Affective dullness: what is it, causes and associated pathologies?

Let's see what is affective blunting and what are the disorders associated with it.

Emotions are a fundamental part of ourselves and therefore something inherent to human beings. But we do not always experience them in the same way.

In fact, there are conditions that can radically vary our processing of emotions. On this occasion we will focus on affective blunting. We will review this term to understand its meaning and what causes it in some people.

What is affective blunting?

Affective dulling, also called affective flattening or dulled affectivity, refers to the inability of a subject to experience emotions in situations that, by their nature, should generate an emotional response in the person. in the person. That is, the subject would feel indifferent to a stimulus that in other circumstances should generate a very specific emotion.

Affective blunting is precisely that indifference, that lack of emotional response to scenarios that should directly provoke a reaction translated, for example, into intense joy or great sadness, depending on the case. On the contrary, the person simply does not react on an emotional level, so he or she remains impassive in that sense.

Emotions accompany us in our daily life, we feel them constantly. They are a psychophysiological manifestation of a specific mental state, and generally any person is able to recognize them, with some exceptions, such as some pathologies. Likewise, all individuals experience them naturally.

But that is where affective blunting comes in, as a psychological phenomenon that can temporarily paralyze this capacity and cause the person not to have the expected emotional correspondence to certain events. and cause the person not to have the expected emotional correspondence to certain events, which have a meaning for the subject, in one sense or another.which have a meaning for the subject, in one sense or another.

Which emotions are affected by affective blunting? All of them, since there is no distinction between those of a positive nature, such as joy, and those of a negative nature, such as anger or sadness.

It must be taken into account that this phenomenon does not always occur completely, but instead of completely eliminating the emotional response, what it can do is to soften it to a certain degree, which can range from a small reduction of the response to an almost inexpressive emotional response, or a total lack of emotional reaction to the stimulus in question.

Psychopathologies associated with this alteration

Affective blunting does not necessarily have to be part of a psychopathology, but sometimes it can appear as a symptom of some different disorders.but sometimes it can appear as a symptom of some disorders of different nature. We are going to know some of the most important ones.

1. Schizophrenia

The first mental disorder in which we can find emotional flattening is schizophrenia. One of the characteristics of this illness, among many others, is that the patients who suffer from it, generally have non-existent or inadequate emotional responses to the events experienced..

Affective blunting is an unfavorable indicator in schizophrenia. Moreover, this condition is more likely to occur in males than in females. These patients have a worse prognosis than the others, although this is merely a statistical indicator, so each case must be considered individually, as is logical.

Study suggests possibility that affective blunting in schizophrenia patients affects only the expressivity of the emotion itself, but not the underlying sentiment. That is, the researchers question whether it is the physical reaction, such as facial gesticulation or changes in tone of voice, that is being limited, or whether the feeling inherent in the emotion is also suppressed.

It has also been observed that in some patients there is a limitation at the motor level that could be the cause of the apparent affective blunting, by hindering or preventing the person from performing the gesticulation or physical movements associated with the expression of the emotion.

2. Depression

Another of the main psychopathological disorders in which affective dullness may appear is depression. In this case, it is important to bear in mind that is not a symptom of the disease itself, but a side effect of some pharmacological treatments that may be prescribed to patients. that may be prescribed to patients.

We would be talking about antidepressants and antipsychotics. Specifically, the compounds most commonly used to treat these disorders are SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors).

The main difficulty in being able to delve into this question is that most of the existing studies on the side effects of these psychotropic drugs are focused on those of a physical nature, being less frequent the ones that locate the side effects of these drugs in the literature.The main difficulty in delving into this issue is that most of the existing studies on the side effects of these psychotropic drugs are focused on the physical side effects, and less frequent are those that focus on the emotional side effects, which would include issues such as affective dullness.

Speaking of depression and the disorders associated with it, it is worth making a small clarification about anhedonia, which is one of the symptoms of this disease and is sometimes confused with affective blunting. Anhedonia refers to the difficulty or even inability of the subject to experience pleasure in any situation.

In this case, anhedonia means that a stimulus that previously caused a certain satisfaction or pleasure to the affected person, now does not cause it.. On the other hand, affective blunting implies the lack (or decrease) of an emotional response to any stimulus, whether positive or negative in nature.

And, as we have seen, this phenomenon, when we speak of depression, is associated with the medication prescribed to treat the disease.

3. Post-traumatic stress disorder

Continuing with the different psychological pathologies in which, for one reason or another, examples of affective blunting can be observed, we must now consider post-traumatic stress disorder, or PTSD. This condition generates in patients different symptoms, and one of them is precisely the difficulty to express emotions..

This emotional flattening becomes more evident when dealing with positive situations, as the subject tends to lose interest in them, which would also imply a certain anhedonia, as we saw when we were talking about depression. In any case, PTSD patients will tend to suppress any emotional response, positive or negative.

Biological basis of affective blunting

After discovering which are the psychological disorders where we can encounter cases of affective blunting, we are now going to explore the Biological bases underlying this phenomenon. To do so, we must focus on several parts of the brain that we must focus on several parts of the brain that are somehow related to the suppression of emotional expressivity.

1. Limbic system

The first structure we should mention is none other than the limbic system, one of the most important of which is the limbic system. the limbic system, one of the most primitive regions of the brain and of particular importance for emotional regulation.. It is mainly composed of the hippocampus and the amygdala. Damage to the amygdala can have direct repercussions on the management of emotions, and can cause, among other effects, that of affective blunting.

This is the case of patients with schizophrenia, as they have difficulties to correctly connect stimuli between the amygdala and other regions of the cerebral cortex, which are necessary to control emotions. The consequence, in some cases, is a flattening of affect, as we have seen above.

2. Brainstem

The brainstem may also be involved in the subject's emotional unresponsiveness. In MRI tests, patients with schizophrenia show an activation in this cerebral area when they observe negative stimuli, such as cinematographic scenessuch as movie scenes with sad content.

3. Prefrontal cortex

Reaching the cortical area, and more specifically the one corresponding to the prefrontal area, we find other parts of the brain that are important in the process of emotions. Following with schizophrenia patients who have been affected by affective blunting, it has been discovered that they have a lower activation in this brain region.

To try to correct this problem, a drug called quetiapine is used, which contributes to recover the activation of these circuits and therefore a better emotional processing, which can reduce the affective blunting.

Within the prefrontal cortex, they would be specifically the orbitofrontal gyrus of the left hemisphere and the medial prefrontal gyrus of the right hemisphere the most relevant parts for the issue at hand.

4. Anterior cingulate cortex

Another part of the cerebral cortex that is relevant to the processing of emotions is the anterior cingulate cortex. Likewise, an anomaly in the activation of this sector is observed when studying the brain of people with schizophrenia when visualizing negative stimuli..

In these people, those suffering from affective blunting, a lower activation would be observed with respect to that shown by people in the control group.

Bibliographical references:

• Arancibia, M., Behar, R. (2015). Alexithymia and depression: evidence, controversies and implications. Chilean journal of neuropsychiatry.
• Crespo, M., Gómez, M. (2012). The assessment of posttraumatic stress: presentation of the global assessment of posttraumatic stress (EGEP) scale. Clínica y Salud. SciELO Espana.
• Donnoli, V.F., Santos, L.G., Almeida, T.S., Ferreyra, P. (2007). Affective flattening in schizophrenia: a qualitative study. Argentine Journal of Clinical Neuropsychiatry.