DISORDER OF EMOTION

Distinction Between Feelings and Emotions

 Feelings: Subjective experiences or reactions to events or situations, often influenced

by our emotional state.
o Example: Feeling sadness after a breakup, or feeling anxious before an
important presentation.
 Emotions: Physiological responses to stimuli, often manifesting as bodily changes,
such as increased heart rate, sweating, etc.
o Example: Feeling nervous (emotion) which may lead to a racing heart
(physical response) before a speech.
 Mood: A prolonged emotional state that influences how we perceive and interact with
the world.
o Example: Feeling down or melancholic for days after a personal loss, even
when no immediate event is triggering the emotion.
 Affect: Short-lived emotional responses, observable through facial expressions, body
language, etc.
o Example: A smile or frown when someone says something funny or upsetting.

Classification of Emotional Reactions

1. Normal Emotional Reactions

 Grief: A natural response to loss (e.g., death of a loved one), involving sadness,
anxiety, and other emotions.
o Example: A person may feel sad and tearful after the death of a parent, but
over time, the emotional intensity reduces.
 Functional Incapacity: Normal emotional reactions do not cause long-term
dysfunction.
o Example: After the loss of a pet, someone might take a few days off work but
resumes normal activities after the grieving period.

2. Abnormal Emotional Reactions

 Adjustment Disorders: Emotional responses to stressors that, although

understandable, lead to persistent symptoms affecting daily life.
o Example: Someone who is overwhelmed by a new job and struggles with
anxiety or depression for months, impacting their work and personal life.
 Yerkes-Dodson Curve: Stress improves performance up to a point but beyond that, it
causes deterioration.
o Example: A student may perform well under moderate pressure but becomes
overwhelmed with too much stress, leading to poor exam performance.

Examples of Abnormal Emotional Reactions:

1. Anxiety:
 o A feeling of excessive fear or worry with no adequate reason.
o Example: A person experiences frequent panic attacks, such as shortness of
breath, despite there being no immediate danger.
2. Phobias:
o An irrational fear of specific objects or situations.
o Example: A person who was bitten by a dog as a child now experiences
severe anxiety when near any dog, even if the dog is calm.
3. Depressed Mood:
o A mood state characterized by sadness, hopelessness, and a lack of interest in
life.
o Example: After a job loss, an individual feels constant sadness and may lose
interest in activities they once enjoyed.
4. Anxious Foreboding:
o A vague sense that something bad is going to happen without knowing what.
o Example: A person feels an intense, unexplained sense of dread, possibly
leading to avoidance behavior, without any specific trigger.
5. Demoralization:
o Feelings of hopelessness and discouragement, but without the severe mood
disturbance seen in depression.
o Example: A person with cancer feels demotivated and isolated, but they are
still able to perform daily activities like going to work.

Abnormal Expressions of Emotion

 Cultural Variations: Some emotional expressions are culturally acceptable, but may
seem abnormal from a psychological perspective.
o Example: In some cultures, loud and expressive mourning is expected after a
death, whereas in other cultures, calmness is preferred.

Types of Abnormal Expression of Emotion:

1. Dissociation of Affect: Emotional response is absent or markedly reduced in the face

of significant stress.
o Example: A person who survives a traumatic accident may describe the event
in a detached or emotionless way, even though it was life-threatening.
2. Smiling Depressive: A person with depression may appear to smile or act cheerful
outwardly but exhibit signs of deep sadness or emptiness internally.
o Example: A person at a party may smile and laugh, but when alone, they feel
overwhelmed by sadness and hopelessness.
3. Belle Indifférence: A person with a serious physical illness shows no emotional
distress or concern about their condition.
o Example: A person with paralysis may show little concern or distress about
their inability to move their legs.
4. Denial: A defense mechanism where a person refuses to acknowledge a distressing
reality or fact.
o Example: A smoker may deny the harmful effects of smoking despite being
informed about its dangers.
 5. Apathy: Emotional indifference, lack of interest or motivation.
o Example: A person who has experienced a major life crisis, such as the death
of a loved one, but shows no visible distress or desire to talk about it.

Morbid Expressions of Emotion

Morbid expressions of emotion refer to emotional reactions that deviate from the norm and
are often observed in conditions like schizophrenia and depression. These expressions may
seem out of place or exaggerated and can be concerning, as patients themselves are often
unaware of the abnormality of their emotional responses.

1. Inadequacy or Blunting of Affect

 Definition: The loss of emotional response, resulting in an indifference to one's own

or others' well-being. Patients may show insensitivity to social nuances and fail to
connect emotionally with others.
 Example: A person with schizophrenia might show little to no emotional reaction to a
tragedy, like the death of a loved one, or might behave inappropriately, such as taking
visitors to see a dead animal without any sense of discomfort or empathy.

2. Incongruity of Affect

 Definition: A mismatch between the emotional response and the situation at hand. An
event that doesn't seem emotionally significant may provoke a strong reaction, while
an event that should logically elicit an emotional response might not affect the person
at all.
 Example: A person might laugh in response to sad news or remain emotionless in the
face of a major life event like the death of a relative.

3. Emotional Constriction and Flattening

 Definition: A reduced range of emotional expressions, where the person shows

minimal emotional response, though it remains congruent with the context.
 Example: A person with chronic schizophrenia might show a flat affect, characterized
by minimal facial expressions and limited emotional reaction, even in the presence of
emotionally charged events.

4. Smiling in Depression (Masked Depression)

 Definition: Some depressed individuals may smile, but this smile is not genuine; it
may mask the sadness or distress they are feeling inside.
 Example: A depressed individual may smile outwardly during social interactions but
may be struggling internally. Psychiatrists should be careful not to misinterpret such
smiles as signs of happiness.
 Distinguishing: The key is noticing that the smile does not engage the eyes and seems
forced or shallow, a hallmark of what is called "masked" depression.
5. Lability of Affect

 Definition: Rapid, unpredictable shifts in emotion, often without external stimuli to

justify the change.
 Example: A person might suddenly burst into tears after a seemingly neutral
comment, or, conversely, they might laugh uncontrollably at a tragic event.
 Common in: Borderline personality disorder, mania, and mixed affective states like
dysphoric mania.

6. Affective Incontinence

 Definition: A total loss of control over emotional expressions, often without the
accompanying feelings of sadness or joy that typically trigger such reactions.
 Example: A person may spontaneously laugh or cry without any emotional context or
underlying feeling, often seen in neurological disorders like cerebral atherosclerosis
or multiple sclerosis.

Morbid Disorders of Emotion

These are pathological states where emotional disturbances persist, even when external
stressors are removed. They include conditions like depressive illness, which are
characterized by mood shifts that do not resolve naturally or easily.

1. Morbid Depression

 Definition: A mood state of persistent, intense sadness and emotional numbness that
does not resolve naturally and may even worsen over time.
 Symptoms:
o Psychomotor Retardation: Slowed physical and mental activities.
o Anhedonia: Loss of interest in activities once found pleasurable.
o Somatic Symptoms: Physical complaints, like feeling a "tight band" around
the head or chest, or experiencing unexplained physical pain.
 Example: A person may describe their feelings as "like a weight" or "a cloud,"
emphasizing the overwhelming nature of the sadness that seems all-encompassing.

2. Diurnal Variation of Mood

 Definition: A typical pattern in morbid depression where symptoms worsen during

specific times of the day, often in the early morning.
 Symptoms: Early morning waking, loss of energy, loss of appetite, and heightened
anxiety.

3. Severe Depression and Stupor

 Definition: A state of such profound depression that the person may appear
indifferent to their surroundings and unable to engage in basic activities.
  Example: The patient may be aware of their inability to perform tasks like housework
but feel overwhelmed by guilt and shame for not doing so, unlike someone with
schizophrenia, who may not care about the undone tasks at all.

4. Morbid Anxiety

 Definition: Severe, pervasive anxiety that occurs without an obvious trigger. It can
accompany depression or psychotic states.
 Example: A person with morbid anxiety may feel constant dread or fear even when
no immediate threat is present.

Other Emotional Expressions in Psychopathology

1. Irritability

 Definition: A heightened sensitivity to stressors or frustrations, leading to emotional

outbursts. It can be a feature of both depression and schizophrenia.
 Example: A person with schizophrenia may appear irritable or angry without any
clear reason for their mood shift.

2. Morbid Euphoria and Elation

 Definition: Elevated mood or excessive cheerfulness that is disproportionate to the

situation. Common in mania, hypomania, or certain organic states.
 Symptoms:
o Pressure of Speech: Rapid speech that may be difficult to follow.
o Flight of Ideas: A subjective feeling of racing thoughts.
 Example: A person in a manic state might be overly energetic, talkative, and appear
cheerful even though there is no specific cause for this happiness.