Emotions Understanding Inappropriate Affect By Arlin Cuncic Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." Learn about our editorial process Updated on April 09, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Getty / Klaus Vedfelt Table of Contents View All Table of Contents Overview Causes Diagnosis Relevant Conditions Symptoms Types Treatment Coping Affect refers to the outward expression of a person's internal emotions. For most people, there is congruence between affect and circumstance; for example, if you are given the news that a friend has passed away, your reaction would be sadness and tears. However, for a certain percentage of the population, outward affect does not match the situation that they are in. This is known as inappropriate affect and can have a variety of causes. 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. To fully understand all the ramifications of inappropriate affect, we will consider in detail symptoms, causes, related conditions, diagnosis, coping, treatment, and related issues. Overview As noted, inappropriate affect involves the display of reactions that do not match the situation that you are in or possibly even your internal state. Emotions, actions, or overall demeanor that seem out of place in a situation all fall under the general umbrella term "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 any cause. 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 1950, Bleuler noted that the clinical prognosis of schizophrenic patients displaying inappropriate affect was much poorer than those who did not. The 6 Types of Basic Emotions and Their Effect on Human Behavior Causes 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, head trauma, etc. When inappropriate affect results from a structural brain problem, areas that are 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, including depression, schizophrenia, bipolar disorder, schizoaffective disorder, and post-traumatic stress disorder (PTSD). Often, these individuals have not lost the capacity for emotional reactions, but appear to have lost the ability to have them occur in a normal and 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 to be consistent with the reality of the situation, but they are in fact consistent with their internal experience of the situation. 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. Stopping abruptly may lead to a rebound of depression symptoms or trigger the opposite effect, including anxiety, agitation, and sleeplessness. Emotional Blunting: Causes, Symptoms & Treatment Psychological Factors There can also be other causes of inappropriate affect that is not due to brain damage or a mental disorder. In most of these cases, the person is capable of responding in a normal way, but for one reason or another does not. For example, a person in therapy may laugh while describing a difficult situation so as to control their emotions in a self protective way. Diagnosis If you are concerned that you are or someone you know is living with inappropriate affect, it is important to obtain 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, which is 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 as well. The severity of the problem would also be assessed, to determine where it falls in the range from mild to severe. How Clinical Interviews Help Diagnose Mental Illness Conditions Involving Inappropriate Affect Various conditions may be associated with inappropriate affect: Mental Disorders Major depressive disorder Schizophrenia Schizoid personality disorder Post-traumatic stress disorder Schizoaffective disorder Psychopathy Depersonalization Borderline personality disorder Neurological Conditions Brain damage Pseudobulbar affect Autism Dementia Alzheimer's disease Head trauma Brain tumor Multiple sclerosis Symptoms 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 sadRecognizing that your reactions are inappropriateEmotions that do not match the reality of a situationShowing happiness during a tragedyBecoming angry without any outward provocationFlat affect or not showing expected emotional reactions (but not in the case of simply holding back emotions) Clearly, the specific types of symptoms experienced will depend on the underlying cause of the inappropriate affect. Types In addition to the broad symptoms of inappropriate affect, there are a number of 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. The various types are listed below. 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 any outside situations or seem to be 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 have control over their emotions. This type of affect is seen often in neurological disorders such as pseudobulbar affect, in manic episodes during bipolar disorder, and in borderline personality disorder. Labile affect can also result from fatigue, stress/anxiety, and over-stimulation. 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." Treatment 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. Even if psychotherapy is used, it is usually as an add-on to medication, because therapy alone often will not help to remediate the problem. 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), as well as a specific medication approved by the U.S. Food and Drug Administration for the treatment of pseudobulbar affect (a combination of dextromethorphan and quinidine). 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 make the situation worse. You might also be confused by their behavior and not know how to react. It's important as a caregiver that you take time to get help for yourself as well. Support groups or other avenues for connecting with other people going through the same issues may be helpful. You could also consider talk therapy for yourself to learn best how to manage the situation and your own needs and emotions. Coping 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 though 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. A Word From Verywell Are you or someone you know living with inappropriate affect? While this can be a debilitating condition because it affects every area of your life from work to social relationships, with the help of a healthcare professional, it is possible to reduce the impact on your life. 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 prescribed protocol 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. Emotions and Types of Emotional Responses 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Szmulewicz A, Samamé C, Caravotta P, et al. Behavioral and emotional adverse events of drugs frequently used in the treatment of bipolar disorders: clinical and theoretical implications. Int J Bipolar Disord. 2016;4(1):6. doi:10.1186/s40345-016-0047-3 Goodwin GM, Price J, De bodinat C, Laredo J. Emotional blunting with antidepressant treatments: A survey among depressed patients. J Affect Disord. 2017;221:31-35. doi:10.1016/j.jad.2017.05.048 Compare A, Zarbo C, Shonin E, Van gordon W, Marconi C. Emotional regulation and depression: a potential mediator between heart and mind. Cardiovasc Psychiatry Neurol. 2014;2014:324374. doi:10.1155/2014/324374 Additional Reading Ahmed A, Simmons Z. Pseudobulbar affect: prevalence and management. Ther Clin Risk Manag. 2013;9:483-489. doi:10.2147/tcrm.s53906 Harris A, Metcalfe M. Inappropriate affect. J Neurol Neurosurg Psychiatry. 1956;19(4):308-13. doi:10.1136/jnnp.19.4.308 By Arlin Cuncic Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety." See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.