The Flat Affect

A Complex Symptom of Schizophrenia

expressionless woman sitting on sofa
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Flat affect, or impaired emotional functioning, is a hallmark symptom of schizophrenia. It's a term used to describe the lack of emotional expression displayed by some people with schizophrenia. It is characterized by an apathetic and unchanging facial expression and little or no modulation of the voice. This extremely limited range of emotions 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 excitement in their tone.

What Causes Flat Affect?

Flat affect, also known as blunted affect, affects millions of people. However, scientists are not entirely sure what exactly causes it but it is hypothesized to be 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, resulting in an apathetic or emotionless response.

How Will Flat Affect Impact My Daily Life?

If you have schizophrenia and have been affected by flat affect, you may find that it negatively impacts your social functioning. People can respond negatively to a lack of emotion, assuming that you are cold or unfeeling when you really can't help it.

It's important to note that while you may have trouble displaying emotion, many people with schizophrenia have no difficulties 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.

Can Flat Affect Be Minimized?

Flat affect can be treated to some degree. This symptom 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. 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 also can help people with schizophrenia by working on tone and modulation of voice to convey more emotion.

In addition to therapy with a psychiatrist specializing in schizophrenia, your doctor may also prescribe medication to help manage your symptoms. Clozaril (clozapine) is a just one of several medications prescribed for schizophrenia and other mental illnesses that has been shown to help combat flat affect. 

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; dopamine plays a major role in the presence of schizophrenia, so by blocking these receptors, symptoms can be better managed and alleviated.

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Article Sources
  • Gur, R., Kohler, C., Ragland, D., et al. Flat Affect in Schizophrenia: Relation to Emotional Processing and Neurocognitive Measures. Schizophrenia Bulletin, 2006, 279-287.