Emotional detachment

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Despair by Edvard Munch (1894) captures emotional detachment seen in Borderline Personality Disorder. Despair Edvard Munch 1894.jpeg
Despair by Edvard Munch (1894) captures emotional detachment seen in Borderline Personality Disorder.

In psychology, emotional detachment, also known as emotional blunting, is a condition or state in which a person lacks emotional connectivity to others, whether due to an unwanted circumstance or as a positive means to cope with anxiety. Such a coping strategy, also known as emotion-focused coping, is used when avoiding certain situations that might trigger anxiety. [3] It refers to the evasion of emotional connections. Emotional detachment may be a temporary reaction to a stressful situation, or a chronic condition such as depersonalization-derealization disorder. It may also be caused by certain antidepressants. Emotional blunting, also known as reduced affect display, is one of the negative symptoms of schizophrenia.

Contents

Signs and symptoms

Emotional detachment may not be as outwardly obvious as other psychiatric symptoms. Patients diagnosed with emotional detachment have reduced ability to express emotion, to empathize with others or to form powerful emotional connections. [4] Patients are also at an increased risk for many anxiety and stress disorders. This can lead to difficulties in creating and maintaining personal relationships. The person may move elsewhere in their mind and appear preoccupied or "not entirely present", or they may seem fully present but exhibit purely intellectual behavior when emotional behavior would be appropriate. They may have a hard time being a loving family member, or they may avoid activities, places, and people associated with past traumas. Their dissociation can lead to lack of attention and, hence, to memory problems and in extreme cases, amnesia. In some cases, they present an extreme difficulty in giving or receiving empathy which can be related to the spectrum of narcissistic personality disorder. [5] Additionally, emotional blunting is negatively correlated with remission quality. The negative symptoms are far less likely to disappear when a patient is experiencing emotional blunting. [6]

In a study of children ages 4–12, traits of aggression and antisocial behaviors were found to be correlated with emotional detachment. Researchers determined that these could be early signs of emotional detachment, suggesting parents and clinicians to evaluate children with these traits for a higher behavioral problem in order to avoid bigger problems (such as emotional detachment) in the future. [7]

A correlation was found of higher emotional blunting among patients treated with depression who scored higher on the Hospital Anxiety and Depression Scale (HADS) and were male (though the frequency difference was slight). [6]

Emotional detachment in small amounts is normal. For example, being able to emotionally and psychologically detach from work when one is not in the workplace is a normal behavior. Emotional detachment becomes an issue when it impairs a person's ability to function on a day-to-day level. [8]

Scales

While some depression severity scales provide insight to emotional blunting levels, many symptoms are not adequately covered. [9] An attempt to resolve this issue is the Oxford Depression Questionnaire (ODQ), a scale specifically designed for full assessment of emotional blunting symptoms. The ODQ is designed specifically for patients with Major Depressive Disorder (MDD) in order to assess individual levels of emotional blunting.

Another scale, known as the Oxford Questionnaire on the Emotional Side-Effects of Antidepressants (OQESA), was developed using qualitative methods. [6]

Causes

Emotional detachment and/or emotional blunting have multiple causes, as the cause can vary from person to person. Emotional detachment or emotional blunting often arises due to adverse childhood experiences, for example physical, sexual or emotional abuse. Emotional detachment is a maladaptive coping mechanism for trauma, especially in young children who have not developed coping mechanisms. Emotional detachments can also be due to psychological trauma in adulthood, like abuse, or traumatic experiences like war, automobile accidents etc. [10] [11]

Emotional blunting is often caused by antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs) used in MDD and often as an add-on treatment in other psychiatric disorders. [12] [13] Individuals with MDD usually experience emotional blunting as well. [9] Emotional blunting is a symptom of MDD, [6] as depression is negatively correlated with emotional (both positive and negative) experiences. [14]

Schizophrenia often occurs with negative symptoms, extrapyramidal signs (EPS), and depression. The latter overlaps with emotional blunting and is shown to be a core part of the present effects. [15] Schizophrenia in general causes abnormalities in emotional understanding of individuals, all of which are clinically considered as an emotional blunting symptom. Individuals with schizophrenia show less emotional experiences, display less emotional expressions, and fail to recognize the emotional experiences and/or expressions of other individuals. [16]

The changes in fronto-limbic activity in conjunction with depression succeeding a left hemisphere basal ganglia stroke (LBG stroke) may contribute to emotional blunting. LBG strokes are associated with depression and often caused by disorders of the basal ganglia (BG). Such disorders alter the emotional perception and experiences of the patient. [14]

In many cases people with eating disorders (ED) show signs of emotional detachment. This is due to the fact that many of the circumstances that often lead to an ED are the same as the circumstances that lead to emotional detachment. For example, people with ED often have experienced childhood abuse. Eating disorders on their own are a maladaptive coping mechanism and to cope with the effects of an eating disorder, people may turn to emotional detachment. [17]

Bereavement or losing a loved one can also be causes of emotional detachment. [17]

Unfortunately, the prevalence of emotional blunting is not fully known. [6]

Behavioral mechanism

Emotional detachment is a maladaptive coping mechanism, which allows a person to react calmly to highly emotional circumstances. Emotional detachment in this sense is a decision to avoid engaging emotional connections, rather than an inability or difficulty in doing so, typically for personal, social, or other reasons. In this sense it can allow people to maintain boundaries, and avoid undesired impact by or upon others, related to emotional demands. As such it is a deliberate mental attitude which avoids engaging the emotions of others.

This detachment does not necessarily mean avoiding empathy; rather, it allows the person to rationally choose whether or not to be overwhelmed or manipulated by such feelings. Examples where this is used in a positive sense might include emotional boundary management, where a person avoids emotional levels of engagement related to people who are in some way emotionally overly demanding, such as difficult co-workers or relatives, or is adopted to aid the person in helping others.

Emotional detachment can also be "emotional numbing", [18] "emotional blunting", i.e., dissociation, depersonalization or in its chronic form depersonalization disorder. [19] This type of emotional numbing or blunting is a disconnection from emotion, it is frequently used as a coping survival skill during traumatic childhood events such as abuse or severe neglect. After continually using this coping mechanism, it can become a response to daily stresses. [20]

Emotional detachment may allow acts of extreme cruelty and abuse, supported by the decision to not connect empathically with the person concerned. Social ostracism, such as shunning and parental alienation, are other examples where decisions to shut out a person creates a psychological trauma for the shunned party. [21]

See also

Related Research Articles

<span class="mw-page-title-main">Borderline personality disorder</span> Personality disorder of emotional instability

Borderline personality disorder (BPD), also known as emotionally unstable personality disorder (EUPD), is a personality disorder characterized by a long-term pattern of intense and unstable interpersonal relationships, distorted sense of self, and strong emotional reactions. Those affected often engage in self-harm and other dangerous behaviors, often due to their difficulty with returning their emotional level to a healthy or normal baseline. They may also struggle with dissociation, a feeling of emptiness, and a fear of abandonment.

Psychology is an academic and applied discipline involving the scientific study of human mental functions and behavior. Occasionally, in addition or opposition to employing the scientific method, it also relies on symbolic interpretation and critical analysis, although these traditions have tended to be less pronounced than in other social sciences, such as sociology. Psychologists study phenomena such as perception, cognition, emotion, personality, behavior, and interpersonal relationships. Some, especially depth psychologists, also study the unconscious mind.

<span class="mw-page-title-main">Anhedonia</span> Inability to feel pleasure

Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions emphasized the inability to experience pleasure, anhedonia is currently used by researchers to refer to reduced motivation, reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), and deficits in reinforcement learning. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anhedonia is a component of depressive disorders, substance-related disorders, psychotic disorders, and personality disorders, where it is defined by either a reduced ability to experience pleasure, or a diminished interest in engaging in previously pleasurable activities. While the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) does not explicitly mention anhedonia, the depressive symptom analogous to anhedonia as described in the DSM-5 is a loss of interest or pleasure.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in. It can be described as feeling like one is on "autopilot" and that the person's sense of individuality or selfhood has been hindered or suppressed.

<span class="mw-page-title-main">Mood swing</span> Extreme or rapid change in mood

A mood swing is an extreme or sudden change of mood. Such changes can play a positive part in promoting problem solving and in producing flexible forward planning, or be disruptive. When mood swings are severe, they may be categorized as part of a mental illness, such as bipolar disorder, where erratic and disruptive mood swings are a defining feature.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

In psychoanalytic theory, a defence mechanism is an unconscious psychological operation that functions to protect a person from anxiety-producing thoughts and feelings related to internal conflicts and outer stressors.

Dissociation is a concept that has been developed over time and which concerns a wide array of experiences, ranging from a mild emotional detachment from the immediate surroundings, to a more severe disconnection from physical and emotional experiences. The major characteristic of all dissociative phenomena involves a detachment from reality, rather than a false perception of reality as in psychosis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences, with extreme examples being violence, rape, or a terrorist attack. The event must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se.

Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.

Acute stress reaction is a psychological response to a terrifying, traumatic or surprising experience. It may bring about delayed stress reactions if not correctly addressed. Acute stress may present in reactions which include but are not limited to: intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. Reactions may be exhibited for days or weeks after the traumatic event.

Dissociative disorders (DD) are conditions that involve significant disruptions and/or breakdowns "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." People with dissociative disorders also use dissociation as a defense mechanism involuntarily. The individual experiences these dissociations to protect themselves from traumatic stress. Some dissociative disorders are triggered by significant psychological trauma, though depersonalization-derealization disorder may be preceded by lesser stress, psychoactive substances, or no identifiable trigger at all.

Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings either verbally or nonverbally, especially when talking about issues that would normally be expected to engage emotions. In this condition, expressive gestures are rare and there is little animation in facial expression or vocal inflection. Additionally, reduced affect can be symptomatic of autism, schizophrenia, depression, post-traumatic stress disorder, depersonalization disorder, schizoid personality disorder or brain damage. It may also be a side effect of certain medications.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

Thought blocking is a neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic. Persons undergoing thought blocking may utter incomprehensible speech; they may also repeat words involuntarily or make up new words. The main causes of thought blocking are schizophrenia, anxiety disorders, petit mal seizures, post-traumatic stress disorder, bradyphrenia, aphasia, dementia and delirium.

Pseudoneurotic schizophrenia is a postulated mental disorder categorized by the presence of two or more symptoms of mental illness such as anxiety, hysteria, and phobic or obsessive-compulsive neuroses. It is often acknowledged as a personality disorder. Patients generally display salient anxiety symptoms that disguise an underlying psychotic disorder.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

References

  1. ↑ Aarkrog T (1990). Edvard Munch: The Life of a Person with Borderline Personality as Seen Through His Art[Edvard Munch, et livsløb af en grænsepersonlighed forstået gennem hans billeder]. Danmark: Lundbeck Pharma A/S. ISBN   978-8798352419.
  2. ↑ Wylie HW (1980). "Edvard Munch". The American Imago; A Psychoanalytic Journal for the Arts and Sciences. Johns Hopkins University Press. 37 (4): 413–443. JSTOR   26303797. PMID   7008567.
  3. ↑ "Emotion-focused coping". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d.
  4. ↑ Dresden, Danielle (27 May 2020). "Emotional detachment: Symptoms, causes, and treatment". www.medicalnewstoday.com. Retrieved 8 January 2024.
  5. ↑ Johnson, Stephen M (1987), Humanizing the Narcissistic Style , NY: Norton and Co., p.  125, ISBN   0-393-70037-2
  6. 1 2 3 4 5 Goodwin, G.M.; Price, J.; De Bodinat, C.; Laredo, J. (2017). "Emotional blunting with antidepressant treatments: A survey among depressed patients". Journal of Affective Disorders. Elsevier BV. 221: 31–35. doi:10.1016/j.jad.2017.05.048. ISSN   0165-0327. PMID   28628765. S2CID   3755520 . Retrieved 2021-11-20.
  7. ↑ Manti, Eirini; Scholte, Evert M.; Van Berckelaer-Onnes, Ina A.; Van Der Ploeg, Jan D. (2009). "Social and emotional detachment: A cross-cultural comparison of the non-disruptive behavioural psychopathic traits in children". Criminal Behaviour and Mental Health. 19 (3): 178–192. doi:10.1002/cbm.732. PMID   19475645.
  8. ↑ Haun, Verena C.; Nübold, Annika; Bauer, Anna G. (2018-01-07). "Being mindful at work and at home: Buffering effects in the stressor-detachment model". Journal of Occupational and Organizational Psychology. 91 (2): 385–410. doi:10.1111/joop.12200. ISSN   0963-1798. S2CID   149204708.
  9. 1 2 Christensen, Michael Cronquist; Fagiolini, Andrea; Florea, Ioana; Loft, Henrik; Cuomo, Alessandro; Goodwin, Guy M. (November 2021). "Validation of the Oxford Depression Questionnaire: Sensitivity to change, minimal clinically important difference, and response threshold for the assessment of emotional blunting". Journal of Affective Disorders. 294: 924–931. doi: 10.1016/j.jad.2021.07.099 . ISSN   0165-0327. PMID   34378539.
  10. ↑ Dell, Paul F.; O'Neil, John A., eds. (2010-11-01), "Chapter The Theory of Trauma-Related Structural Dissociation of the Personality", Dissociation and the Dissociative Disorders, Routledge, pp. 273–292, doi:10.4324/9780203893920, ISBN   978-0-203-89392-0
  11. ↑ Foa, Edna B.; Hearst-Ikeda, Diana (1996), Michelson, Larry K.; Ray, William J. (eds.), "Emotional Dissociation in Response to Trauma", Handbook of Dissociation: Theoretical, Empirical, and Clinical Perspectives, Boston, MA: Springer US, pp. 207–224, doi:10.1007/978-1-4899-0310-5_10, ISBN   978-1-4899-0310-5 , retrieved 2021-03-22
  12. ↑ McCabe, Ciara; Mishor, Zevic; Cowen, Philip J.; Harmer, Catherine J. (2010). "Diminished Neural Processing of Aversive and Rewarding Stimuli During Selective Serotonin Reuptake Inhibitor Treatment". Biological Psychiatry. 67 (5): 439–445. doi:10.1016/j.biopsych.2009.11.001. PMC   2828549 . PMID   20034615.
  13. ↑ "Emotional blunting: unresolved MDD symptom or effect of treatment?". Progress In Mind. 10 September 2019.
  14. 1 2 Paradiso, Sergio; Ostedgaard, Katharine; Vaidya, Jatin; Ponto, Laura Boles; Robinson, Robert (2013-02-28). "Emotional blunting following left basal ganglia stroke: The role of depression and fronto-limbic functional alterations". Psychiatry Research: Neuroimaging. 211 (2): 148–159. doi:10.1016/j.pscychresns.2012.05.008. ISSN   0925-4927. PMC   4019790 . PMID   23176970.
  15. ↑ Müller, M. J.; Kienzle, B.; Dahmen, N. (2002). "Depression, Emotional Blunting, and Akinesia in Schizophrenia: Overlap and Differentiation". The European Journal of Health Economics. 3: S99–S103. doi:10.1007/s10198-002-0114-9. ISSN   1618-7598. JSTOR   3570157. PMID   15609162. S2CID   42372770.
  16. ↑ Henry, Julie D.; Green, Melissa J.; de Lucia, Amber; Restuccia, Corinne; McDonald, Skye; O'Donnell, Maryanne (2007-09-01). "Emotion dysregulation in schizophrenia: Reduced amplification of emotional expression is associated with emotional blunting". Schizophrenia Research. 95 (1): 197–204. doi:10.1016/j.schres.2007.06.002. ISSN   0920-9964. PMID   17630254. S2CID   44415559.
  17. 1 2 Reid, Marie; Wilson-Walsh, Rebecca; Cartwright, Luke; Hammersley, Richard (May 2020). "Stuffing down feelings: Bereavement, anxiety and emotional detachment in the life stories of people with eating disorders". Health & Social Care in the Community. 28 (3): 979–987. doi: 10.1111/hsc.12930 . ISSN   0966-0410. PMID   31840343. S2CID   209384124.
  18. ↑ Allwood, Maureen A.; Bell, Debora J.; Horan, Jacqueline (2011). "Posttrauma numbing of fear, detachment, and arousal predict delinquent behaviors in early adolescence". Journal of Clinical Child and Adolescent Psychology. 40 (5): 659–667. doi:10.1080/15374416.2011.597081. ISSN   1537-4416. PMID   21916685. S2CID   205874162.
  19. ↑ Michal, Matthias; Koechel, Ansgar; Canterino, Marco; Adler, Julia; Reiner, Iris; Vossel, Gerhard; Beutel, Manfred E.; Gamer, Matthias (2013-09-13). "Depersonalization disorder: Disconnection of cognitive evaluation from autonomic responses to emotional stimuli". PLOS ONE. 8 (9): e74331. Bibcode:2013PLoSO...874331M. doi: 10.1371/journal.pone.0074331 . ISSN   1932-6203. PMC   3772934 . PMID   24058547.
  20. ↑ Kaplan, Carola M. (September 2013). ""Sudden Holes in Space and Time": Trauma, Dissociation, and the Precariousness of Everyday Life". Psychoanalytic Inquiry. 33 (5): 467–478. doi:10.1080/07351690.2013.815064. ISSN   0735-1690. S2CID   219728825 – via EBSCO.
  21. ↑ Williams, Kipling D.; Nida, Steve A. (2011), Ostracism, Consequences and Coping, West Lafayette, IN: Purdue University
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