Descriptive Psychopathology: The Signs and Symptoms of ...

200 Section 3: Examination domainsTable 8.2. Emotional bluntingLoss of emotional expressionAbsent, shallow, incongruous moodConstricted expressionUnvarying expression lackingmodulationExpressionless faceUnvarying monotonous voiceAvolitionIndifference or unconcern for ownpresent situationIndifference or unconcern for own future(lacks plans, ambition, desires, drives)Unlike patients suffering with motor aprosodia (see later), the emotionallyblunted patient also loses subjective emotional experience, described as emotionaldullness. 12 The patient is indifferent toward family members and other previouslyclose persons. They experience little or no pleasure, grief, joy, satisfaction, ordisappointment. They are without sentiment or sympathy, and are indifferent totheir circumstances. They may laugh suddenly, but offer no reason for theoutburst, and deny any sense of associated joy, an ataxia of feelings. 13 When askedif a prolonged hospital stay would interfere with their plans, they commonlyrespond “Well, if I have too”. When asked what they would do if they won thelottery, their response is often limited to “Put the money in the bank”.The emotional dullness is associated with a loss of social graces, and suchpatients become rude and ill-mannered, but usually without aggression. Whensuddenly assaultive, violence is unemotional, and may be related to a delusionalidea or a hallucination. Many of the features of emotional blunting reflect deficitsin executive functioning. 14Motor aprosodiaMotor prosody is the expression of emotion in spoken language, facial expression,gesture and body language. Receptive prosody is the ability to recognizethe emotional expression of others. Motor aprosodia is associated with disease inthe non-dominant cerebral hemisphere, particularly in frontal circuitry. Motoraprosodia is descriptively identical to the loss of emotional expression describedas emotional blunting/flat affect. Motor aprosodia is described in autistic spectrumdisorders, 15 schizophrenia, 16 and depression. 17AvolitionAvolition is reduced interest and activity associated with an absence of emotion,interest, and concern. Avolition is associated with schizophrenia and frontal lobe