Are you able to name the 6 basic human emotions? Happiness, sadness, anger, fear, surprise, and disgust. How do emotions arise and how can they be measured? What anatomic correlations should you know? What are the most important theories about emotions? The following article answers all of these and even more questions. Moreover, you will learn important clinical connections: anxiety disorders and depression are common diseases that you will encounter in your clinical routine. Make yourself familiar with the basics so that you are perfectly prepared for preclinical exams and your "Physikum".
Last updated: 19 May, 2022
An emotion is a subjective, important human reaction to a physical stimulus. Situations, actions, or concrete objects can have negative or positive meanings for individuals.
Physiological arousal refers to the excitation of the body’s internal state. Behavioral reactions to emotion include some expressive behavior. The cognitive aspect involves an appraisal or interpretation of the situation.
Darwin assumed that emotions had a strong biological basis. He argued that they evolved via natural selection Natural Selection Population Genetics and have a universal cross-cultural expression. This has been validated and supported by preliterate cultures Cultures Klebsiella. There are 6 major universal emotions.
Visual representations of different emotions
Image by Lecturio.The Yerkes-Dodson law states that the relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship between performance and emotional arousal is a U-shaped correlation Correlation Determination of whether or not two variables are correlated. This means to study whether an increase or decrease in one variable corresponds to an increase or decrease in the other variable. Causality, Validity, and Reliability. There is an ‘optimal’ range where arousal provides benefit. It varies depending on the individual.
Emotion may enhance survival by increasing arousal and priming for quick decisions (fear, anger). Emotions can influence daily life decisions providing framework and consequences.
Yerkes-Dodson law curve
Image by Lecturio.James-Lange theory
Perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of emotion-arousing stimulus
Image by Lecturio.
Interpretation of physiological changes as the emotion
Image by Lecturio.Weakness in the theory includes:
Visual representation of encountering a frightening stimulus
Image by Lecturio.Physiological and cognitive responses to stimuli occur simultaneously and independently. This then leads to a behavioral reaction. This model can explain the overlap in physiological states between emotions (i.e. fear and sexual arousal). It is unable to explain the phenomenon in which behavioral response influences the physical and cognitive aspects of emotion (i.e. smiling leads to happiness).
Cannon-Bard theory
Image by Lecturio.
Cannon-Bard theory: Response algorithm for an emotionally induced stimulus
Image by Lecturio.Schachter-singer theories of emotion
Physiological arousal leads to conscious cognitive interpretation based on circumstance.
Schachter-singer theory: Response algorithm for an emotionally induced stimulus
Image by Lecturio.Summary
| Theory | Pattern | |
|---|---|---|
| James and Lange’s theory: “We don’t cry because we are sad, we are sad because we cry.” |
Physical changes are the reason for emotions. |
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| Cannon and Bard’s theory | Emotions are only possible via the perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of stimuli/ perception Perception The process by which the nature and meaning of sensory stimuli are recognized and interpreted. Psychiatric Assessment of stimuli in the brain Brain The part of central nervous system that is contained within the skull (cranium). Arising from the neural tube, the embryonic brain is comprised of three major parts including prosencephalon (the forebrain); mesencephalon (the midbrain); and rhombencephalon (the hindbrain). The developed brain consists of cerebrum; cerebellum; and other structures in the brain stem. Nervous System: Anatomy, Structure, and Classification. |
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| Schachter and Singer’s 2-components theory: “No emotion without cognition.” |
The precondition for emotion is an unspecific physiological stimulus. |
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Emotions are classified into primary emotions and secondary emotions. Current scientific knowledge estimates the first development of primary emotions to be of genetic origin.
The facial expression of basic emotions is the same across different cultures Cultures Klebsiella. A coding system called the facial action coding system (FACS) has been developed that lists the individual groups of muscles responsible for showing each emotion. This means that for each basic emotion there is a corresponding, defined facial expression!
To a large extent, genetics Genetics Genetics is the study of genes and their functions and behaviors. Basic Terms of Genetics may be responsible for the development of primary emotions. However, social and cultural influences shape the subsequent experience of emotions.
A culturally-specific example is the appropriateness of emotions in certain situations. Anger is either unleashed in rage or controlled. Social roles shape emotional behavior even further. E.g., boys are still taught that crying is not appropriate behavior for men.
Emotions can be measured through muscle activity. The FACS makes a classification possible.
| Basic emotion | Facial expression |
| Happiness | Tense lower eyelid raised corners of the mouth |
| Surprise | Raised eyebrows, raised upper eyelid, open mouth |
| Anger | Lowered eyebrows, frowning, raised upper eyelid, tense lower eyelid |
| Disgust | Tense lower eyelid, raised upper lip Upper Lip Melasma |
| Fear | Partly raised/partly lowered eyebrows, frowning, raised upper eyelid, open mouth |
| Sadness | Partly raised/partly lowered eyebrows, lowered corner of the mouth |
| Disdain | Tense corner of the mouth raised on 1 side |
Below we will present you with the anatomically important correlates for the generation and processing of emotions.
Fear has many qualities. Roughly speaking it describes the feeling of being threatened and of anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder. The different above-mentioned components usually express themselves (even though there are great differences from 1 person to another!) as follows:
| Physiological component | Cognitive component | Observable behavior |
| Tachycardia Tachycardia Abnormally rapid heartbeat, usually with a heart rate above 100 beats per minute for adults. Tachycardia accompanied by disturbance in the cardiac depolarization (cardiac arrhythmia) is called tachyarrhythmia. Sepsis in Children, tremor Tremor Cyclical movement of a body part that can represent either a physiologic process or a manifestation of disease. Intention or action tremor, a common manifestation of cerebellar diseases, is aggravated by movement. In contrast, resting tremor is maximal when there is no attempt at voluntary movement, and occurs as a relatively frequent manifestation of parkinson disease. Myotonic Dystrophies, chills Chills The sudden sensation of being cold. It may be accompanied by shivering. Fever, nausea Nausea An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. Antiemetics, and urge to urinate | Worries, speculation, and concern | Raising of the lower lip and tension of the eyelids Eyelids Each of the upper and lower folds of skin which cover the eye when closed. Blepharitis |
Infants develop the 1st expressions of fear with their fear of strangers (6 months of age) and separation anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder (8 months of age). Just like every emotion, fear in its normal manifestation is a functional emotion that warns and protects us against dangerous situations. Too much or too little fear is referred to as anxiety Anxiety Feelings or emotions of dread, apprehension, and impending disaster but not disabling as with anxiety disorders. Generalized Anxiety Disorder disorder. Affected individuals are usually extremely restricted in their quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life and have a high subjective level of suffering.
Although the complete lack of fear may be desirable at first glance, it leaves the affected person without any of the very important protective effects.
Other types of fear:
Do you deal with your fear deliberately or do you repress or suppress your fear as best as possible?
Sensitizers try to gather as much information as possible about the situation, the object or the circumstances that frighten them (e.g., the package information for drugs is read in great detail).
Repressors try to expose themselves as little as possible to factors that trigger Trigger The type of signal that initiates the inspiratory phase by the ventilator Invasive Mechanical Ventilation fear. Both behaviors are possible means to cope with fear.
Practical advice: As a physician, you have to learn to handle both types of coping with fear. Conversations and therapies have to be customized according to the coping strategy and the patient’s wish for information (e.g., does the patient want information about every little detail of a routine surgery or does he want only basic information?).
Generalized anxiety disorder Generalized anxiety disorder Generalized anxiety disorder (GAD) is a common mental condition defined by excessive, uncontrollable worrying causing distress and occurring frequently for at least 6 months. Generalized anxiety disorder is more common in women. Clinical presentation includes fatigue, low concentration, restlessness, irritability, and sleep disturbance. Generalized Anxiety Disorder
Affected individuals suffer from diffuse fear and are permanently tense, brooding, worried, and full of concern about trivial things.
Panic disorder Panic disorder Panic disorder is a condition marked by recurrent and episodic panic attacks that occur abruptly and without a trigger. These episodes are time-limited and present with cardiorespiratory (palpitations, shortness of breath, choking), GI (nausea, abdominal distress), and neurologic (paresthesias, lightheadedness) symptoms. Panic Disorder
A panic disorder Panic disorder Panic disorder is a condition marked by recurrent and episodic panic attacks that occur abruptly and without a trigger. These episodes are time-limited and present with cardiorespiratory (palpitations, shortness of breath, choking), GI (nausea, abdominal distress), and neurologic (paresthesias, lightheadedness) symptoms. Panic Disorder is diagnosed when patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship spontaneously, as if ‘struck by thunder’ in their everyday lives, suffer from panic attacks. The affected individuals are severely impaired. Often physicians Physicians Individuals licensed to practice medicine. Clinician–Patient Relationship do not detect panic disorders because patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship rarely present during an episode.
Specific phobias Phobias Neurological Examination
In the case of specific phobias Phobias Neurological Examination, fears, and respective avoidance strategies, focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on a specific object or situation. Few common examples that quite frequently occur in exam questions are the following:
Social phobias Phobias Neurological Examination
Social phobias Phobias Neurological Examination describe the fear of social situations in which 1 could disgrace oneself or be humiliated. They are characterized by a fear of being assessed negatively by others in interaction and performance situations.
Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia
People suffering from agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia are afraid of public places, crowds, and means of transport as well as other situations where an escape Escape With constant immune mechanisms holding unstable tumor cells in equilibrium, tumor-cell variants may emerge. These cancer cells may express fewer antigens on their surfaces or lose their MHC class I expression.Variants may also protect themselves from T-cell attack via expression of IC molecules on their surfaces, like normal cells.Creation of an immunosuppressive state in the microenvironment is another way to grow without immunologic interference. Cancer Immunotherapy could be difficult or embarrassing. Agoraphobia Agoraphobia Agoraphobia is fear or anxiety in a situation that would be difficult to leave or to obtain help in the event that one develops panic-like symptoms. Situations include being in public or open spaces, lines, crowds, or public transport. Agoraphobia has high comorbidity with panic disorders.
Obsessive-compulsive disorders
Obsessive-compulsive disorders are based on fear as well. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship suffering from compulsions Compulsions Repetitive behaviors or mental acts that the individual is driven to perform in relation to an obsession. Obsessive-compulsive Disorder (OCD) are afraid that terrible things are going to happen if they cannot carry out the compulsive act (“If I do not tie my shoelaces 7 times my grandfather will die.”). Usually, the compulsive acts consume most of the day and impair the patient’s quality Quality Activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps. Quality Measurement and Improvement of life significantly.
The most common obsessions Obsessions Recurrent thoughts, images, or urges that are intrusive and recognized as unwanted, causing significant anxiety and distress . Obsessive-compulsive Disorder (OCD) are:
Definition: the motive to harm oneself ( self-harm Self-harm Psychiatric Assessment) or others
Psychoanalytical perspective:
According to psychoanalytic theory, Thanatos, the death instinct, is responsible for aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. Human beings are compared to ‘steam boilers’ that build up pressure until the pressure has to be released.
Aggressive venting is a purification process (catharsis hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation) that reduces drive tension. It is assumed that, e.g., the viewing of aggressive scenes of a film substitutes for the real release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology of aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. This view contradicts the theory, that the original form of aggressive behavior is learned!
Ethological perspective:
Ethology interprets aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder as an animalistic instinct that serves the defense of habitat, the protection of the community, and the creation/preservation of social hierarchy.
Learned behavior-perspective:
This theory is based on the assumption that aggressive behavior is acquired through theoretical learning mechanisms. Special emphasis is placed on learning from role models.
The frustration- aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder hypothesis Hypothesis A hypothesis is a preliminary answer to a research question (i.e., a “guess” about what the results will be). There are 2 types of hypotheses: the null hypothesis and the alternative hypothesis. Statistical Tests and Data Representation has its focus Focus Area of enhancement measuring < 5 mm in diameter Imaging of the Breast on the conditions that are responsible for the development of aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder. Frustration is experienced if an aspired goal is not reached because external factors act as obstacles.
People with high frustration tolerance Tolerance Pharmacokinetics and Pharmacodynamics are better at handling restrictions on their way to achieving a goal and without having their physical and psychological wellbeing offended; hence, they do not need to release Release Release of a virus from the host cell following virus assembly and maturation. Egress can occur by host cell lysis, exocytosis, or budding through the plasma membrane. Virology tension through aggression Aggression Behavior which may be manifested by destructive and attacking action which is verbal or physical, by covert attitudes of hostility or by obstructionism. Oppositional Defiant Disorder.
Sadness, shame, disgust, rage, anger, hostility, and fear characterize the feeling of depression, an affective disorder. According to the Diagnostic and statistical manual of mental disorders (DSM)-IV, at least 4 other symptoms have to be present in addition to a loss of interest or low spirit for depression ( unipolar Unipolar Nervous System: Histology disorder/major depression) to be diagnosed.
If manic and depressive stages are alternating, this is referred to as bipolar Bipolar Nervous System: Histology disorder. Mania Mania A state of elevated excitement with over-activity sometimes accompanied with psychotic symptoms (e.g., psychomotor agitation, inflated self esteem and flight of ideas). It is often associated with mental disorders (e.g., cyclothymic disorder; and bipolar diseases). Bipolar Disorder is characterized by extreme euphoria Euphoria An exaggerated feeling of physical and emotional well-being not consonant with apparent stimuli or events; usually of psychologic origin, but also seen in organic brain disease and toxic states. Hepatic Encephalopathy, hyperactivity Hyperactivity Attention Deficit Hyperactivity Disorder, and a lack of critical faculties.
Besides the genetic component (especially in the case of bipolar Bipolar Nervous System: Histology disorders), neurochemical, and environmental factors play a major role. Risk factors that contribute to the risk of developing depression are female gender Gender Gender Dysphoria, serious loss event (divorce, death of important attachment Attachment The binding of virus particles to virus receptors on the host cell surface, facilitating virus entry into the cell. Virology figures, loss of work, etc ETC The electron transport chain (ETC) sends electrons through a series of proteins, which generate an electrochemical proton gradient that produces energy in the form of adenosine triphosphate (ATP). Electron Transport Chain (ETC).) and low socioeconomic status.
Depression
Image: “Man holding his face” by G. Altmann. License: Public Domain| Model for the development of depression | Example | |
| Lewinsohn’s loss-of-reinforcement theory | Little
positive reinforcement
Positive reinforcement
Psychotherapy in everyday life through:
|
Feeling pleasure in baking a cake for oneself and one’s partner. No motivation after separation because the positive reinforcement Positive reinforcement Psychotherapy is missing. |
| Aaron Beck’s cognitive explanation | Depression is a consequence of a distorted view of reality: negative evaluation of oneself, the environment and the future (cognitive triad) | ‘I’m just incapable of a relationship Relationship A connection, association, or involvement between 2 or more parties. Clinician–Patient Relationship, everybody else thinks that and that’s never going to change.’ |
| Seligman’s learned helplessness theory | Basic assumption derived from experimental animal
research
Research
Critical and exhaustive investigation or experimentation, having for its aim the discovery of new facts and their correct interpretation, the revision of accepted conclusions, theories, or laws in the light of newly discovered facts, or the practical application of such new or revised conclusions, theories, or laws.
Conflict of Interest: lack of
avoidance behavior
Avoidance behavior
Specific Phobias even with missing exposition to
pain
Pain
An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.
Pain: Types and Pathways. Symptoms of learned helplessness:
|
Even after rats were unharnessed from the electric shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock plate and could have fled to the safe part of the cage, they continued to sit in the danger zone where they were exposed to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways. |
The International Association for the Study of Pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways (IASP) defines pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways as an ‘unpleasant sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology and emotional experience associated with actual or potential tissue damage or described in terms of such damage’.
The subjectivity of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways differs greatly between individuals: susceptibility to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, sensibility to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways, and the relation of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways to its cause vary to a great degree among individuals.
There are 5 different components of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways:
The
sensitivity
Sensitivity
Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives.
Blotting Techniques to
pain
Pain
An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons.
Pain: Types and Pathways, which is referred to as algesia, is interrupted in the case of
analgesia
Analgesia
Methods of pain relief that may be used with or in place of analgesics.
Anesthesiology: History and Basic Concepts (medicinally through analgesics).
The
pain threshold
Pain threshold
Amount of stimulation required before the sensation of pain is experienced.
Fibromyalgia defines the point beyond which a consciously perceived stimulus is perceived as painful.
The point in time when a patient starts taking measures against the pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is his or her intervention threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction. The tolerance Tolerance Pharmacokinetics and Pharmacodynamics threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction is the maximum intensity of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways a person can endure (exceeding this threshold Threshold Minimum voltage necessary to generate an action potential (an all-or-none response) Skeletal Muscle Contraction can result in loss of self-control, shock Shock Shock is a life-threatening condition associated with impaired circulation that results in tissue hypoxia. The different types of shock are based on the underlying cause: distributive (↑ cardiac output (CO), ↓ systemic vascular resistance (SVR)), cardiogenic (↓ CO, ↑ SVR), hypovolemic (↓ CO, ↑ SVR), obstructive (↓ CO), and mixed. Types of Shock, and coma Coma Coma is defined as a deep state of unarousable unresponsiveness, characterized by a score of 3 points on the GCS. A comatose state can be caused by a multitude of conditions, making the precise epidemiology and prognosis of coma difficult to determine. Coma). Phantom pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is experienced in body parts that have been removed (e.g., after amputations). Phantom pains are explained by the reorganization of the sensory Sensory Neurons which conduct nerve impulses to the central nervous system. Nervous System: Histology cortex areas. Chronic pain Chronic pain Aching sensation that persists for more than a few months. It may or may not be associated with trauma or disease, and may persist after the initial injury has healed. Its localization, character, and timing are more vague than with acute pain. Pain Management refers to pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways that lasts longer than 6 months.
Note: The experience of pain Pain An unpleasant sensation induced by noxious stimuli which are detected by nerve endings of nociceptive neurons. Pain: Types and Pathways is more intense for people dealing with depression and social isolation than it is for aged people and those with reduced vigilance.
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