943943 ANP ANZJP ReflectionsANZJP Reflections
Reflections
Getting emotional about affect
and mood
Cornelia Kaufmann1,2, Neelya Agalawatta2,3,
Erica Bell2,4,5 and Gin S Malhi2,4,5
According to Robert C Solomon, an
American professor of philosophy,
emotions are the ‘meaning of life’
(Solomon, 1993). They are the driving
force behind all our goal-directed activ-
ities and they are a key ingredient in the
factors that determine our judgement
and preferences for specific choices.
Arguably, our autonomy and emotional
existence are key to providing our lives
a sense of meaning. Solomon goes on
to say that we do not experience a
neutral, objective reality but live in ‘sur-
reality’ of purpose, value and signifi-
cance (Ratcliffe, 2009).
In psychiatry, there is a need to
measure and describe emotional
states and to do this in a manner that
is universally understood both for
reliable and valid communication, but
also to further research. Psychiatrists,
when referring to feelings and emo-
tions, often use the terms ‘mood’ and
‘affect’, sometimes interchangeably.
This is particularly confusing because,
in the psychological realm, affect is
used to mean emotion. The ambigu-
ous use of these descriptors is clini-
cally unhelpful and can lead to
misdiagnosis and thus should be
avoided (Malhi and Bell, 2019).
DSM describes mood as a pervasive
and sustained emotion that colours an
individual’s perception of the world. It
is an internal emotional state that can-
not be accurately or fully inferred by a
clinician from observation alone, and
instead it requires the patient to ver-
balise their feelings. In the sphere of
emotion, it can be thought of as the
emotional ‘climate’ of the brain. In
contrast, an individual’s affect is less
consistent and more changeable and
Australian & New Zealand Journal of Psychiatry, 54(8)
can be regarded analogously as the
emotional equivalent of the ‘weather’.
Even though mood tends to be a
more sustained feeling state which
does not change as quickly as affect, it
is readily impacted by life circum-
stances and individual temperament
and disposition. Mood is also suscep-
tible to reporting bias by the patient.
Solomon (1993) has suggested that
mood should be assessed in the con-
text of the patient’s entire history, as
emotions are holistically linked and
every emotion “presupposes the
entire body of previous emotional
judgements to supply its context and
its history” (p. 137). While thorough
and comprehensive, this broad per-
spective is somewhat impractical for
everyday psychiatric practice.
Changes in mood need to be care-
fully traced and the pertinent ques-
tion is what is ‘unusual’ for a person,
meaning, does it deviate from their
baseline. For a person with a sunny
disposition, having depressive symp-
toms deviates significantly from what
is ‘normal’ for this particular person.
Someone with a negative and gloomy
outlook on life might remain unno-
ticed or, conversely, might attract a
diagnosis of depression when none is
warranted. Thus, careful questioning
about the timeline of mood changes is
necessary in order to identify change
in relation to a baseline.
In contrast to mood, affect is a
state that changes within seconds and
minutes and the observant clinician
can get a glimpse of this external
expression of a person’s internal
emotional state. It can serve as a guide
to the underlying mood state of the
Australian & New Zealand Journal of Psychiatry
2020, Vol. 54(8) 850­–852
https://doi.org/10.1177/0004867420943943
DOI: 10.1177/0004867420943943
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person. Affect is by definition observ-
able, versus mood which needs to be
reported by the patient.
Formally, affect is described in
terms of its range, reactivity, variabil-
ity, intensity and the degree to which
it is in keeping with a person’s
expressed thoughts and topics of con-
versation (appropriateness). This is
sometimes referred to as its congru-
ence with mood. The assessment of
affect also involves gauging the per-
son’s tone of voice, prosody, intona-
tion and non-verbal affective
expressions like facial expressions,
gesticulation, posture and overall
demeanour. The range of affect can
be described as normal, meaning the
individual displays the emotional
nuances expected. Affect can be fur-
ther described as restricted (con-
stricted), blunted or flat. Restricted
affect is a clear reduction, whereas
1
 orthside Group St Leonards Clinic, Ramsay
N
Health Care, St Leonards, NSW, Australia
2
Department of Psychiatry, Northern Clinical
School, Faculty of Medicine and Health, The
University of Sydney, Sydney, NSW, Australia
3
Mental Health Service, Hornsby Ku-ring-gai
Hospital, Hornsby, NSW, Australia
4
Academic Department of Psychiatry,
Northern Sydney Local Health District, St
Leonards, NSW, Australia
5
CADE Clinic, Department of Psychiatry,
Royal North Shore Hospital, Northern
Sydney Local Health District, St Leonards,
NSW, Australia
Corresponding author:
Cornelia Kaufmann, Northside Group St
Leonards Clinic, Ramsay Health Care, Level
3 Consulting Suites, Northside Group St
Leonards, 2 Frederick Street, St Leonards,
NSW 2065, Australia.
Email: KauffmanC@ramsayhealth.com.au
ANZJP Reflections
Table 1. Basic definitions of affect and mood.
Term
Affect
Restricted affect
Blunted affect
Flat affect
Labile affect
Mood
Euthymia
Dysphoria
Expansive mood
Irritable mood
Labile mood
Elevated mood
Depressed mood
Affect should not be confused with affectivity and affect as used in the psychological literature
where it refers to the total or whole emotional life of an individual. Expansive mood can also
refer to a mood that is characterised by unrestrained emotional expression.
blunted affect represents a severe
reduction in the intensity of affective
expression (although the two are
often used interchangeably), while flat
affect is a complete lack of affective
expressions. For example, the voice
may be monotonous and the face
immobile. Conversely, affect is
described as labile when several rapid
and abrupt shifts are observed, for
example, switching from laughing to
anger or being tearful. Affect may also
reflect a particular mood disorder
subtype, for example, a labile affect
may indicate a mixed affective episode
of bipolar disorder and a flat affect
may suggest melancholia, while a
blunted affect could be a sign of an
underlying psychotic process. Affect is
further described as incongruent
when it is clearly discordant with the
topic of conversation (Table 1).
An important influence on both
mood and affect is temperament,
which is probably determined largely
by genetic factors, as it is an enduring
trait that remains fairly consistent
Definition
A clear reduction in affective response
A severe reduction in affective response
A lack of any affective expression
Rapid and dramatic shifts in affect
A mood neither elevated nor depressed
Mood is consistently low
Emotional expression unaffected by others’
reactions
Prolonged state of negative and increased
reactivity
Marked fluctuation of mood
Increased feeling of success, confidence and
well-being
Mood which is negative and unhappy beyond
reason
throughout adulthood. In contrast,
mood is a state and not an enduring
trait per se. Temperament includes
behavioural traits such as extrover-
sion or introversion, emotionality
(self-regulating or reactive), activity
level, attention level and persistence
(determined or easily discouraged)
(Rettew and McKee, 2005). The her-
itability of temperament is compli-
cated, and there does not appear to
be a clear pattern as there are no
specific genes that confer particular
temperamental traits. It is postulated
that the combination of many com-
mon gene variations influences indi-
vidual characteristics of temperament.
Environmental factors also play a
role, in that they influence gene activ-
ity. Children raised in an adverse
environment may have more impul-
sive characteristics due to activation
of certain genes responsible for such
behaviours, while children raised in a
positive environment may have a
calmer disposition because a different
set of genes have been activated.
Australian & New Zealand Journal of Psychiatry, 54(8)
851
In practice, patients being assessed
by a psychiatrist at a particular moment
in time experience their emotions as a
combination of their temperament,
mood and affect all occurring at once.
In other words, their experience of
all three components is concurrent,
and in the same moment. (Figure 1)
It is up to the psychiatrist to sepa-
rate the different aspects, and for
this, a careful history is necessary to
determine normative traits and
states; specifically, what is ‘normal’
for this person and what is abnor-
mal or out of character and at vari-
ance with respect to their past
experience.
For the patient, the delineation of
these aspects might not be seen as
important at the moment of presenta-
tion. However, the individual’s
response to the development of a
mood disorder and their engagement
in the treatment phase can be influ-
enced by a person’s temperament and
thus can have a bearing on their recov-
ery. For instance, a study by Bahrini
et al. (2016) examined the effect of
temperament on treatment adherence
and found it to be poor in patients
with depressive and irritable tempera-
ments. These patients required more
education concerning the necessity of
medication. In addition, patients with
cyclothymic, irritable and anxious
temperaments were more sensitive to
the negative side effects of psycho-
tropic medication and also required
more instruction regarding their medi-
cations. Therefore, consideration of a
patient’s temperament can inform the
clinician in anticipating barriers to
treatment, and gaining as much infor-
mation as possible and supporting the
patient’s pathway to recovery can be
aided by attention to the careful delin-
eation of temperamental traits from
more changeable mental states of
mood and affect.
In summary, there are three layers
in the emotional mental state exami-
nation of a patient: the immediate
and observable affect, the patient’s
description of their mood and the
852 ANZJP Reflections

Health, NSW Health, American Foundation

Figure 1. Three components that contribute to emotional mental state. for Suicide Prevention, Ramsay Research
and Teaching Fund, Elsevier, AstraZeneca,
Janssen-Cilag, Lundbeck, Otsuka and Servier,
and has been a consultant for AstraZeneca,
Janssen-Cilag, Lundbeck, Otsuka and Servier.
The authors N.A., C.K. and E.B. declared no
potential conflicts of interest with respect
to the research, authorship and/or publica-
tion of this article.

Funding
The author(s) received no financial sup-
port for the research, authorship and/or
publication of this article.

ORCID iDs
Erica Bell https://orcid.org/0000-0002-
8483-8497
Gin S Malhi https://orcid.org/0000-
0002-4524-9091
Temperament (green): this remains relatively stable over years and decades. Mood (red): usually
changes within hours and days. Affect (orange): often changes within seconds and minutes. The
blue column represents the concurrent experience of all three components, which an individual
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Australian & New Zealand Journal of Psychiatry, 54(8)