Disorders of Emotion

1. Disorders of emotion
Anxiety
Panic
Irritability
Phobia
Obsession
Moderator
Dr. Sudha Rani

2. Emotion
Emotion is a subjectively experienced feeling that
is related to affect and mood.
Expression of emotion occurs through a set of
expressive behaviours, function of nervous system,
and cognitive perception.
It has behavioural, somatic and psychic
components.

3. Theories of emotion
James-Lange theory
Emotions are the result of self awareness of
physical and bodily changes in the presence of
stimulus.
Walter Cannon and Philip Bard
Emotional activation may occur without the
activation of higher cognitive process.

4. Schachter and Singer
Two factor theory-physiological arousal and
cognition.
Emotion is a result of the individual's appraising the
context of a situation.

5. Basic emotions:
Ekman - anger, disgust, fear, happiness, sadness,
and surprise.
Izard - contempt, guilt, interest, shame.
Emotions are communicated non-verbally by
different parts of the body, face(eyes), gestures,
posture, tone of voice and general appearance.

6. Affect and Mood
Affect is the wave of emotion in which there is
sudden exacerbation of emotion as a response to
some event.
It is a short-lived emotion and it fluctuates.
Mood is pervasive and sustained feeling tone that is
experienced internally and that in extreme markedly
influence virtually all aspects of person's behaviour
and percepts of the world.
It is frequently the reported emotional state.

7. Description of Affect
Parameters
Appropriateness
Intensity
Mobilty
Range
Reactivity
Abnormalities
Inappropriate,
Incongruent
Exaggerated, Blunt, Flat
Fixed, Labile
Restricted
Non-reactive, Nonresponsive

8. Disturbances of Affect
Blunted
Severe reduction in the intensity of emotional
expression
Fixed
Display of one particular emotion and absence
of range and mobility

9. Flat
Near absence of affective expression
Labile
Repeated, rapid and abrupt variability in
expression
Restricted
Mild to moderate reduction in emotional
expression

10. Classification of Emotional disorders
Abornomalities of basic emotions
Intensity of emotions, including diminution and
exacerbation
Duration, time and quality of experience, including
lability of mood, pathalogical crying and laughing,
parathymia and paramimia
Expression of emotion, including blunting and
flattening of affect
Appropriatness to object, including phobia

11. Abnormality of physiological arousal
Alexithymia
Abnormalities of evaluation of social context
Negative cognitive schemas
Prosopoaffective agnosia
Receptive vocal dysprosody

12. Anhedonia
Introduced by Ribot.
Refers to a loss of capacity to experience joy or
pleasure.
Prominant symptom of depressive illness.
Best clinical marker, predicts the response to
treatment.

13. Diminution of intensity:
It's experienced as loss of feeling, affecting
emotions including sadness, joy, anger, fear etc.,
Patient suffers greatly, feels guilty about this
feeling. It's a subjective experience rather than
objectively observed absence.
Occurs in depressive psychosis, occassionally with
personality disorders, schizophrenia.
Depersonalisation

14. Exacerbations of emotions
Intensification of sadness or joy
In sadness, this may present as feelings of sadness
and gloom, despondency, despair or hopelessnes.
Depression
Refers to an emotional state characterised by grief
or mild periods of sadness or being “down”
It also refers to a clinical condition characterised
by depressed mood.

15. Depressed mood states are present in simple
unhappiness, grief or breavement and mood
disorders.
Intensification of joy or pleasure
Euphoria
State of excessive unreasonable cheerfulness
Intense elation often associated with feelings of
grandeur
When euphoria goes beyond the range of normal
experience and becomes a psychiatric problem,
mania or hypomania is present
Bipolar, cyclothymic, schizoeffective disorders

16. Changes in timing, duration, quality of experience
Pathological grief, it can be delayed or prolonged
Lack of persistance in expression of emotions
leading to inappropriateness to social context.
Often a sign of brain damage.
Pathological laughter or crying – an unprovoked
emotion that does not have an apparent object.
Gelastic epilepsy, Acquired brain injury, focal brain
injury

17. Parathymia – patients react to sad news with
cheerfulness or laughter become sad by events to
which normal people will react with pleasure.
Paramimia – lack of unity between the various
modes of expression of emotion.
Both seen in schizophrenics

18. Abnormalities of Expression and Appropriateness to
Object
Blunting – unchanging facial expression, decreased
spontaneous movements, poverty of expressive
gestures, poor eye contact, affective
unresponsivity, lack of vocal inflection.
Flattening – Limition of usual range of emotions,
expressed by face and bodily gestures.
Both occur in schizophrenia

19. Abnormality of experience and Physiological
activity
Alexithymia
A specific disturbance in psychic functioning
characterised by difficulties in the capacity to
verbalise affect and elaborate fantasies.
Difficulty in identifying feelings, externally
oriented thinking, difficulty expressing feeling,
reduced day dreaming or fantasizing.

20. Abnormalities of Evaluation
Cognitive schemas – assumptions about self, the
world, the future that developed from previous
experiences.
These cognitive errors could induce mood change
either directly or disrupting self esteem leading to
intiation or maintainance of depression.

21. Abnormalities of Evaluation
Prosopoaffective agnosia – selective deficiency
inappreciating the emotional expression displayed
in faces of others
Acquired brain disease, fronto temporal dementia.
Receptive vocal dysprosody-selective deficit in
recognising the emotional tone in speech. seen in
parkinson's disease.

22. Anxiety
It is an unpleasant affect state with the expectation
but not the certainity of something untoward
happening.
Morbid anxiety is accompanied by one or more
somatic & autonomic symptoms.
Palpitations
Difficulty in breathing
Dry mouth
Nausea
Dizzines
Muscular tension
Sweating
Abdominal churning
Tremors
Coldskin

23. Generalized anxiety.
Free floating autonomic anxiety
Panic attacks
Observation during interview.
Situational anxiety
Specific phobias

24. Panic attacks and disorder
These occur as discrete episodes of somatic or
autonomic anxiety associated with marked psychic
anxiety as an extreme sense of fear.
Attack ends when there is complete interruption to
the person's current stream of behaviour.
Duration varies from less than a minute to several
hours, normally about 10 to 20 mins.
Can occur many times in a day but not frequently.

25. Panic disorder is also called episodic paroxysmal
anxiety; recurrent severe attacks of anxiety occur
often unpredictably.
Onset is sudden, associated with symtoms.
Panic disorder is established as a separate diagnostic
category in ICD.

26. Phobia
Phobias are unreasonable fears restricted to a
specific object, situation or idea and results in
avoidance of the same.
Benjamin Rush defined it as “a fear of an imaginary
evil, undue fear of real one”
Criteria for phobia
Fear out of proportion to demands of
situation
Cannot be reasoned
Not under voluntary control
Leads to avoidance of situations

27. Subdivisions of phobic neurosis
Phobias of external stilmuli
Agoraphobia
Social phobias
Animal Phobias
Phobias of internal stimuli
Illness phobias
Obsessive phobias
Miscellaneous specific phobias

28. Examples
Agoraphobia(fear of leaving home, of being alone at
home or on the streets, in crowds, of travelling by
car or train)
Social phobia(fear of performing – speaking,
writing, eating in public or in the presence of others)
Simple phobia - describes a single but life disrupting
fear.

29. Irritability(Snaith & Taylor)
It is a feeling state characterised by reduced control
over temper, which results in irascible verbal or
behavioural outbursts.
It may be observed by others or experienced
subjectively directed towards other people or to self.
When expressed outwardly, it is considerd as an
independent mood disorder.

30. Seen in both sexes, its severity has an inverse
correlation with age.
Associated with depression and anxiety, also seen in
Post traumatic stress disorder.

31. Obsession
Obsessions are recurrent, persistent thoughts,
impulses or images that enter the mind despite the
persons efforts to exclude them.
Essential features:
A feeling of subjective compulsion
Resistance to it
Preservation of insight
They are recognised by the person as his own and
not implanted from elsewhere.

32. The person usually functions satisfactorily in other
areas of life, but as they become more severe, there
is an increasing social incapacity and misery that
can disrupt his life style.
Obsessions may occur as thoughts, images,
impulses, ruminations or fears.
Compulsions are repetitive and seemingly
purposeful behaviours, performed in a stereotyped
way.

33. Usually associated with an obsession as if it has the
function of redusing the distress caused by the latter.
D/D :
Delusions
Voluntary repititive acts

34. Thank You
Dr. Shirisha