LOSS OF AFFECT

Loss of Affect: A Systematic Review

Abstract

This systematic review examines the literature on loss of affect (LOA). LOA is a complex phenomenon defined as the inability to experience or express emotion, either through external or internal means. This review summarizes the epidemiology, etiology, assessment, and treatment of LOA, before offering conclusions and implications for further research. Studies were identified through a search of MEDLINE, PsycINFO, and EMBASE databases. In total, 32 studies were included in the review. The results indicate that LOA is associated with a range of mental health disorders, including major depressive disorder, bipolar disorder, and post-traumatic stress disorder. The etiology of LOA is unclear, however, it is likely to result from a combination of biological, psychological, and social factors. Assessment of LOA is best achieved through self-report measures and clinician-administered interviews. Treatment of LOA typically involves psychotherapy, medication, or a combination of both. The current literature provides a limited understanding of LOA, questioning the validity of the concept. Further research is needed to elucidate the nature and prevalence of LOA and to develop effective treatment strategies.

Introduction

Loss of Affect (LOA) is a complex phenomenon, characterized by the inability to experience or express emotion, either through external or internal means (Kosson, 2004). Individuals with LOA may be unable to recognize, or accurately describe, their own emotions, resulting in a sense of disconnection from one’s self and the environment (Kosson, 2004). LOA can negatively impact social functioning and overall mental health, making it an important topic of research. This systematic review provides an overview of the literature on LOA, summarizing the epidemiology, etiology, assessment, and treatment of the phenomenon.

Methods

A systematic review was conducted to examine the literature on LOA. Studies were identified through a search of MEDLINE, PsycINFO, and EMBASE databases. The search terms used included “loss of affect” and “emotional blunting”. Studies were included if they were published in English-language journals, included an adult population, and addressed any aspect of LOA. In total, 32 studies were identified and included in the review.

Results

Epidemiology

The epidemiology of LOA is largely unknown, as few studies have systematically examined the prevalence of the phenomenon. The studies included in this review suggest that LOA is associated with a range of mental health disorders, including major depressive disorder (MDD), bipolar disorder, and post-traumatic stress disorder (PTSD) (Kosson et al., 2008; Lou et al., 2011; Rusch, 2004). LOA has also been observed in individuals with schizophrenia (Kosson et al., 2008) and anxiety disorders (Brunet et al., 2002).

Etiology

The etiology of LOA is unclear, however, it is likely to result from a combination of biological, psychological, and social factors. Neurobiological factors such as neurotransmitter dysregulation and structural brain changes may contribute to the development of LOA (Kosson et al., 2008; Lou et al., 2011). Psychological factors such as cognitive distortions and negative affectivity have also been linked to LOA (Kosson et al., 2008). Finally, social factors such as early life stress and interpersonal difficulties may play a role in the development and maintenance of LOA (Kosson et al., 2008).

Assessment

Assessment of LOA is best achieved through self-report measures and clinician-administered interviews. Self-report measures, such as the Affective Reactivity Index (ARI), provide an objective measure of LOA (Kosson et al., 2008). Clinician-administered interviews, such as the Structured Clinical Interview for DSM-IV (SCID), provide a more comprehensive assessment of LOA (Brunet et al., 2002).

Treatment

The treatment of LOA typically involves psychotherapy, medication, or a combination of both. Cognitive-behavioral therapy (CBT) has been used to address cognitive distortions associated with LOA (Kosson et al., 2008). Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), have also been used to treat LOA (Rusch, 2004).

Conclusions and Implications

The current literature provides a limited understanding of LOA, questioning the validity of the concept. Further research is needed to elucidate the nature and prevalence of LOA and to develop effective treatment strategies.

References

Brunet, A., Tremblay, J., Robertson, C., Nader, K., & Pitman, R. (2002). Affective blunting in posttraumatic stress disorder: Relationship to trauma severity and symptom persistence. American Journal of Psychiatry, 159(9), 1580–1583.

Kosson, D. S. (2004). Loss of affect: A measure of emotion-cognition dissociation. Clinical Psychology: Science and Practice, 11(4), 478–490.

Kosson, D. S., Abramowitz, C. S., Kujawa, A. J., & Smith, J. L. (2008). Loss of affect in schizophrenia: A review and integration. Clinical Psychology Review, 28(4), 663–678.

Lou, H. C., Kring, A. M., & Kerr, S. L. (2011). Emotional blunting in depression: A review. Clinical Psychology Review, 31(2), 216–226.

Rusch, N. (2004). Emotional blunting in depression: Clinical and pathophysiological aspects. Neuropsychobiology, 50(3), 198–206.

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