Abstract
Blunted affect, also referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions. The work of Abrams and Taylor and their development of the Rating Scale for Emotional Blunting in the late 1970’s was an early indicator that blunted affect could indeed be assessed reliably. Since then, several new instruments assessing negative symptoms with subscales measuring blunted affect have been developed. In light of this, we aim to provide researchers and clinicians with a systematic review of the different instruments used to assess blunted affect by providing a comparison of the type, characteristics, administration and psychometric properties of these instruments. Studies reporting on the psychometric properties of instruments assessing blunted affect in patients with schizophrenia were included. Reviews and case studies were excluded. We reviewed 30 full-text articles and included 15 articles and 10 instruments in this systematic review. On average the instruments take 15–30 minutes to administer. We found that blunted affect items common across all instruments assess: gestures, facial expressions and vocal expressions. The CAINS Self-report Expression Subscale, had a low internal consistency score. This suggests that this sub-scale does not reliably assess patients’ self-reported blunted affect symptoms and is likely due to the nature of blunted affect. Instruments correlated minimally with instruments measuring positive symptoms and more importantly with depression suggesting that the instruments distinguish between seemingly similar symptoms.
Highlights
Blunted affect, referred to as emotional blunting, is a prominent symptom of schizophrenia
We report on the selected items according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (S1 PRISMA Checklist)
We reviewed 30 full-text articles and excluded 15 due to the following reasons: studies did not investigate the instrument’s divergent or convergent validity (n = 13); and articles reported on instruments in their developmental phase (n = 2)
Summary
Referred to as emotional blunting, is a prominent symptom of schizophrenia. Patients with blunted affect have difficulty in expressing their emotions [1], characterized by diminished facial expression, expressive gestures and vocal expressions in reaction to emotion provoking stimuli [1,2,3]. Patients’ reduced outward emotional expression may not mirror subjective internal emotional experiences [4] suggesting a disconnect in what. Measuring Blunted Affect in Schizophrenia educational meetings. The authors would like to note that even though two of the authors (RE and BC) have conflict of interests this does not alter the authors' adherence to PLOS ONE policies on sharing data and materials
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