Showing No Emotion? It Could Be Flat Affect

Certain medications, like antidepressants, can cause a flat affect.

In a 2017 study that examined 3,243 user reviews of antidepressants from three health websites, 41% of reviews reported negative emotional and behavioral effects, including a flat affect.

In this case, the reviewers were taking either:

• escitalopram (Lexapro)
• duloxetine (Cymbalta)
• vilazodone (Viibryd)
• vortioxetine (Trintellix)

Research shows an overlap in symptoms between schizophrenia and autism. This may sometimes include a flat affect, which has confused experts for decades because the two conditions are very different.

Some autistic people may have a hard time expressing emotions or responding to social interactions, which can present as a flat affect.

For example, in a small 2019 study, researchers found that autistic people had more muted muscle movements in their faces when watching films designed to stimulate emotions than a control group.

Some forms of dementia can cause changes to the frontal and temporal lobes of the brain, which can sometimes manifest behaviorally as a flat affect.

Although not always the rule, symptoms of dementia may include progressive aphasia (the inability to communicate) and a loss of facial expression, according to the National Institute on Aging.

As you may know, depression exists on a spectrum.

In some cases, a flat affect may be present along with related symptoms, like anhedonia, or the inability to feel pleasure. This isn’t always the case, though.

Flat affect can result from a decreased emotional response to events around you.

• Facial paralysis, such as after a stroke or from other muscle disorders, can give someone the appearance of a flat affect.
• People with Parkinson’s disease may experience hypomimia, more commonly known as a “masked face.” This refers to a progressive decline in facial expression, which can manifest as a flat affect.
• A flat affect is considered a “negative” symptom of schizophrenia, which means there’s an absence of a certain emotion or behavior.

People who live with schizoid personality disorder may sometimes have some symptoms that overlap with schizophrenia.

According to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), this includes avoiding social interactions and displaying emotional coldness, detachment, or a flat affect toward others.

Having a flat affect doesn’t mean that you don’t feel emotions. Rather, it means that your reactions on the outside don’t necessarily match what you’re feeling on the inside.

Some telltale signs of a flat affect include:

• appearing to lack interest
• avoiding eye contact
• apathetic body language or nonverbal cues
• neutral facial expressions
• monotone or flat voice
• lack of hand gestures

If you have a flat affect, you may consider treating it. With the appropriate treatment plan in place, this symptom may be treatable and recovery is possible.

It’s highly advisable to reach out to a doctor, neurologist, or mental healthcare professional. A trained professional will be able to determine the underlying cause of your flat affect and provide treatment options.

Treatment will vary according to what caused the flat affect. 

Medications

If a medication is causing your flat affect, your doctor may change the type of medication you’re taking or the dosage.

 Psychotherapy

Therapy is considered a first-line treatment in many of the conditions associated with a flat affect.

 Social skills training

For people living with schizophrenia, social skills training can teach you how to express your emotions and body language appropriately for social situations.

Speech therapy

Since a monotone voice is often a sign of a flat affect, this type of training can help you express more emotion using different tones of voice.