inappropriate or constricted affect

What on earth does that even mean?

A quick Google search describes constricted affect as a restriction in the range or intensity of display of feelings. While inappropriate affect is the display of feelings inappropriate for the situation.

I’ve already talked some about the restriction in the range or intensity of display of feelings in Symptom: Emotionally Inexpressive.

Inappropriate affect however, I haven’t talked about at all. It’s fairly easy for me to find examples of this in my own life.

Two memories in particular stand out to me:

The first, I was younger than 15 at least. Maybe 13-14 or a couple years younger? I was in an indoor swimming pool with my dad, his girlfriend and my youngest half brother. I knew the girlfriend could swim. She would jump into the deep end and dog-paddle around. Then, suddenly she began calling for help while splashing around in the deep end of the pool. Maybe she had suffered a panic attack and forgotten how to swim. She wasn’t a very good swimmer to begin with. I didn’t understand any of this. All I saw was that this woman, who I knew could swim, was splashing around as if she didn’t and people were starting to look concerned. It was so funny to me, I couldn’t help but laugh. Being the one closest to her, I simply swam over and pushed her to the shallow end of the pool where she could reach the bottom and get out of the pool herself. Chuckling all the way. It was an indoor pool. Where was the danger? The harm? Of course, I was reprimanded by the attending life guard for laughing. She could have drowned! But she knew how to swim! I know now, that being able to swim is not the same as being unable to drown.

Looking back now, I can see how inappropriate my laughter was. But I still remember how absurd the whole situation was to me. The way she splashed around looked really funny. I just didn’t understand the gravity of the situation.

The second memory is somewhat similar. This one was in high school. The high school I attended had a proud history with not a single suicide among its students. This is significant, given the high suicide rate in Greenland. That record was broken when the school was hit with a suicide epidemic in my second or third year. 3 students killed themselves that year. Including one of my classmates.

After every suicide, the school would gather all the students and hold a memorial. 1 minute’s silence for the poor sod, every single time. By the third time, it went from horribly tragic to downright absurd. Students started asking each other: “Who’s next?” As if there was some invisible serial killer going around offing random people.

At the last memorial, I stood at the back, chuckling to myself. Laughing in the face of tragedy. This time I was well aware of how inappropriate that was. It was no laughing matter. But it still struck me as funny. 3 people, who’d suffered were dead by their own hands and all the rest of us could offer was a speech and a minute’s silence. It was so goddamn sad it was funny.

But yeah, laughing at a memorial is hardly appropriate behavior.

We tend to do odd things when we don’t know what to do. Some lash out and become violent. Others are paralyzed and overcome with their own inadequacies. Some, like me develop a warped sense of humor and laugh at tragedy.

Behavior that is inexplicable or inappropriate when looking from the outside, usually makes sense when seen from the inside. Our behavior, no matter how insane are bound by their own internal logic. Even if we can’t quite explain it, it makes sense to us. It feels natural. I couldn’t not laugh.

Reacting to horrible things by smiling or laughing isn’t actually as out there as it might sound. Laughter and smiles are mechanisms deeply ingrained in humans. They have a relaxing, calming effect. Even disarming. After all, people will like someone who’s smiling better than someone who’s frowning. It’s an excellent coping and defense mechanism. For example, we automatically laugh when we get tickled. I don’t know about you, but I don’t particularly enjoy being tickled, even though it does feel good to laugh.

So, do I laugh at horrible things because I’m a horrible person who lacks empathy? I don’t think that’s the case at all. But it’s very easy to make that assumption. If tragedy makes you laugh, you’re assumed to be horrible, if comedy makes you cry, you’re assumed to be overly sensitive and if you get angry at nothing at all, you’re an excellent target for bullying.

So, I think inappropriate affect is an expression of a divide between what goes on on the inside and what goes on on the outside. Either due to the outside stuff being interpreted incorrectly inside your head, like putting 2 and 2 together and getting chicken pot pie, or because you’re reacting to something going on inside your mind that doesn’t necessarily have anything to do with the outside world. I find that spending too much time with your own thoughts tends to dull awareness of what’s actually going on around you. My point is, the inappropriate behavior has meaning and logic behind it. Just not meaning or logic that’s obvious when seen from the outside.

Disorder or Personality Disorder?

When searching “schizotypal” around the net, you may have seen it referred to either as a personality disorder or simply a disorder.

Why is that, and what’s the difference?

I’ve dug through a few internet pages including APA’s (American Psychiatric Association) homepage and various danish sites on psychiatry and mental health information pages.

Far as I can tell, the main difference lies simply in the diagnostics system. There are two distinct, primary diagnostics systems used in psychiatry largely depending on where you live in the world: ICD (International Classification of Disease) and DSM (Diagnostic and Statistical Manual of Mental Disorders).

ICD is developed by WHO (World Health Organization). It is primarily used in Europe and various countries connected to WHO. It is the official diagnostics system used in Denmark, where I live. The newest iteration and currently used version is ICD-10. In this system, schizotypal is listed as a disorder. Here, it is loosely grouped with psychotic disorders such as Schizophrenia, paranoid delusions and acute or passing psychoses. This, I believe is due to the relationship and similarity to schizophrenia.

DSM is published by APA and is primarily used in USA, Canada and Australia. If memory serves correctly, it is also the system most commonly used in research papers. The newest iteration and current version in use is DSM-5. In this system, schizotypal is listed as a personality disorder. It is classed as a cluster A personality disorder, which is known as the “eccentric personality disorders” along with schizoid and paranoid personality disorders.

There are a total of 3 clusters of personality disorders in DSM-5.
B is the dramatic, emotional, irratic cluster, which consists of antisocial, histrionic, narcissistic and borderline personality disorders. cluster C is the fearful, anxious cluster and consists of avoidant, dependant and obsessive compulsive personality disorders.
So, what is a personality disorder? It is a type of disorder so deeply ingrained in a person’s behavior and way of thinking that it could be considered a distinct part of their personality. Roughly speaking. Symptoms typically become apparent during adolescence and cause long-term difficulties in personal relationships and function in society.

Essentially, Schizotypal Disorder and Schizotypal Personality Disorder are the same disorder, only classified differently, with slight variations. Symptoms are essentially the same. In DSM-5, the symptoms have to appear even without outside stressors, whereas ICD-10 is slightly more lenient in this. In practice, there’s hardly any difference that I could detect.

I might remember this wrong, but I believe the difference in classification comes from the structure of the diagnostics system. In ICD-10, disorders are largely classified on a spectrum or several, like autism spectrum disorders, whereas in DSM-5, they are largely categorical.

By calling it a personality disorder, DSM-5 focuses on the distinct pattern of thought and behavior in people with schizotypal personality disorder, which deviates from what is considered normal in society. Personality disorders affect the way one thinks of oneself, relates to other people, responds emotionally and controls one’s behavior. These problematic behaviors and thinking patterns persist over very long periods of time and treating a personality disorder can be a lengthy endeavor both with psychotherapy and if needed, medication. The fact that psychotic symptoms such as delusions and hallucinations are very limited or entirely non-existent probably also plays a role in this classification.

ICD-10 on the other hand seems to primarily consider the similarity of shizotypal disorder to schizophrenia. Research has shown a fairly strong familial relationship between schizophrenia and schizotypal disorder where families with cases of schizophrenia are more likely to also have cases of schizotypal disorder. Another reason for this classification might be the hierarchical nature of ICD-10, where disorders are ranked by numbers where the lower numbers take priority over lower numbers. So if someone has symptoms fitting into several different disorders, it is the disorder listed first in the system that takes priority. That way if I have enough symptoms to be diagnosed with both schizotypal disorder and bipolar disorder, depression or anxiety, it is the schizotypal disorder that is diagnosed first while any symptoms of the other disorders are treated as part of my schizotypal disorder. I’d guess this is to prevent over-long, messy diagnoses.

I am slightly more familiar with ICD-10, but I am by no means an expert in either diagnostics system, so there’s a good chance I got some things wrong. If you spot any mistakes, please correct me in the comments.

In this blog I use the term schizotypal disorder, because that is the term I am most familiar with.

TL;DR version: DSM-5 is American and calls it a personality disorder, ICD-10 is European and calls it a disorder related to schizophrenia.