Humans have access to a wide range of emotions. You may express these emotions through physical gestures, facial expressions, and variations in tone of voice. The physical manifestations of your emotions help you communicate and connect with the people around you. However, in some cases, you might not be able to show emotions. This lack of emotional expression is known as “flat affect.”
In conversation, your facial expressions may remain neutral, and you may avoid making eye contact. While the cause behind flat affect varies from person to person, it’s largely categorized by showing no physical expression of your emotions. You may feel emotions but not show them.
In either case, navigating the experience of flat affect can be challenging. Determining how to approach and treat it can look different for each person. With the proper knowledge and support, you can learn to work with flat affect or resolve it entirely.
What is flat affect?
Flat affect is the lack of physical reaction, such as facial expressions, gestures, or tone of voice, in response to emotional stimuli. You may feel emotions but not express them. It’s important to remember that flat affect is characterized by a lack of showing emotions, not a lack of experiencing them.
You can develop flat affect from schizophrenia, mood disorders, post-traumatic stress disorder (PTSD), and other mental health conditions. Flat affect is also a typical symptom of autism. Neurodivergent people may be less likely than neurotypical individuals to express their emotions outwardly.
As opposed to anhedonia, which is the inability to feel joy, pleasure, or other positive emotions, flat affect impacts all emotions. With flat affect, you don’t show emotional expression of any kind.
Flat vs. blunted affect
You may see the terms “flat affect” and “blunted affect” used interchangeably. However, the two describe different conditions. Whereas flat affect describes a lack of emotional expression, blunted affect is a decrease in emotional expression.
An individual dealing with blunted affect may show less emotion through facial expressions, tone of voice, and physical movements. Similar to flat affect, people with blunted affect experience emotions. The key difference between the two is the amount of emotional expression a person reveals.
A person with flat affect shows nearly no emotional response to stimuli, whereas someone with blunted affect shows a reduced emotional reaction.
Flat affect symptoms
The exact presentation of flat affect may look a little different for everyone. However, these are five of the most common symptoms:
- Little to no facial or verbal reactions
- No changes in speech, or speaking in a monotone
- Seeming lack of interest in the conversation or other people
- Lack of body language, gestures, or other forms of nonverbal communication
- Avoiding eye contact
Flat affect symptoms overlap with the practices of the grey rock method. In this technique, you display no emotional response in order to distance yourself from a toxic person. The key difference between the two is that flat affect is an inability to show emotions, whereas the grey rock method is actively trying to avoid showing emotions to avoid interacting with a difficult person.
Flat affect examples
Depending on the cause of flat affect, it can be either a temporary or a lifelong experience. These examples help illustrate what flat affect can look like:
- When a loved one shares exciting news, you show little to no excitement in response.
- You may avoid making eye contact while in conversation.
- You learn that you won a contest at work but don’t express any excitement.
- A pet passes away and, while you may feel sad, you don’t cry or express the emotion.
The best treatments for flat affect depend on how it presents in each person and its origin.
What causes flat affect?
There are several causes for flat affect, some of them related to mental health conditions and others physical:
Flat affect and schizophrenia
A lack of emotional expression is one of the most common symptoms of schizophrenia. In a study published by the National Institutes of Health (NIH), scientists named flat affect as a key diagnostic factor for schizophrenia. It states that people with schizophrenia often have a lower ability to process and show emotions.
The presence of flat affect alone is not enough to diagnose schizophrenia or any other mental health condition. People with schizophrenia may display flat affect symptoms in addition to others that are common for the condition.
Mental health professionals also consider disorganized thinking, hallucinations, and many other symptoms when diagnosing schizophrenia. It’s always best to consult with a medical professional if you experience any of these symptoms.
Flat affect and autism
It’s common for individuals with autism spectrum disorder (ASD) to present flat affect as one of their symptoms. The mannerisms of autistic individuals are often referred to as robotic, and they often show minimal expression through their body or facial movements. This may give off the impression that the autistic person is uninterested or unhappy. In an effort to blend in, autistic individuals may defer to masking.
Masking is an effort to alter your vocal tones, facial expressions, and body language to match the environment. However, masking can sometimes look strained or forced, which can make navigating neurotypical social settings a challenge. Flat affect impacts autistic individuals on a sliding scale, and it doesn’t look the same for everyone.
Flat affect and depression
You may see both flat affect and blunted affect in those living with depression.
Some scientists believe that flat affect occurs as a result of a depressed individual’s natural brain chemistry. Alternatively, others believe it’s a side effect of certain antidepressants. A 2022 study published by NIH noted that different antidepressants can have varying impacts on an individual’s ability to feel and express emotions.
It’s possible for people dealing with depression to take medication that helps remedy flat affect. But it’s always best to speak with your doctor to determine the best course of treatment.
Similar to other mental health conditions, flat affect is just one of many diagnostic criteria for depression. It occurs alongside symptoms such as difficulty concentrating, languishing or feeling apathetic, changes in appetite, feeling empty, and other adverse experiences.
Flat affect and traumatic brain injury (TBI)
Flat or blunted affect can arise as a symptom after someone suffers a traumatic brain injury (TBI). Depending on the damage suffered from the injury, they may not be able to display emotions to the same degree as they did before the injury. They may understand the importance of an event, such as a friend’s wedding or the loss of a job, but lack an emotional response to it.
Healing is sometimes possible, depending on the severity of the injury. Retraining the brain to recognize and process emotions or more experimental treatments like cranial electrotherapy stimulation are options. Some individuals report that their ability to feel emotions returns over time, while others state the opposite. It depends on the injury and the person.
Flat affect and post-traumatic stress disorder (PTSD)
Flat affect can also be a symptom of PTSD. For some people, surviving a traumatic event can lead to difficulty with emotional regulation. They may struggle to identify and manage emotions. This separation from emotions can sometimes lead to emotional detachment or numbing.
Numbing is a biological process wherein a person’s emotions are detached from thoughts and behaviors. A person may experience a limited array of emotions, no emotions at all, or feel unsafe showing big emotions. Flat affect can appear as a symptom of the trauma.
Flat affect and medication
Some medications can reduce the ability to feel or express emotions. Certain antidepressant medications, like selective serotonin reuptake inhibitors (SSRIs), can cause flat affect or emotional blunting as a side effect. Additionally, some antipsychotic medications or anti-seizure drugs may show the same result.
It’s worth consulting with your health care or mental health provider. They can help you determine if medication is the root cause of flat affect and the best way to address it.
How to treat flat affect
Talk to your health care provider
Before you can address flat affect, you must identify the cause. The exact treatment for flat affect will vary depending on its source. A health care provider can use one of these scientific scales to understand the severity of your flat affect and the best treatment:
Note that the use of “negative” in these assessments doesn’t refer to bad. Rather, it’s the lack of a trait seen in a neurotypical person. It’s additionally important that you work with a qualified health care professional to receive an accurate diagnosis and assessment. They can help you identify the cause of flat affect and create a treatment plan that works for your unique case.
Try therapy
Therapy can help boost emotional intelligence by teaching you how to identify and express your emotions. A mental health professional, occupational therapist, or another provider can help identify emotions and elicit the appropriate response.
Additionally, they can assist in navigating emotional distress or other intense and complicated feelings that arise when working on improving flat affect. Your treatment may include naming the emotion using an emotion wheel, practicing facial expressions, and making changes in tone of voice.
Train your social skills
Flat affect impacts your ability to communicate, express emotion, and connect with other people. One way you can navigate flat affect is by improving your social skills. You don’t need to take on everything at once. Instead, choose to focus solely on making eye contact for short periods. Once you feel comfortable with making more eye contact, you may move on to practicing another strategy.
Somatic therapy
For individuals dealing with flat affect as a result of PTSD, a traumatic brain injury, or another type of physical injury, somatic therapy can prove helpful. Somatic coaching is a therapy that focuses on reconnecting your mind and body. It teaches you how to identify the emotions your body feels. By naming the emotion and focusing on how it feels in your body, you may be better able to express your feelings and find inner peace.
Self-acceptance
Proper treatment and therapy can help improve flat affect. However, the best treatment depends entirely on the reason for the flat affect. For example, autistic individuals are naturally less likely to express their emotions physically. It’s important to remember that this does not need to change. Radical self-acceptance, improving emotional intelligence, and practicing vulnerability can help you be confident in who you are and find your purpose in life.
Navigating flat affect for greater life fulfillment
Flat affect has the potential to impact multiple parts of your life. It changes how you connect with people, communicate, and express yourself. Depending on the source of your flat affect, the right treatment and self-acceptance can help you navigate the experience.
Understanding and treating flat affect can be a huge undertaking, but working with a professional can help. BetterUp Coaches are equipped with the skills and resources to create an approach to flat affect that is unique to you. Design your path forward with a BetterUp Coach.
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