Mood and affect answer different questions #
Mood is the person’s reported emotional state over a relevant period. Affect is the observed expression of emotion during the encounter. They can differ: a person reporting persistent sadness may smile briefly while discussing a supportive relative. This does not automatically invalidate the mood account. Specify the time period, context and source of each finding.
| Domain | Evidence | Documentation |
|---|---|---|
| Subjective mood | The person’s description, examples and change from usual state. | “Reports feeling persistently low over recent weeks.” |
| Observed affect | Facial expression, voice, gesture and emotional responsiveness. | “Appeared sad; expression became more animated discussing family.” |
| Longitudinal pattern | History, episodes, triggers and collateral information. | “Describes intervals of recovery between distinct episodes.” |
Words such as depressed, anxious, irritable or elevated can describe symptoms or observations without establishing a disorder. Diagnosis requires the associated pattern, course and functional context.
Describe affect along useful dimensions #
| Dimension | Meaning | What to avoid |
|---|---|---|
| Quality | Predominant emotional tone, such as sadness, anxiety or irritability. | Treating the examiner’s impression as the person’s entire inner experience. |
| Range and intensity | Breadth and strength of expression during the encounter. | Equating restricted expression with absence of feeling. |
| Reactivity | Change in response to topics or interpersonal events. | Assuming one smile excludes substantial depression. |
| Stability | Sustained expression versus rapid or marked shifts. | Calling every ordinary shift labile. |
| Congruence | Relationship to reported mood and discussed content. | Judging without language, cultural or interpersonal context. |
Blunted and flat describe reduced expression to differing degrees; terminology should be accompanied by observations. Incongruent expression is a description of the relationship to context, not an explanation of why it occurred. Nervous laughter, social convention, medicines and neurological factors may contribute.
Explore the emotional experience #
- Ask the person to describe their emotional state in their own words.
- Clarify persistence, daily variation, triggers and intervals of usual mood.
- Explore interest and pleasure, motivation, energy, sleep, appetite and concentration separately.
- Ask about irritability, anxiety, guilt, hopelessness and emotional numbness where relevant.
- Establish changes in activity, confidence and sleep need when elevated states are possible.
- Document impact on work, self-care, relationships and meaningful activities.
Context and limits #
Culture, temperament, interpersonal comfort, pain, fatigue, medicines and communication conditions influence expression. A short remote encounter may provide a narrower sample than an in-person interview. Record these limits rather than assuming the observed expression is stable across settings.