Flattening Affect

7/26/2019 Flattening Affect

1/7

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/17758275

Flattening of affect and personal constructs

Article in The British Journal of Psychiatry February 1970

Impact Factor: 7.99 DOI: 10.1192/bjp.116.530.39 Source: PubMed

CITATIONS

8

READS

11

5 authors, including:

Frank Mcpherson

Crown Office and Procurator Fiscal Service, S

57PUBLICATIONS 376CITATIONS

SEE PROFILE

Available from: Frank Mcpherson

Retrieved on: 22 May 2016
https://www.researchgate.net/profile/Frank_Mcpherson?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_7https://www.researchgate.net/profile/Frank_Mcpherson?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_5https://www.researchgate.net/?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_1https://www.researchgate.net/profile/Frank_Mcpherson?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_7https://www.researchgate.net/profile/Frank_Mcpherson?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_5https://www.researchgate.net/profile/Frank_Mcpherson?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_4https://www.researchgate.net/?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_1https://www.researchgate.net/publication/17758275_Flattening_of_affect_and_personal_constructs?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_3https://www.researchgate.net/publication/17758275_Flattening_of_affect_and_personal_constructs?enrichId=rgreq-2d447347-9318-40f6-ad71-a73c778f8888&enrichSource=Y292ZXJQYWdlOzE3NzU4Mjc1O0FTOjI3MTA0MjQzODQ5NjI1NkAxNDQxNjMyOTYxNDAy&el=1_x_2


2/7

10.1192/bjp.116.530.39Access the most recent version at doi:

1970, 116:39-43.BJPF. M. MCPHERSON, VALERIE BARDEN, A. JOAN HAY, D. W. JOHNSTONE and A. W. KUSHNERFlattening of Affect and Personal Constructs

permissionsReprints/

[email protected] obtain reprints or permission to reproduce material from this paper, please write

to this article atYou can respond http://bjp.rcpsych.org/cgi/eletter-submit/116/530/39

fromDownloaded

The Royal College of PsychiatristsPublished byon July 31, 2011http://bjp.rcpsych.org/

http://bjp.rcpsych.org/site/subscriptions/go to:The British Journal of PsychiatryTo subscribe to
http://bjp.rcpsych.org/http://bjp.rcpsych.org/


3/7

Brit. 3 . Psychiat. 1970 , ii6, 3943

Flattening of Affect and Personal Constructs

By F. M . M cPH ERSON, VALERIE BARDEN, A. JOAN HAY, D. W . JOH NSTONE and

A. W . KUSHNER

Affective flattening is a disorder of em otional

expression, of which a good definition is a

gross lack of emotional response to the given

situation' (Fish, 1962). It is a clinical sign

whose assessment depends upon the clinician's

intepretation of the patient's facial expression,

tone of voice and content of talk (Harris

M etcalfe, 1956). Although these are subtle cues,

it has been shown that experienced clinicians

can assess the severity of affective flattening

with a high level of inter-rater agreement

(M iller et al., 1953; Harris M etcaife, 1956;

W ing, 1961; D ixon, 1968). The disorder is

usually associated with a diagnosis of schizo

phrenia, although it m ay occur in other

conditions, such as the organic psychoses

(B ullocketal., ig@ i).

There have been very few investigations of

a ff ec ti ve f la tt en in g H er ro n K an to r, 1 96 8) .

M ost authors have suggested that the disorder is

m erely one aspect of a m ore widespread deficit

such as intellectual slowness (Harris

M etcalfe, ig@ 6) or a generally reduced rate of

responding (Salzinger Portnoy, @ 64).

Recently, however, Dixon (i 968) has found

a m ore specific abnorm ality associated w ith

flattening of affect. She investigated the personal

construct system s (Kelly, 1955; Bannister,

1965; Bannister M air, 1968) of schizophrenic

patients with affective flattening. W hereas

m ost previous studies of the construct systems of

schizophrenics have been of the structure of

their system s e.g. the relationships am ong

constructs (Bannister, i96o, 1962; Bannister

Fransella, 1966), D ixon was concerned

w ith the content of their system s i.e. w ith the

types of constructs which they use w hen differ

entiating between or among other people. Her

method of eliciting constructs required the

subject (5) to give what he considered to be the

m ain differences between the people in pairs

of photographs. In a very carefully controlled

study of 37 schizophrenics, Dixon showed that

those with affective flattening, when construing

other people, m ade relatively little use of con

structs descriptive of personality charac

teristics or current em otional state, whereas

they used other types of construct as frequently

a s th e o th er s ub je cts.

The present study aim s to confirm D ixon's

findings. In schizophrenia research, because of

difficulties associated with the selection of

sam ples and with the reliability of diagnosis and

assessm ent, it is im portant for replication

studies to be conducted.

M ETHOD

Patients. i8 Ss were studied. Equal numbers of

male and female, and paranoid and non-paranoid

patients were selected randomly from am ong those

in two wards who satisfied the following criteria:

that they had had an unchanged diagnosis of schizo

phrenia for at least tw o years; that they w ere show ing

active, psychotic signs or sym ptom s (not necessarily

flattening of affect); and that they w ere aged 1760,

inclusive.

The selected sam ple had the following charac

teristics:

Age: mean 3I@2 years, S.D. 8@8 years, range

1862years.

L en gth o f illne ss: m ea n tim e fro m first a dm issio n

5@8years , S .D. 2@4yearS,range 215ears .

linic l ssessment

Raters: The rating of flattening was m ade by two

p sy ch iatrists, bo th o f w hom w ere ex perien ced in the

assessment of schizophrenic patients, and knew the

Ss w ell. They independently interview ed each S,

and rated the am ount of flattening show n. T he ratings

of each S were m ade within one day of each other.

Rating: The raters were instructed to use the term

affective flattening' as they norm ally did: it was

emphasized that it was a ffe ct'ath er th an mood',

and la tt ening'a th er th an n co ng ru ity ',hat was


4/7

F LA TT EN IN G O F A FFE CT A ND PE RSO NA L C ON ST RU CT S

to be rated. The assessment was recorded by the

rater placing a m ark at any point on a line go m m .

long and labelled N ola tte nin g a t o ne e nd a nd

Veryonsiderable f la tten ing a t the o the r .

Inter-rater agreement: Over the :8 Ss, the rank order

correlation coefficient (Kendall s tau) between the

two raters w as +0 .@ (p< @ OO5, one-tailed test).

Because of this high inter-rater agreem ent, in sub

sequ en t calc ulatio ns the m ean o f the tw o ratin gs w as

u se d a s th e c rite rio n o f t he a mo un t o f f la tte nin g sh ow n

by each S .

Analysis of constructs

Erperi m ental task: The procedure for eliciting

constructs was that used, and described in detail,

by D ixon (1968). The m aterial com prised five

pairs of photographs; each was of one or two adults

or children w ho w ere engaged in activities such as

carrying objects, fighting or reading. The people in

each pair were usually similar in age, sex and

apparent social and ethnic background, although

these factors varied considerably betw een pairs. S

w as instructed to give the m ain differences betw een

the people in each of the pairs; three m inutes w ere

allow ed per pair. The instructions w ere repeated

b efo re e ac h p air. T he re sp on se s w ere ta pe -re co rd ed

a nd tr an sc ri be d. T h e p sy ch olo gis t w h o a dm i ni ste re d

the procedure had no knowledge of the clinical

ratings. Testing took place within a day of the

clinical ratings being m ade.

Content analysis: From each S, a series of bi-polar

de sc rip tiv e te rm s c on stru cts h ad th us b ee n e lic i

ted. Analysis of the content of these gives som e

indication of the characteristics to w hich S had

attached greatest im portance when differentiating

among the people in the photographs. The use

m ade of each of the following i 2 categories of

c on st ru ct w a s a na ly se d:

Activ4y : constructs which differentiated be

tw een or am ong the people according to w hat

th ey w ere d oin g, e.g. heom an in th is p ho to

is carrying som ething, but the one in the other

phot oisnot

Stance :constructs which referred to the stance

or posture of the people, e.g. standingsitting ,

armsa is ed a rm s b y s id e .

Physique :hese described the physical charac

teristics or condition of the people, e.g. all

s ho rt , hungry-lookingwell-fed .

P er so na l4 yn d e m ot io na l s ta te : t he se d es cr ib ed

th e fe elin gs, e mo tio na l sta te o r m o re p erm an en t

personality traits of the people e.g. happy

s ad , o ok sn gr y lo ok s p ea ce fu l , apprehen

siveangry , n te ll igent- looking-stupid-look

i ng , kindcruel .

Agereferences to the age of the people in the

p ho to gra ph , e .g . olderyounger ,abo ut5

about so .

X ation al4y re fe re nc es to th eir n atio na lity ,

r ac ia l o r e th ni c c ha ra ct er is ti cs .

Occupationconstructs which referred to their

occupation, social class or status e.g. sh es

p oo r sh e i s b et te r o ff .

Clothes :eferences to what the people were

wearing.

rrelevance : occasionally, a patient would

differentiate between the people in terms of

constructs based on his own preoccupations or

d el us io n al s ys te m, e .g . h eo uld try to ha rm m c

s hew o ul d l ik e m e .

Background :om etim es S ignored the people

(and the instructions) entirely and referred

to the background of the photograph or to its

non-hum an features, e.g. t sunny in this one

but dull in that one or here s book here but

notthere

Photography :ometimes all aspects of the con

te nt w e re ig no re d a nd S d es cr ib ed th e p ho to gr ap h

i ts el f, e .g . over-exposedunder-exposed .

Denial :his was scored when S said spon

taneously that he could observe no (further)

differences.

D etailed criteria are given in D ixon (1968).

Scorers: The content analysis of the transcribed

descriptions was performed by two psychologists

w ho w orked independently and had no know ledge

o f th e c lin ic al r ati ng s.

Scoring: The description of each pair of photographs

b y e ac h S w as s co re d s ep ara te ly . T o sim p lify s co rin g,

an d to im pro ve in ter-scorer reliability , the scorers

d ecid ed m ere ly w heth er e ach c ateg ory o f co nstru ct

had or had not been used by S. Each category was

assigned a score of o (not used) or i (used). Over

the five pairs, each category thus had a score ranging

from 0 to 5. The score obtained in this way from

each of the i 2 categories was expressed as a per

centage of the total category score obtained by sum

m ing the i 2 individual scores. T hese percentage scores

indicated the relative frequency w ith w hich S had

used each category of construct. Percentage scores

w ere used in order to control the effects of inter-S

d iff er en ce s in th e to ta l n um b er o f c on str uc ts e li cite d.

Inter-scorer agreement: For each 5, 6o scoring

decisions had to be m ade, i.e. whether or not each

of 1 2 c ateg orie s h ad b een u sed o n each o f occ asio ns.

Therefore over the i 8 Ss i o8o scoring decisions

were made The two scorers disagreed on only three

o f th ese . B ec au se o f th is v ery h ig h in te r-sc ore r a gre e

m entw hich had also been found by D ixonthe


5/7

Category of

constructCategory

of

tauonstructtauActivity

02 Occupation + .6Stance'+

@26Clothes'+

22Physique'.

o 8 r re le va nc e +2Personality

andemotional

state'

.47* Background +

32Age'+

@02Photography'+o8Nationality'+@

1 5 Denial '

@24

BY F. M . M CPHERSON ET AL.

m ean o f th e tw o sco res w as u sed as th e m easure o f t he

frequency w ith w hich each S had used each category.

Compa ri so no f c on st ru ct u se and rat ed f la tt en in g. Rank

o rd er co rrelatio n co efficien ts (K end all's tau) w ere

calculated over the 18 Ss between each of the 12

in di vid ua l c ate go ry p er ce nta ge s co re s a nd th e c li ni ca l

ratings.

RES ULTS

T he tw elve correlation coefficients are show n

in Table I.

TArn..EI

Correlations between ratings of affective flattening and

r el ati ve ) u se o f 1 2 c ate go rie s of c on str uc t

Positive correlations show that the category of

constru ctas usedmor eoftenby Ssw ithhighamounts

of rated flattening; negative correlations show that the

category w as used less often by Ss w ith high ratings of

flattening. N = :8.

The use of the p e rs o na li ty an d e mo ti on al

state' category was not related to the length of

time for which the patient had been in hospital,

nor to drug dosage. There was no difference

in the scores of m ale and fem ale patients.

Differences related to sub-diagnosis will be

con sid ered in a later article.

DISCUSSION

The present results have confirm ed those of

Dixon (1968) in showing that schizophrenic

patients with flattening of affect are character

ized by an abnorm ality in the content of their

personal construct system s. W hen construing

other people (or at any rate people in photo

graphs), they m ake relatively little use of

constructs referring to their personality traits

or to their current em otional state. The fre

quency of use of other categories of construct,

e.g. those describing other people's activities,

physicalcharacteristicsr dress is not signifi

cantly related to affective flattening.

It m ight be argued that an explanation of

these results is that constructs in the personality

and em otional state' category are m ore diffi

cult' than other constructs and that their less

frequent use by the m ore flattened schizo

phrenics m ay m erely reflect the lower vocabu

lary level of these patients. H ow ever, this is not

so. In a study of 47 schizophrenics, M cPherson

Buckley (1969) found a non-significant

correlation betw een the use of these constructs

and scores on the M ill Hill Synonym Selection

test. M oreover, H arris M etcalfe (1956)

found no difference in the W echsler vocabulary

scores of three groups of schizophrenics, clinic

ally rated as showing gross',m o de ra te ' a nd

n o a ff ec ti ve f la tt en in g.

The correlations between the percentage use

m ade of personality and em otional state'

constructs and the ratings of each of the

clinicians considered separately were +0 .@

and +o@ 53, whereas that between the two

ratings was +0 44.The present procedure

can thus provide an estim ate of the severity of

a p atien t s affective flattening w hich agrees w ith

the rating of an experienced rater at least as

well as, and possibly better than, experienced

raters agree w ith on e an oth er.

However, failure to use personality and

p


6/7

FLATTENING OF AFFECT AND PERSONAL CONSTRUCTS

42

em otional state constructs is not what leads

clinicians to regard a patient as being affectively

flattened. Rather it is because the patient does

use constructs of this type, but w ithout con

com itant affect, i.e. expression of emotion.

The explanation of this apparent paradox is

probably that there is an im portant difference

between the norm al clinical interview, which a

clinician uses to assess whether affective flat

tening is present, and the method of eliciting

constructs described in this study. In the latter

situation the patient is free to attend to and

em phasize, and conversely to ignore, any

features of the people in the photographs:

e.g. he can talk about their em otional state or

he can choose not to. The procedure therefore

assesses the patient s spontaneous use of con

structs of different sorts. In the clinical inter

view situation, on the other hand, it is the

clinician who usually determines what m ust

be discussed. The patient will therefore often

be required to refer to em otional topics and hence

to use constructs in the p er so n al it ya nd e m o

tional state category. W hether or not he

expresses appropriate em otion when using them

will determine whether he is assessed as showing

affective flattening. The present results show

that there is a close relationship betw een these

abnorm alities in the two situations, i.e. that it

is those patients who spontaneously tend not

to em ploy pe rso na lity a nd em otio nal state

constructs who also, in an interview situation,

use them without the concom itant expression

of em otion, and are therefore assessed as show ing

flatte nin g o f affec t.

Two points should be m ade regarding the

m ethod of content analysis used in the study.

The first is that the personal ityand emotiona l

state category is obviously a very broad one,

including as it does both constructs describing

current emotional state, e.g. happysad ,

a pp re he ns iv e ca lm a nd t ho se d es cr ib in g m or e

permanent personality traits, e.g. honestdis

honest , k indc rue l , c leverstup id . How

ever, the category could not be defined more

narrowly sinceinspectionof the resultsof the

content analysis show ed that affectively flattened

patientsfailedto use eithertype of construct

Secondly, as described above, in the scoring

m ethod em ployed in this study and Dixon s,

only the first use of each category of construct

was scored for each pair of photographs. How

ever, sim ilar results would have been obtained

even if the m ore time-consuming m ethod had

been used of counting every use m ade of each

category during each three-m inute period. In

a sam ple of i8 schizophrenics, Buckley (1969)

found a correlation of +0 8 o betw een the tw o

estim ates of the percentage frequency of use of

the p erso nality a nd e mo tio nal sta te ca te go ry .

The present findings, along with those of

Dixon, have im plications both for personal

construct theory and for theories of flattening

of affect. For exam ple, by dem onstrating the

existence of an abnorm ality confined to one

aspect of the construct system, they do not

support those theories w hich account for affec

tive flattening in terms of som e generalized

deficit such as retardation or a general reduction

in activity. On the other hand, they appear to

be com patible with an explanation in term s

of personal construct theory. These topics w ill

be discussed in detail in subsequent articles.

S UMMARY

A content analysis of the constructs used by

i8 schizophrenics to differentiate people in

photographs confirm ed D ixon s (@ 68) finding

that affective flattening, as rated clinically, is

significantly associated with a relative failure to

use constructs descriptive of personality and

em otional state. The use of other types of

construct is not related to the severity of affec

t ive f la tt ening.

AcxuowLp.noaienwrs

W e are grateful to D r. P . M . D ixon for assistance at all

stages of the investigation and to Dr. A . D. Forrest for per

m ission to see the patients. F. M . M . is supported by the

M ental Health Research Fund, whose help he gladly

acknowledges.

REPERENCES

B Ale nirrF .a, D . (ig6 o). C on ce pt ua l s tr uc tu re i n t ho ug ht

d is or de re d s ch iz op br en ic s. J . m e nt .S ci ., i o6 , 1 23 0- 49 .

12). The nature and m easurement of schizo

phren ic thought d iso rde r . ibid ., io8 , 825@z.

1965). The rationale and dinical relevance of

R e pe rt or y G r id T ec hn iq ue . B r . . P @ y ch ia t. ,i ii ,

97782.

and Fw@sEuA, F. 1966). A g rid test of schizo

p hr en ic th ou gh t d is or de r. B r it. 3 . s oc . d i n. P ly ch ol.,

5 95102


7/7

BY F M MCPHERSON ET L

[email protected] . (I96 o) an d MA IR ,J.M .M .(19 68 ) T he E val

u atio n o f P ers on al C on str uc ts. L on do n: A ca demic P re ss.

BucIa EY , F . (1 96 9). F latn ess o f A ffec t, T ho ugh -P ro ce ss.

Disorder and Personal Constructs. Unpubi. M.Sc

Disse rt ., Un ive rsi ty o f Ed inburgh .

B uu.ocx, F. N ., C LANCEY ,. W ., and FL .P .zscim AcK ER ,

H. H. ( ig@i) . Studiesn schizophrenia. '3. ment .Sd.,

97 , 197208.

DIXON, P. M . (ig68) Reduced Emotional Responsiveness in

Schizophrenia. U npubi. Ph.D. D issert., University of

London.

Fws, F . J . ( 19 62 ). S ch iz ophr en ia . ris to l: J o hn Wr ig ht

Sons.

HMtais,A.,and MEYCAU E,M. (1956). nappropriate

affect. 'J. Neurol.Xeurosurg.P@ychiat.,I9,308-13.

HERRON , W . G ., and KAN 'roR, R. E. (i968). L os s o f

a f fec t. 'J . P .@ychol .,0 , 3549.

Kaux, G. A. The P@ ology o f PersonalConstructs.

New Yo rk : No rt on .

MCPHERSON, F. M ., and Buczzx@ , F. (1969). Flattening

o f a ff ec t, pe rsona l cons tr uc ts and vocabul ar y l eve l. '

( In preparat ion) .

M iuia, D . H ., Cw ecv, J., and Cusw mos, E. (953).

Aethod of evaluat ing progressin pat ients suffer ing

fro m ch ro nic sch izo ph re nia . P ia t. Q jia rt. 2 7

4395'.

SA.i.zINoER, K., and PoRmoY, S. (1964). Verbalcon

ditioning in interviews: application to chronic

schizophrenics and relationship to prognosis for

acute schizophrenics .'J .p .@ychiat .Res.2 , 1-9 .

W ING, J. K. (96,). Aim ple and reliable sub-classifi

cation of chronic schizophrenia.' 3. m eat. Si., io@ ,

86275.

F . M. McPher son , M.A., Ph .D. , Dip.C l in .P .ycho l. ,A .B .P I .S .

Vale rie B ard en , B .A ., D ip . C l in . P@yc ho 1., . B.P I.S .

A . Joan Hay, M .B., Ch.B.

D. W . Johnstone, M .A.

A . W . Kus hn er, B .S c.,M .B ., C h .B ., D .P .M .

U niversity D epartm ent @ fP@ vhiat@ y and Royal Edinburgh H ospital, M orningside Park, Edinburgh io

R ece iv ed i@ A pr 11 , 1 969

Documents

Flattening Affect