Disorders of Emotions

DISORDERS OF EMOTIONS
Ms. Hemangi Narvekar, Clinical Psychologist
National Institute for Empowerment of Persons with Multiple Disabilities (NIEPMD), Chennai

Contents
 Introduction
 Emotions
 Physiology of Emotion
 Theories of Emotion
 Basic Emotions
 Factors Affecting Emotions
 Classification of Disorders of Emotion
 Disorders of Emotions
 Diagnosis & Assessments
 Treatment & Interventions
 Summary
 References

Introduction
 In everyday language, the terms affect, emotions, and feelings are often used
interchangeably.
 In the scientific literature, emotions are described as coordinated sets of responses to internal
or external events which have a particular significance for the organism (e.g., Lazarus, 1993 ).
 The subjective experience of an emotion is often called a feeling.
 Mood is a pervasive and sustained emotion that colours the person’s perception of the world.
 Affect, meaning short-lived emotion, is defined as the patient’s present emotional
responsiveness. It is what the doctor infers from the patient’s body language including facial
expression and it may or may not be congruent with mood.

Emotions
 Schelling (1960), Frank (1988) and others view emotions as important because they are
involuntary and difficult to fake; they advertise our inner states.
 Emotions are communicated non-verbally by different parts of the body. For e.g. face, gesture,
posture, tone of voice and general appearance.
 Different emotions have different specific functions:
Fear motivates escape from danger;
anger motivates attack;
joy motivates continuing on the present course or,
interest motivates exploration.
 Thus, ‘emotional’ behaviour can be highly adaptive for an animal.

Physiology of Emotion
 Biological Basis of Emotions
Right Cerebral Hemisphere plays important role in emotional functions.
Right Hemisphere is specialized for processing emotional information.
Activation of the left cerebral hemisphere is associated with positive affect.
Activation of the right cerebral hemisphere is associated with negative affect.
Activation of anterior portion of both hemisphere is associated with valence
(pleasantness/unpleasantness) of emotion.
Activation of the posterior portion of both hemisphere is associated with arousal – the intensity of
emotion.
In the human brain, emotions are housed in the limbic system surrounding the brainstem.
Within the limbic system, emotional impulses originate in the amygdala that triggers the
physiological reactions associated with emotions.
The amygdala is also responsible for imprinting emotions onto memories by releasing some of the
same neurochemicals when an event is recalled as when it occurred.

Physiology of Emotion
 Role of Nervous System
All the emotional experiences and their expressions are controlled and regulated by the
autonomic or visceral nervous system.
Parasympathetic
Nervous System
(Calming)
Sympathetic
Nervous System
(Arousing)
ANS
(Self-Regulatory)

Theories of Emotion
 James-Lange Theory of Emotion
Emotions are the result of self-awareness of physical and
bodily changes in the presence of a stimulus.
 Cannon-Bard Theory of Emotion
Felt emotion and bodily changes occur in parallel with each
other and result from activity in certain brain areas.
 Schachter and Singer’s Two-factor Theory of Emotion
Two factors: Physiological arousal and cognition
Emotion is a result of the individual’s appraising the context of a
situation.
 Lazarus’s Appraisal Theory
Emotions are extracted from our “appraisals’’
(i.e. our evaluations, interpretations and explanations) of events.

Basic Emotions
 Some theories postulate just two basic states—positive and negative; others postulate a small set of “basic”
emotions; and still others argue for a potentially infinite number.
 All theorists agree, however, that valence is a necessary quality of emotions: Emotions are about pleasure and
pain, approach and avoidance (Barrett, 2006b; Ekman, 1992b; Rolls, 2005).
 J. B. Watson proposed 3 Basic Emotions:
Anger, Love and Fear
 Ekman and Colleagues (1971)
Proposed 6 basic emotions
These can be combined to yield more complex emotions like
Sadness + Surprise = Disappointment

Basic Emotions
 Robert Plutchik (1984) identified eight
fundamental emotions.
 They are; joy, anger, sadness,
surprise, fear, acceptance, disgust
and anticipation.
 He named it as Plutchik's emotional
wheel.

Factors Affecting Emotions
Gender
Genetics
Personality
Cognition
Memory
External Stimuli
Health
Circadian Rhythm
Meditation

Classification of Disorders of Emotion
 There is no consensus on how to classify disorders of emotion.
 Cutting (1997) provided a framework wherein he classified emotional disorders based on
intensity, duration, timing, quality of experience, expression and appropriateness to the object
or social setting.
 Fish’s Clinical Psychopathology describes 5 levels of emotional reactions and expression that
have clinical relevance. Those are
1. Normal Emotional Reactions
2. Abnormal Emotional Reactions
3. Abnormal Expressions of Emotion
4. Morbid Disorders of Emotional Expression
5. Morbid Disorders of Emotion

Normal Emotional Reactions
 The term normal emotional reactions is used to describe emotional states that are the result
of events and that lie within cultural and social norms.
 Normal emotional reactions are normal responses to events or to primary morbid
psychological experiences.
 E.g. The grief reaction that follows the death of a loved one or the response of a previously
healthy person to a life-threatening diagnosis.
 E.g. The understandable distress that many patients exhibit when they experience
hallucinations or other psychotic symptoms.
 There has been little attempt to distinguish these understandable and non-morbid reactions
from those that are abnormal.
 One problem is that many of the symptoms complained of are present both in the normal
responses and in those that are abnormal.
 A further aspect of the distinction that has not been examined is functional incapacity, which
is present in abnormal states but absent or brief in the normal reactions.

Abnormal Emotional Reactions
 Abnormal emotional reactions are those that are understandable in the context of stressful
events but are associated with more prolonged impairment in functioning.
 A clear representation of the distinction between normal and abnormal emotional states is
illustrated by the Yerkes−Dodson curve (1908), which shows that up to a certain level of stress
there is no impairment but beyond a certain point functioning deteriorates.
 The point at which this happens is determined by individual attributes such as genetic and
personality predisposition and by external factors including social support and the duration
and severity of stressors.
 Diagnostically, both the ICD-10 and DSM define these abnormal emotional reactions as
adjustment disorders with disturbance of mood (to include anxiety, depression, other
emotions or disturbance of conduct).

Abnormal Emotional Reactions
 Anxiety
An unpleasant affective state and fear for no adequate reason.
Sometimes is accompanied by physical symptoms such as palpitations,
sweating, difficulty breathing, dizziness, etc.
If the physical symptoms occur suddenly, and in combination, the result is
overwhelming fear, and the term panic attack is used.
Anxious foreboding - A sense that something terrible will happen but without
the knowledge of what this will be.
Anxious foreboding is present in several disorders such as generalized anxiety,
depressive illness and panic disorder.

Abnormal Emotional Expressions
 Phobia
When the fear is restricted to one object, situation or
idea, the term phobia is used.
Phobias are associated with physical symptoms of
anxiety and with avoidance.
Most fears are learned responses, such as the person
who develops a fear of dogs after being bitten.
Some phobias are secondary to morbid states, most
commonly depressive illness, and others, such as fear
of contamination, are regarded as obsessional
symptoms.

Abnormal Emotional Expressions
 Depressed Mood
Depressed mood is one of the commonly experienced abnormal reactions.
‘Depression’ term is used to describe the appropriate sadness that is
associated with bereavement, the low mood that comes from frustration and
the profound gloom that is part of severe depressive illness.
Depression can be also a symptom secondary to another morbid process, an
understandable reaction or an illness in itself.
Reactivity of mood is the term used to describe the fluctuations in mood that
occur in parallel with change to one’s environment.

Abnormal Expressions of Emotion
 Abnormal expressions of emotion refer to 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 as well as lack of emotional response may be the result of learning and of
different cultural norms.
 Dissociation of affect is said to be an unconscious defence reaction against anxiety. It is a lack of
manifestation of anxiety or fear under conditions where this would be expected.
 It may be described as a feeling of numbness.
 Dissociation of affect can be observed in depressed people as well as in depersonalization and
derealization.

Abnormal Expressions of Emotion
 The Dissociation of Effect covers a number of different forms of behavior:
Denial - A defence that may manifest as lack of emotion. This occurs when the person denies
awareness of an event even though such an event has clearly taken place.
Belle indifference - Gross symptoms and severe disabilities but is undisturbed by his suffering. This is
seen in conversion disorder.
 Dissociation of affect should not be applied to:
Apathy - Emotional indifference, often with a sense of futility.
It may manifest itself as a lack of motivation.
Perplexity - Tentative or bewildered, slightly puzzled state.

Morbid Expressions of Emotion
Morbid emotional expressions differ from abnormal expressions of emotion in that the person is unaware of the
abnormality even though it is apparent to observers.
 Parathymia
The term was given by Bleuler.
Insensitivity to the subtleties of social intercourse and is known as inadequacy or blunting of affect.
It manifests itself as social awkwardness and inappropriateness.
 Incongruity of Affect
Misdirection of emotions so that an indifferent event may produce a severe emotional outburst, while an event that
objectively seems to be emotionally charged has no effect on the patient’s emotional response.
 Stiffening of Affect
Emotional response is at first congruent but does not alter as the situation changes.

Morbid Expressions of Emotion
 Smiling Depression
Smiling with lips but not with eyes.
Unless the person is overwhelmed by their miseries they can produce this – a smile that may be trying to conceal sadness
or that may be trying to say ‘Don’t worry about me; I’m all right’.
 Compulsive (forced) Affect
The expression of emotion in the absence of any adequate cause.
 Lability of Affect
Rapid and abrupt changes in emotion largely unrelated to external stimuli. These shifts occur without warning.
This is common in Borderline Personality Disorder, Dysphoric Mania and Depression.
 Affective Incontinence
Complete loss of control over emotions.
This is particularly common in cerebral atherosclerosis and in multiple sclerosis, where spontaneous outbursts of laughter
or crying occur.

Morbid Disorders of Emotion
These can be regarded as pathological states that, although sometimes triggered by stressful events, do not
spontaneously resolve with removal of the stressor, and therefore have their own independent momentum. These also
include those states that arise without any precipitant.
 Depressive Illness
Those with depressive illness use terms such as ‘a weight’, ‘a cloud’ or ‘a darkness’ to attempt to capture the exact
emotional feeling.
The morbid sadness in this illness may be associated with morbid thinking that may reach delusional intensity.
Often there is inhibition of thinking, loss of drive and decreased voluntary activity.
The physical and/or psychological slowing that occurs is known as psychomotor retardation.
There may be difficulty making decisions due either to poor concentration or to obsessional doubting, secondary to
the mood state.

 Anhedonia (Ribot,1986)
Loss of the capacity to experience joy and pleasure.
An inability to enjoy anything in life or even get pleasure from everyday occurrences.
For example being hugged by one’s children, a fine spring morning, etc., are prominent.
Prominent symptom of depressive illness.
 Vital Hypochondriacal Depression (Schneider)
Here patient feels a tight band around his head and there may be a sense of oppression in the chest
associated with anxiety.
 Somatisation
There is misattribution of symptoms as due to physical illness rather than having a psychiatric cause.

 Morbid depression
This also abolishes the normal reactive changes of emotion or emotional resonance.
This leads to a sense of inner emptiness or deadness, so the patient does not feel they are participating
in the world any more.
This loss of feeling for the environment gives the person with depression the impression of unreality.
This loss of emotional resonance gives rise to complaints of depersonalisation and derealisation in
morbid depression but is obviously not at all the same.
If depression is severe and psychomotor retardation is marked, depressive stupor may occur.
The apparent indifference of the person with severe depression must be differentiated from the apathy
and lack of concern of the person with schizophrenia.
Apart from depressive illness and bipolar disorder, morbid depression is also found in schizophrenia
and in acute and chronic organic states.

 Morbid Anxiety
Morbid anxiety frequently occurs in association with morbid depression and can cause difficulties in
diagnosing depression.
In severe form it can present a picture of agitation.
Morbid anxiety is also found in organic states and may sometimes be secondary to terrifying visual
hallucinations.
Acute and chronic brain disease, when mild, can produce anxiety mixed with depression and irritability. This
was previously called ‘organic neurasthenia’.
Anxiety and fear are often present in psychotic states such as paranoid schizophrenia but this may not be
morbid but rather a natural reaction to delusions and hallucinations.

 Irritability
Irritability may be seen in depressive illness and schizophrenia.
In mania or hypomania the patient is often cheerful and elated but there is frequently significant
irritability also.
Irritability is also prominent in mixed states in which the patient is both depressed and
manic/hypomanic simultaneously (known as dysphoric mania).
 Apathy
Extreme apathy may be a feature of severe depression, schizophrenia or damage to the frontal
lobe.

 Morbid Euphoria and Elation
Morbid euphoria and elation classically occur in mania and hypomania but can also be seen in organic states and in schizophrenia, especially the
hebephrenic subtype, where the patient presents as silly and annoying.
In mania and hypomania the elation is not related to any specific event and is not modified by depressing influences.
In both there is an increased pressure of speech with prolixity, and flight of ideas or a subjective awareness of racing thoughts.
Superficial bustling activity, disinhibition, distractibility, sometimes hypersexuality and a tendency to be argumentative if thwarted are also present.
Many projects may be initiated but none completed.
Lesions of the hypothalamus may produce a clinical picture resembling mania with flight of ideas.
Euphoria also occurs in multiple sclerosis, when it is associated with a sense of well-being and is linked to the degree of organic brain change
(Benedict et al, 2004).
Euphoria and a passive attitude may also feature in the amnestic syndrome and in lesions of the frontal lobe
Frontal lobe damage with euphoria, often presenting as silliness, lack of foresight and indifference, is known as moria or Witzelsucht.

 Ecstacy
A sense of extreme well-being associated with a feeling of rapture, bliss and grace.
It can occur in the healthy population at times of profound religious experience or occasions of deep
emotion such as following childbirth.
Unlike elation, it is not associated with overactivity or flight of ideas.
The mind is usually occupied with a feeling of communion with God or some religious figure.
Sometimes it may be associated with grandiose delusions.
Ecstatic states may occur in schizophrenia, in those who misuse lysergic acid diethylamide, in epilepsy and
in mass hysteria associated with religious services.

Disorders of Emotions
 The term ‘Disorders of Emotions’ is not a fully accurate medical term, but is commonly used
in ordinary context to refer to those psychological disorders that appear to affect the
emotions (e.g. anxiety disorders or depressive disorders).
 Although emotions play a role in most types of psychopathology, Bipolar Disorders, Anxiety
Disorders, Personality Disorders, Schizophrenia are some of the known emotional disorders
because emotional disturbances are salient features in each of these conditions and there is a
fairly well-characterized body of theory and empirical research supporting the role of
emotional disturbances in these disorders.

Disorders of Emotions
 Bipolar and related disorders has symptoms that include an alternating
pattern of emotional highs and emotional lows or depression.
 The common feature of all of these disorders is the presence of sad,
empty, or irritable mood, accompanied by somatic and cognitive
changes that significantly affect the individual's capacity to function.
Bipolar & Related Disorders
Bipolar I
Bipolar II
Cyclothymic Disorder
Depressive Disorders
Disruptive mood
dysregulation disorder
Major depressive disorder
Persistent depressive disorder
(dysthymia)
 The anxiety disorders are a heterogenous group of
disorders that typically involve a number of negative
emotions, the most prominent being anxiety, fear, and
disgust.
ANXIETYDISORDERS
Selective Mutism
Specific Phobias
Social Anxiety Disorder
Panic Disorder
Agoraphobia
Generalized Anxiety Disorder

Diagnosis & Assessments
 Formal diagnosis of an emotional disorder requires that a clinician decide whether or not the
person meets the criteria for the disorder as described in classification systems.
 During the diagnostic process, the clinician typically observes and interacts with the client,
and considers reports from adults who know the client well.
 Signs or symptoms such as angry outbursts, irritability, sadness, shyness, or fearfulness are
key features of certain emotional disorders; however, they are also normal behaviors under
certain circumstances or at certain stages of development.
 In reaching diagnoses, clinicians are thus often required to make subtle distinctions, based on
their assessment of the intensity and/or developmental appropriateness of behavior.
 Cultural factors can also impact the expression and interpretation of signs and symptoms
(Westermeyer and Janca 1997).

Diagnosis & Assessments
 Emotional responses have at least three components:
 All can be measured in humans.
 Self-report techniques can be used to assess subjective feelings; observational and other physiological equipments can
assess behavioural and physiological measures.
 However, subjective experience generally cannot.
 Disorder-specific scales are available to better characterize the severity of each disorder and to capture change in
severity over time. For e.g. Beck Depression Inventory, Bipolar Spectrum Diagnostic Scale, Fear Questionaire, Hamilton
Anxiety Rating Scale, Mood Disorder Questionaire, Rating Scale for Mania, etc.
SUBJECTIVE
(e.g. the feeling of fear)
BEHAVIOURAL
(e.g. facial expression,
immobility, avoidance
behaviour)
PHYSIOLOGICAL
(e.g. heart rate, blood pressure,
respiratory rate, EEG Patterns,
Hormone secretion and skin
conductance)

Treatment & Interventions
 An evolutionary view of the emotions does not encourage one kind of treatment above
others, but it does suggest a simple framework for considering what can be changed to
relieve an emotional disorder.
 Emotions arise from situations, the appraised meaning of which, influences brain mechanisms.
 Four things can change: the objective situation, the person’s motivational structure, the
perception of the situation, and the brain.
 Emotional disorders are, thus, typically treated with psychosocial interventions and
medications, alone or in combination.
 Because there are so many specific disorders within the broad category of emotional
disorders, there are also many different approaches to treatment.

Treatment & Interventions
 Although the exact treatment approach depends on the type of disorder, one or a combination of the
following therapies may be used for most disorders:
Psychoeducation
•It helps people better understand the conditions and increase awareness
about it.Counselling
Individual, Group and Family
Social Skills Training
•This can assist the individuals to adapt and fit into their social
environment.
Interpersonal Therapy
•The techniques in IT helps in identification of emotions, expression of
emotions and dealing with issues from the past.
Brain Stimulation Therapies
Electroconvulsive Therapy and other brain stimulation techniques such as Transcranial
Magnetic Stimulation (TMS), Vagus Nerve Stimulation (VNS), Deep Magnetic Stimulation
(DMS), etc helps in reducing some of the symptoms.
Medication
•Drugs that help reduce the symptoms of disorders include many
antidepressants, certain anticonvulsant medicines and low-dose
antipsychotics, and other anxiety-reducing drugs.
Cognitive-Behavioural Therapy
•This is a particular type of psychotherapy in which the person learns to
recognize and change thought patterns and behaviors that lead to
troublesome feelings.
Dietary and Lifestyle Changes
•Following a healthier lifestyle helps to reduce emotional disturbance as
well as to live longer.Relaxation Therapy
Methods such as progressive muscle relaxation (PMR), deep breathing techniques, imagery, and
self-hypnosis may help the individual to sequentially tense and relax the body's major muscle
groups while concentrating on contrasting sensations of tension and relaxation.
Meditation
It is an ideal tool to achieve serenity and balance between brain’s right and
left hemispheres.

Summary
 Emotions are integral part of our life for normal existence.
 Emotions are universal and this allows us to read other people’s emotions, empathize with them, and negotiate our
emotional lives together.
 The term emotional disorder is not a formal diagnosis, and thus there are no well-defined guidelines for its use.
 These kinds of disorders are characterized by feelings of intense internal and/or emotional distress that last for a
period of months or years.
 There are lots of valid and reliable assessment measures to diagnose the disorders as well as to facilitate research
on the same.
 Apart from these treatments, researchers are coming up with some new treatment models such as:
 Dialectical Behaviour Therapy which was found to be useful in altering emotion regulation and amygdala activity in
patients with BPD (Goodman, et.al.,2014).
 For normal people, the best ways to regulate emotions are reappraisals, distraction and venting out feelings.

References
Book References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual for Mental Disorders (5th ed.). Washington: APA.
Casey, P., & Kelly, B. (2007). Fish’s Clinical Psychopathology: Sign and symptoms in psychiatry (3rd ed. ). London: Gaskell.
Frank, R. H. (1988). Passions within reason: the strategic role of the emotions. Norton: New York.
Gabbard, G.O. (2014). Treatments of Psychiatric Disorders (5th ed.). USA: American Psychological Association.
Morgan, C. T., King, R.A., Weisz, J.R., & Schopler, J. (1986). Introduction to Psychology (7th ed.). New Delhi: Tata Mc Graw-Hill Publishing Company Limited.
Oyebode, F. (2011). Sim’s Symptoms in the Mind: An Introduction to Descriptive Psychopathology (4th ed.). Philadelphia: Saunders Elsevier.
Schelling, T. C. (1960). The strategy of conflict. Harvard University Press: Cambridge.
Journal References
Benedict, R. H., Carone, D. A. & Bakshi, R. (2004) Correlating brain atrophy with cognitive dysfunction, mood disturbances, and personality disorder in
multiple sclerosis. Journal of Neuroimaging, 14 (3), 36−45.
Kring, A.M., & Bachorowsky, J. (1999). Emotions and Psychopathology. Cognition and Emotion, 13(5), 575-599.
Lazarus, R. S. (1993). From psychological stress to emotions. Annual Review of Psychology, 44 ,1–21.
Nesse, R. (1998). Emotional disorders in evolutionary perspective. British Journal of Medical Psychology, 71, 397-415.
Nesse, R.M., Ellsworth, P.C. (2009). Evolution, Emotions and Emotional Disorders. American Psychological Association, 64(2), 129-139.
Westermeyer, J., & Janca, A. (1997). Language, culture and psychopathology: Conceptual and methodological issues. Transcultural Psychiatry, 34, 291-311.

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