flat affect is an underlying symptom of several conditions, including depression and post-traumatic stress disorder (PTSD)—not just schizophrenia. It may even be a side-effect of certain medications. A plan of action should begin by consulting with a psychologist or psychiatrist who diagnoses and treats mental health conditions.

Flat affect can be treated to some degree. It often requires comprehensive therapy, including working with a healthcare provider and taking medication. While it often cannot be completely eliminated, therapy and intervention can help you interact with others more warmly and naturally.

Therapy and Intervention

Part of therapy usually starts with techniques to help you recognize your emotionless response and how it doesn't match what is required in the specific situation. Your therapist may then have you practice appropriate reactions to different stimuli like grief or celebration so that you can force yourself to react as other people do. Speech therapists can help people with schizophrenia work on tone and modulation of voice to convey more emotion.

Medication

Clozaril (clozapine) is a just one of several medications shown to help combat flat affect in people with schizophrenia and other mental illnesses for which this is a concern. 

While these antipsychotic medications control symptoms like delusions and hallucinations, they also help treat symptoms like flat affect, speech difficulties, and impaired social functioning. These drugs function by blocking receptors for dopamine. Since this neurotransmitter plays a major role in schizophrenia, symptoms can be better managed and alleviated by blocking receptors.

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