Mood, Affect and Emotional States

Affect is the way in which a person is emotionally affected by an idea or perception. However, some psychiatrists use the words affect and mood interchangeably while others use mood as a term for the prevailing emotional tone (equivalent to affect), referring to the underlying, sustained, mood as the mood state.

Some simply lump together every kind of emotional distress (depression, elation, anger, irritability, panic, fear, anxiety) under the general rubric of the patient’s mood.

The approach taken here is to restrict the term mood to states of depression or elation; the term affect to emotional responsiveness; and to deal with other emotions, such as anger, separately.

This is because many of these other emotions may or may not be associated with depression or elation and are commonly seen in people whose mood, as defined, is normal.

AFFECT

A person’s affect is how s/he appears to be emotionally affected by an idea or perception. For example, s/he seems happy, sad, or indifferent about it.

A person whose mood is normal may nevertheless be profoundly affected emotionally by some idea or perception.

Psychiatrists are particularly interested in whether a person’s emotional responsiveness is impaired. Affect, therefore, is often described as being:

• flat (absent or very limited emotional range)
• blunted (severe lack of normal emotional sensitivity)
• shallow or restricted (reduced)
• appropriate, harmonious or congruous
• inappropriate or incongruous
• or labile (unstable).

Incongruous affect describes the incongruity between what a person is saying and his affect. For example, a patient laughs or displays no concern when recounting how his imaginary persecutors intend to kill him.

Apathy is emotional indifference and, as such, it is virtually indistinguishable from flat or blunted affect. It is common in depression and certain forms of schizophrenia Opens in new window although resignation, rather than true indifference, often better describes the patient’s lack of responsiveness.

Apathy must therefore be distinguished from the hopelessness which is often the final stage of depression and also from La Belle Indifference (literally, “beautiful indifference”), a sublime resignation to distressing symptoms which are the product of hysteria Opens in new window.

MOOD

It is subjective and reflects the experience of the individual.

Consequently, it is sometimes described as sustained affect; and mood disorders Opens in new window may inaccurately be said to involve a morbid change of affect.

The term euthymic mood is used to describe a normal or equable mood. Inferences about mood generally stem from present observations and past events.

1. Heightened mood

Various words are used to describe the features of heightened mood, many of them essentially interchangeable.

1. Hyperthymia is a tendency to be overcheerful and unrealistically optimistic.
2. Elation consists of feelings of euphoria, triumph, immense self-satisfaction or optimism.
3. Euphoria is an exaggerated feeling of physical or emotional well-being seen in organic mental states and in toxic and drug-induced states.
4. Exaltation is an excessively intensified sense of well-being seen in manic states.
5. Ecstasy describes a state of elation beyond reason and control or a trance state of overwhelming (often religious) fervor.
6. Grandiosity, although not usually bracketed with mood, describes feelings of tremendous importance, characterized by an inflated appraisal of one’s worth, power, knowledge, importance, or identity, and commonly expressed as absurd exaggerations. Extreme grandiosity may attain delusional proportions and is seen in mania and schizophrenia.

2. Depressed mood

Dysthymia is a long-standing tendency to be sad and miserable and a person with this outlook on life is sometimes said to have a dysthymic personality.

Depression Opens in new window describes feelings characterized by sadness, apathy, pessimism and a sense of loneliness.

Melancholia is simply the Latin word for melancholy an is essentially inability to experience pleasure in acts that normally are pleasurable.

3. Fluctuating mood

Cyclothymia, a term invented by Kahlbaum, describes a personality characteristic typified by marked changes of mood (cyclothymic personality).

Lability of mood is emotional instability, a rapid changing mood. The person affected may laugh one minute and cry the next without there being any corresponding change in external stimuli to account for that.

4. Inappropriate mood

Mood-congruent psychotic features are delusions or hallucinations the content of which is entirely consistent with the individual’s depressed or manic mood.

Thus, if the individual’s mood is depressed, the content of the delusions Opens in new window or hallucinations Opens in new window involve themes of personal inadequacy, guilt, disease, death, nihilism, or deserved punishment. Likewise, if the mood is manic, their content involves themes of inflated worth, power, knowledge, or identity or special relationship to a deity or a famous person.

Conversely, mood-incongruent psychotic features are delusions or hallucinations the content of which is inconsistent with either a depressed or a manic mood.

If a distinction is drawn between a person’s affect and his mood, the patient may instead be described as having an incongruous or inappropriate affect.

OTHER EMOTIONAL STATES

Many other terms are used to describe an individual’s emotional state, among them anxiety, fear, agitation, restlessness, panic, and irritability.

The customary distinction between the first two of them used to be that fear always had an object (whether a situation or thing) whereas anxiety was fear without an object or dread.

Unfortunately, the current definitions of anxiety in the international classifications have eroded this useful distinction.

1. Anxiety

Anxiety is characterized by an apprehension, tension, or uneasiness that stems from the anticipation of danger.

The associated symptoms include tachycardia (abnormal rapidity of heart beat), palpitations, breathlessness, and light-headedness.

Both of the main international classifications distinguish between anxiety which is tied to or focused on some particular situation (specific anxiety) or object (phobia) and generalized anxiety where no such external triggering factor is apparent (free-floating anxiety).

The ICD Opens in new window classification also distinguishes between trait anxiety and state anxiety, the former being an enduring aspect of personality and the latter is temporary disorder.

2. Fear

Phobia denotes a persistent irrational fear of, and desire to avoid, a particular object or situation.

In Agoraphobia, the fear is one of going into open spaces and of entering public places: the patient is filled with dread at the prospect of venturing out of his home and may experience panic attacks.

In some cases, what initially seems to be agoraphobia may transpire to be claustrophobia (a fear of enclosed spaces). Thus, a patient may not venture out of his home because of the suffocating, claustrophobic effects of being in a crowded shopping centre rather than because of a fear of open spaces.

If the individual has a chronic abnormal fear that s/he is ill or diseased, this is termed hypochondirasis.

3. Irritability

Anxiety Opens in new window may be expressed as irritability. The depressed patient may become anxious about their inability to respond positively to the problems surrounding them, which makes them anxious and often increasingly irritable.

Conversely, sustained, unremitting anxiety and irritability have a depressive effect over a period of time because the individual’s performance is constantly undermined and dejection sets in.

4. Agitation and restlessness

In other cases, uncontrollable anxiety or fear surface in the form of motor restlessness (agitation) which, as with tics Opens in new window, both reflects and appears to partially alleviate the underlying state of tension.

The ICD classification Opens in new window reserves the term “agitation” for cases where anxiety is accompanied by “marked restlessness and excessive motor activity” — states referred to in the DSM classification Opens in new window as psychomotor agitation.

There is a restless, usually non-productive and repetitious, inability to keep still as a result of the underlying tension. The patient may pace up and down, pick at his clothes or skin, be unable to concentrate or relax and so start but not complete various tasks. In severe cases, there may be shouting or loud complaining. Restlessness caused by certain drugs may mimic agitation (see akathisia Opens in new window).

5. Panic

A further way of dealing with anxiety or fear is attempt to repress it. Anxiety or fear may surface in discrete periods of sudden onset and be accompanied by physical symptoms — panic attacks.

A panic attack is a sudden, overwhelming anxiety or fear, sometimes accompanied by an intense fear of dying and associated with particular times, places, thoughts or ideas. Hyperventilation occurs with fast, shallow, breathing and a range of other physical symptoms.

6. Aggression and hostility

Fear may lead to aggression and hostility.

Biologically, aggressiveness is a component of animal behavior which is released in particular conditions in order to satisfy vital needs or to eliminate an environmental threat. In the case of patients who are irrationally fearful, aggression and hostility perform the same function as in cases where there is an objectively real threat to the individual’s safety. The individual attempts to eliminate fear by eliminating its cause.