Emotional detachment

In psychology, emotional detachment, also known as emotional blunting, has two meanings: one is the inability to connect to others on an emotional level; the other is as a positive means of coping with anxiety. This coping strategy, also known as emotion focused-coping, is used by avoiding certain situations that might trigger anxiety.[1] 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 as reduced affect display is one of the negative symptoms of schizophrenia.

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. 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.[2] 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.[3]

In children (ages 4–12 were studied), 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.[4]

A correlation was found of higher emotional blunting among patients treated with depression who scored higher on the Hospital Anxiety and Depression (HAD) scale and were male (though the frequency difference was slight).[3]

Scales Of Measurement

While some depression severity scales provide insight to emotional blunting levels, many symptoms are not adequately covered.[5] 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 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.[3]

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, or to psychological trauma in adulthood.[6]

Emotional blunting is often caused by antidepressants in particular selective serotonin reuptake inhibitors (SSRIs) used in major depressive disorder (MDD), and often as an add-on treatment in other psychiatric disorders.[7][8] Individuals with MDD usually experience emotional blunting as well.[5] Emotional blunting is a symptom of MDD,[3] as depression is negatively correlated with emotional (both positive and negative) experiences.[9]

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.[10] Schizophrenia in general causes abnormalities in emotional understanding of individuals, all of 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.[11]

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.[9]

Unfortunately, the prevalence of emotional blunting is not fully known.[3]

Behavioral mechanism

Emotional detachment is a behavior 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, psychic integrity 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",[12] "emotional blunting", i.e., dissociation, depersonalization or in its chronic form depersonalization disorder.[13] 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.[14]

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.[15]

See also

References

  1. ↑ "Emotion-focused coping". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d.
  2. ↑ Johnson, Stephen M (1987), Humanizing the Narcissistic Style, NY: Norton and Co., p. 125, ISBN 0-393-70037-2
  3. 1 2 3 4 5 ora.ox.ac.uk https://ora.ox.ac.uk/objects/uuid:8a7067a3-7b21-481f-ac80-32f1929d3ff7/download_file?safe_filename=Emotional+blunting+survey+AAM.pdf&file_format=application/pdf&type_of_work=Journal+article. Retrieved 2021-11-20. {{cite web}}: Missing or empty |title= (help)
  4. ↑ 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.
  5. 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.
  6. ↑ 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
  7. ↑ 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.
  8. ↑ "Emotional blunting: unresolved MDD symptom or effect of treatment?". Progress In Mind. 10 September 2019.
  9. 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.
  10. ↑ 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. ISSN 1618-7598.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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. doi:10.1371/journal.pone.0074331. ISSN 1932-6203. PMC 3772934. PMID 24058547.
  14. ↑ 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 – via EBSCO.
  15. ↑ Williams, Kipling D.; Nida, Steve A. (2011), Ostracism, Consequences and Coping, West Lafayette, IN: Purdue University
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