Disorders of

Emotion

Presenter – Dr Athul Raj

Chair – Dr Radhika
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“There can be no transforming of darkness
into light and of apathy into movement
without emotions”

Carl Jung
Plan of presentation

 Definitions

 Basic Emotions

 Psychological aspects

 Neurobiological aspects with clinical correlation

Disorders of emotion
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Definitions
As per Fish’s Clinical Psychopathology

 Emotion: Stirred-up state caused by physiological changes occurring

as a response to some event and which tends to maintain or abolish
the causative event.

 Feeling: It is a subjective experience of emotion.

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Definitions

 Mood: Pervasive and sustained emotion that colors the person’s

perception of the world.

 Affect: Patient’s present emotional responsiveness.

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Basic Emotions (Ekman and Friesen ,1971)

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Psychological aspects
 James- Lange Theory
 Cannon- Bard Theory
 Schachter- Singer Theory
 Facial Feedback theory
 Cognitive- Appraisal Theory
 Theory of Relationships among Emotions
 Network theory of emotions
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James- lange theory

We perceive the situation.

We react

We notice our reaction

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Cannon- bard theory

We perceive the environmental situation

Patterns of activity produced in lower brain areas (e.g.: Hypothalamus)

Pattern of lower brain activity perceived Patterns of bodily activity expressing

in cerebral cortex as felt emotion. the emotion.

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Schachter-singer theory

Perception of an A generalized state of

environmental situation bodily arousal

Felt emotion depends

Interpretation of the
upon the reasons given for
reason of for the
the generalized arousal
generalized arousal state.
state.
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 Facial feedback theory

The facial feedback hypothesis, rooted in the conjectures of Charles

Darwin and William James, is that one's facial expression directly affects
their emotional experience
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Cognitive appraisal theory
 This theory was given by Richard Lazarus

 This theory emphasizes on Appraisal (an act of assessing something)

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 Theory of relationships among emotions
 Robert Plutchik

 Mixing of Primary emotions

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Network theory of emotions

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Neuroanatomy

 Key structures involved in emotions:

 Limbic system
 Frontal lobe
 Temporal lobe
 Brainstem autonomic nuclei

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Amygdala

The amygdala is commonly

thought to form the core of a neural
system for processing fearful and
threatening stimuli 

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Cerebral Cortex

• Left hemisphere houses the analytical mind whereas the right hemisphere
appears dominant for affect, socialization and body image.

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Cerebral Cortex
Area of lesion Right Left
Prefrontal cortex • Activating lesion: • Activating lesion: Lifts
Depression the mood (eg: Gelastic
seizures)
• Destructive lesion:
laughter, euphoria and a • Destructive lesion:
tendency to make jokes Depression and
and puns uncontrollable crying
Temporal lobe • TLE: Display excessive • TLE: Generate
emotionality ranging references to personal
from sadness to elation. destiny and
philosophical themes
and display humourless
approach to life
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 Neurochemistry

 The ascending monoamine systems include

the serotonin, norepinephrine, and dopamine
systems.

 These neurotransmitter systems are involved

in the emotions that are experienced.
 Perceived Stimulus
Hippocampus

GABA
Parabrachial Amygdala Prefrontal cortex
nucleus

Increased
respiration Locus ceruleus Paraventricular Nucleus Periaqueductal
grey area

Noradrenaline Pituitary
Serotonin
CRH
AVP

Adrenal Defensive
medulla Posturing and
Epi and NE
freezing
Raphe Nucleus
Increased sympathetic
activity
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Normal emotional reactions

 Normal response to events or to primary morbid psychological experiences

 One aspect of distinction between normal and abnormal reaction is

Functional incapacitation

 This is explained by Yerkes-Dodson curve given in 1908.

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Yerkes Dodson
Curve

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 Disorders of emotion

Morbid disorders of Abnormal expression

emotion of emotion

Sun

Abnormal emotional Morbid expression of

reaction emotion
Abnormal Emotional Reactions

 Anxiety is an unpleasant affective state and a simple definition is fear for no

adequate reason.

 When the fear is restricted to one object, situation or idea, the term phobia is used.
They are associated with physical symptoms of anxiety and with avoidance.

 Most fears are learned responses, while some are secondary to morbid states and
some regarded as obsessional symptoms. 26
 Depressed mood is one of the commonly experienced abnormal reactions

 Anxious foreboding is defined as a fear that something terrible will happen

although the person cannot identify what they are frightened of.

 Demoralization - individual feels trapped and unable to plan or initiate

action towards a specific goal .
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Abnormal Expression of emotions

 Emotional expressions that are very different from the average normal reaction.

 Those with abnormal expressions of emotion are generally aware of the

abnormality.

 Excessive emotional response may be the result of learning and different cultural
norms.
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Dissociation of affect
• Some depressed people fail to exhibit any emotion where some would be
expected, this is termed as Dissociation of affect.

• Another variant of dissociation of affect is the “belle indifference” that is

seen in conversion disorder.

• A defence that may manifest as lack of emotion is denial

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Abnormal Expression of emotions

 Apathy is often used to mean emotional indifference, often with a sense of

futility.

 Perplexity is a tentative, slightly puzzled state that occurs in anxiety, mild

clouding of consciousness and emerging schizophrenia.

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Morbid Expression of emotions

• The patient is unaware of the morbidity in emotional expression even

though it is apparent to observers.

• Inadequacy and incongruity of affect are characteristic of schizophrenia.

• Inadequacy: complete loss of all emotional life so that the patient is

indifferent to their own well-being and that of others. It is known as
inadequacy or blunting of affect and was called parathymia by Bleuler.

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Morbid Expression of emotions

• Incongruity: misdirection of emotions

• Flattening: limitation in the usual range of emotional responses so that

that the patient displays little emotional response in any direction.

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Morbid Expression of emotions

• Lability of affect: rapid and abrupt changes in emotion largely

unrelated to external stimuli. It can be seen in mixed affective states,
mania, borderline personality disorder and organicity.

• Affective incontinence: Total loss of control over emotions. It is

commonly seen in cerebral atherosclerosis and multiple sclerosis.
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Morbid disorders of emotions

• These are pathological states.

• They do not spontaneously resolve with removal of the stressor and

have their own independent momentum.

• They are sometimes triggered by stressful events and sometimes

occur without any precipitant.

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Morbid disorders of emotions

• Depressive illness: Patients use terms such as ‘a weight’, ‘a cloud’ or ‘a

darkness’ to attempt to capture the exact emotional feeling.

• Morbid depression also abolishes the normal reactive changes of

emotion and is usually associated with diurnal variation in mood/.

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Morbid disorders of emotions
 Mania/Hypomania: Morbid euphoria and elation classically occur in mania and
hypomania

 The distinction between mania and hypomania lies in the presence of psychotic
symptoms in mania and marked impairment in functioning.

 Elation is not related to any specific event and is not modified by depressing influences.

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Morbid disorders of emotions

• Ecstasy: exalted state of feeling. It can occur in the healthy population at

times of profound religious experience or occasions of deep emotion.

• It is a state of extreme well-being associated with a feeling of rapture, bliss

and grace. Unlike elation, it is not associated with overactivity or flight of
ideas.

• It may occur in schizophrenia, in those who misuse LSD, in epilepsy and in

mass hysteria associated with religious services. 37
Abnormality of Experience and Physiological
activity
• Alexithymia: Coined by Sifenos (1972). It is characterized by difficulties in
the capacity to verbalize affect and elaborate fantasies.

• Originally introduced to describe psychosomatic disorders occurring in

individuals with difficulty expressing their emotions.

• Absence or diminution of fantasy is a consistent finding.

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Emotional Intelligence

Knowing our own emotions

Managing our emotions

Motivating ourselves

Recognizing the emotions of others

Handling relationships
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If your emotional abilities aren't in hand, if you don't
have self-awareness, if you are not able to manage
your distressing emotions, if you can't have empathy
and have effective relationships, then no matter how
smart you are, you are not going to get very far.

.
—Daniel Goleman
References
1. Fish’s clinical psychopathology, 4th ediition.
2. Kaplan and Saddock’s Synopsis of Psychiatry, 11th edition.
3. Morgan and King, Introduction to Psychology, 7th edition.

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