DELHI PSYCHIATRY JOURNAL Vol. 14 No.
2 OCTOBER 2011
Review Article
Emotions and Mood
Vijay Pathak*, Bhatia MS**, Sriniwas J*, Batra D*
Department of Psychiatry, Dr. R.M.L. Hospital & PGIMER* and U.C.M.S. & G.T.B. Hospital**, Delhi
Emotions, feelings and mood are commonly
used terms in psychiatry practice. In clinics, these
terms are used more or less exchangeable.
Observation and assessment of mood state and
changes in it are essential in clinical work in
psychiatry and psychology. The terms used in this
context are not standardized. In different languages,
the description of mood states is not uniform and
poses a problem in terminology.1
Fish2 defines and differentiates these terms as
feeling is defined as “A positive or negative reaction
to some experience” or “The subjective experience
of emotion”. “Emotion is a stirred up state due to
physiological changes which occurs as a response
to some event and which tends to maintain or
abolish the causative event”. “Affects are waves of
emotion in which there is a sudden exacerbation of
emotion usually as a response to some event”.
Mood is “the emotional state prevailing at any given
time” or “The dominant hedonic tone of the
moment”. Mood state is a lasting disposition, either
reactive or endogenous, to react to events with a
certain kind of emotion. Although defined
differently these terms are closely interrelated. It
could be said, that emotion is subjectively
experienced feeling that related to affect and mood3.
In ICD-10 4 , Affect and mood are used
interchangeable.
Differentiation of Concepts
Bennett and Hacker5 have tried to differentiate
different terms used in psychology of emotions.
They state Feelings must be differentiated into
sensations, tactile perceptions, appetites, and affec-
tions.
220 Delhi Psychiatry Journal 2011; 14:(2) © Delhi Psychiatric Society
Sensations like pain tickle etc. just determinate
bodily location of stimulus and they are different
from perception for not being correct or incorrect.
Unlike perception, sensations are not susceptible
to cognitive error. Sensations can be further divided
in localized and of overall body condition as
lassitude.
Tactile perception e.g. feeling of heat, solidity,
elasticity or dampness of an object – is an exercise
of a cognitive faculty. This informs individual how
things are in environment in respect to perceptible
qualities such as warmth, cold, hardness, softness,
wetness, dryness, and so forth. Like all perceptions,
they may be correct or incorrect.
Appetite is desire and sensation in combination.
Natural appetites are such things as feelings of
hunger, thirst or animal lust. Non-natural (acquired)
appetites are addictions. Sensations of appetites
have a somatic site (sensations of hunger are located
in one’s midriff) and are forms of unease that directs
individual in act to gratify the desire. The intensity
of the desire is characteristically proportional to the
intensity of the sensation. Fulfilling an appetite
leads to satiation temporarily Appetites are not
constant, but recurrent, typically caused by bodily
needs or hormonally determined drives.
Affections are the feelings that can be
distinguished into agitations (e.g. Astonishment,
excitement), moods (e.g. cheerfulness, depression)
and emotions (e.g. fear, love) – Unlike sensations;
affections do not inform one about the state of one’s
body, though they are sometimes linked with
sensations. Unlike feelings that are perceptions, the
affections do not inform one of the states of the
OCTOBER 2011 DELHI PSYCHIATRY JOURNAL Vol. 14 No.2

world around one.

Feelings

Sensations Tactile Perceptions Appetites Affections

Localized of overall Natural Non-natural

body
Fig. 1. Types of Feelings 5
Agitations are short-term affective distur-
bances, commonly (but not only) caused by
something unexpected, e.g. being and feeling
excited. As they are disturbances, caused by
unexpected disruptions, they are not motives for
action as emotions may be, but temporarily inhibit
motivated action. One’s agitations are manifested
in expressive behavior. Agitations are considered
as modes of reaction.
Moods as feeling cheerful or depressed are
states or frames of mind. They may be occurrent or
longer-term dispositional states (one may feel
depressed for an afternoon or one may be suffering
from a depression that lasts for months). Moods
are less closely tied to specific objects than
emotions. They are not linked to specific patterns
of intentional action hence they do not afford
motives for action. Moods color one’s thoughts and
pervade one’s reflections.
Emotional perturbations, episodic in nature,
resemble agitations in certain respects. Some, e.g.
fear or anger, have characteristic somatic
accompaniments, both sensations that are felt and
measurable physiological reactions. Others do not,
e.g. feelings of pride but they are manifest in
expressive behavior that may take various forms.
Emotional attitudes, such as love, hate may last
for long periods of time and motivate action done
for reasons. One’s emotions are then evident in the
reasons that weigh with one in one’s deliberations,
in the desires one harbors in respect of the object
of the emotion, and in associated thoughts and
fantasies.
Emotions have objects as well as causes. A
person need not know the cause of his emotion,
but, save in pathological cases, he cannot be
ignorant of the object of his emotion, i.e. whom he
is angry with. Intensity of one’s emotions is not
proportional to the intensity of whatever sensations
may accompany their occurrent manifestations.
Unlike appetites, emotions do not display the same
pattern of occurrence, satiation, and recurrence.
Human emotions, rooted though they are in our
animal nature, are nevertheless run through, as mere
animal emotions are not, with thought and belief,
wish and want, fantasy and imagination – as should
be expected of language-using, concept-exercising
creatures.

Affections

Agitation Emotions Mood

Occurent disposition
Emotional Emotional
pertubations attitudes

Fig.2 Types of affection5

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DELHI PSYCHIATRY JOURNAL Vol. 14 No.2
Emotional Experience
Every individual has plenty of experience with
emotions. Psychology has evolved from science of
mind to science of theory with passage of time and
involvement of new schools of thoughts. At the
different level of time emotions have been studied
more and more. Currently it is understood that
emotional experience is a complex constellation of
following component.
The Cognitive component: subjective feelings
Any language has multiple words for emotions
e.g. in English there are more than 550 words.
People have difficulty in describing about their
emotions to others 6. Emotions are highly personal
and subjective feelings which have their own life.
Lazarus 7 reported that key determinant of the
emotions are the cognitive appraisal of the events
of an individuals life. The psychological study of
this component depends on the verbal report of the
subject of their experiences. The conscious
experience includes an evaluative aspect i.e. people
characterize their emotions as pleasant or
unpleasant8.
The Physiological component: autonomic
arousal
The autonomic nervous system, which
regulates the activity of glands, smooth muscles and
blood vessels, is associated with physiological
arousal at time of experience of emotions. The
experience of highly arousing flight or fright
reaction is best example of it. ANS is controlled by
neural structure in CNS by subcortical grey matter
while in cerebral cortex cognitive appraisal of
events take place. Hence it is proposed that
emotions appear to be start by activity in a
constellation of interaction of brain centers and
systems8.
The Behavioral component: Nonverbal
expressiveness
Emotions are characteristically expressed with
overt expressions as smiles, frowns etc. These are
emotions expressed in “body language” or in non
verbal behavior8. In 1971, Ekman and Friesen, with
their experiment have shown that people are able
to identify six fundamental emotions through facial
expressions: happiness, sadness, anger, disgust
222 Delhi Psychiatry Journal 2011; 14:(2) © Delhi Psychiatric Society
OCTOBER 2011
surprise and fear.9 Later Ekman10 added that four
more emotions can be recognized through facial
expressions: contempt, shame, guilt, and interest.
Theories of Emotions
With the progress of understanding in
psychology there are numerous models and theories
of emotions differ in their emphasis on the innate
biological basis versus the social, environmental
issues.
Early Theories
Aristotle classified emotions into opposites and
explained the physiological and hedonic qualities
associated with emotions. Later, Rene Descartes
introduced the idea that a few emotions (or
passions) underlie the whole of human emotional
behavior11.
James-Lange theory
During 1880s, the American psychologist
William James and the Danish physiologist Carl G.
Lange independently reached the conclusion that
emotions arise from perception of the physiological
state after close examination of the peripheral
components of emotions such as somatic arousal.
The theory puts emphasis on physiological
determinants of emotions. It highlights that
difference in various emotion is due to difference
in pattern of autonomic arousal i.e. people
supposedly distinguish emotions such as fear ,joy ,
and anger on the exact configuration of physical
reaction they experience8.
Cannon-Bard Theory
In 1927, a paper by Walter Cannon in American
journal of psychology criticized the James-Lange
theory .it argued that physiological arousal could
be produced without emotional experiences as in
exercises. He also added that visceral changes were
not rapid enough to precede the conscious
experience. Furthermore people with different
emotional experiences have same physiological
changes. He produced a different explanation which
was later elaborated by Philip Bard.
The Cannon-Bard theory argues that emotions
occur when the thalamus sends signals simul-
taneously to the cortex (conscious awareness) and
to ANS. Hence in there theory primary role of
thalamus (Limbic system) is proposed in response
OCTOBER 2011
to a stimulus 8.
Schachter’s Two-Factor Theory
Schachter views that an individual explores
situational cues to differentiate between alternative
emotions. He argues that this experience depends
on two factors:
a) Autonomic arousal
b) Cognitive interpretation of that arousal.
He explains when an individual experiences
visceral arousal he tries to search for an explanation
in environment and experiences the emotions which
appear most close to that explanation.
Schachter’s theory agrees with both previous
two theories and merges these along with an added
view that people look to external rather than internal
cues to differentiate and label their specific
emotions. Primary role of thalamus (Limbic system)
is proposed in response to a stimulus8.
Evolutionary theories of emotions
Charles Darwin in 1872 in his work “The
Expression of Emotions in Man and Animals”
believed that emotion developed because of their
adaptive values and necessary for an organism to
adapt to its environment. Human emotions were
considered product of evolution. The evolutionary
aspect of emotions was neglected for almost a
century before the work of other experimenters who
were not satisfied with the explanation of above
mentioned theories. Tomkins, Izard and Plutchik
are prominent names among others. This school of
thought consider emotions be largely innate
reactions to stimuli. Primitive animals are incapable
of complex thought process are able to recognize
their emotions. Hence it is considered that emotions
evolved earlier than thoughts and thoughts play a
little role in emotions. This is supported by origin
of subcortical brain structure before cortical
structures.
Regulation of Mood and Emotions and
Development Stages
Emotions by definition represent responses in
reaction to stimuli. Emotional reaction facilitates
an appropriate response for stimuli which can be
considered either positive or negative. An emotion’s
association with either approach or avoidance
behavior is called its valence. Positive-valence
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DELHI PSYCHIATRY JOURNAL Vol. 14 No.2
emotions are associated with approach behavior,
whereas negative-valence emotions are associated
with avoidance behavior to stimuli12.
Emotional reactions have varying degrees of
intensity. The level of emotional intensity is termed
‘‘arousal’’, experienced by the organism as
physiologic activation. Arousal serves as an
indicator of propensity for action in response to a
stimulus. Hence the role of valence is to assigns a
directional component of action and arousal assigns
a level of urgency to that action.13
Mood and emotion are related concepts, but
there are significant differences. Emotions are easily
evoked by environmental stimuli and are of brief
duration. In contrast moods are more long-lasting
and do not need stimuli to appear. 2 Ekman 14
proposed that the relationship between emotions
and moods is bidirectional. He viewed that mood
can be brought about by ‘‘dense emotional
experiences.’’ That is, recurrent experiences of the
same emotion at a high intensity, in the absence of
opposing emotions, can precipitate a sustained
mood of the same valence conversely; a prevailing
mood of a given valence can predispose an
individual to experience a similarly valenced
emotion. Examples of such related emotions and
moods are fear and anxiety.
Emotional regulation and normal development
Affective neuroscience is the study of
emotional processes and their neural components.
Most research in affective neuroscience has been
done in animals and control human subjects. But
results could be extrapolated to clinical popula-
tions15.
The regulation of emotion is an individual’s
ability to respond to his or her life experiences with
a range of socially acceptable emotions that flexibly
permit or delay reactions as the situation requires
In other words, the regulation of emotion is the
ability to manage arousal or to modulate the
intensity of emotional reactions 16 . Affective
neuroscience has revealed that regulation of
emotion is influenced by a number of neural
structures, including the autonomic nervous system
and the frontal cortex.
At birth only excitatory systems (sympathetic
nervous system) are functional with corresponding
inhibitory structures (the parasympathetic nervous
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DELHI PSYCHIATRY JOURNAL Vol. 14 No.2
system and the prefrontal cortex) continue to
develop after birth. Thus, newborns lack control
on their internal excitatory experiences .this makes
them dependent on adult caregivers to regulate their
emotions by initiation of soothing, distracting, or
stimulating behavior.17
Between 7 to 15 months of age two crucial
changes appear in nervous system
(a) Myelination of limbic and cortical
association areas which allows maturation
of the inhibitory cortical areas
(b) Descent of inhibitory neural projections
from the prefrontal cortex to subcortical
(excitatory) structures 18. It is believed that
such development in human infants
contributes to a child’s ability to regulate
his or her own affective experiences. In
humans, improved affect regulation can be
observed when infants more effectively use
gaze aversion and self-soothing mecha-
nisms17.
As age progresses to the preschool years there
is an improved ability to regulate emotions. This
time there is maturation of the frontal lobes which
allows the development of executive functions. It
leads to development of Effortful control. Effortful
control refers to the “ability of an organism to inhibit
a dominant response to perform a subdominant
response” 18. Effortful control brings ability to
sustain attention and to delay reactions. The ability
to sustain attention is correlated with self-control
measures of affective and behavioral style. Till the
third year of life there is a marked increase in
executive attention. By the end of the third year
children are able to inhibit an incorrect response
with effortful control. Because control involves the
ability to focus executive attention, to shift set, and
to exert inhibitory control, effortful control
facilitates the child’s ability to diminish negative
affect by shifting attention away from negative
cues19.
This ability to shift attention away from a
negative stimulus or toward a positive stimulus is
called Attentional control. By directing attention
away from a negative stimulus, attentional control
dampens high levels of arousal. Furthermore,
maintaining attention on positive stimuli can sustain
prosocial behavior. This ability is correlated with a
person’s ability to cope with emotional demands20.
224 Delhi Psychiatry Journal 2011; 14:(2) © Delhi Psychiatric Society
OCTOBER 2011
Additional factor of development of language
during the toddler and preschool years plays
important role in emotional regulation. As children
develop verbal skills, they are better able to think
and to talk about their emotions. They can
communicate more effectively with their caregivers
which lead to enhancement of social contact17.
Development of language provides a form of
internal inhibition called Verbal self-control. Verbal
self-control consists of using the symbolic capacity
of language to control unconditioned reflexes and
conditioned responses. It is hypothesized that the
development of verbal self-control depends on the
maturation of the hippocampus and prefrontal
cortex19.
Regulation of emotion progresses through
childhood as cognitive and language skills continue
to develop. Children older than 6 years develop
the cognitive capacity to understand that some
emotions should not be expressed externally and
that others must be exaggerated. This cognitive
capacity is called as display rule. These rules
become more complex as the child matures.
With further growth there is maturation of brain
and mind faculties of visuospatial skills and abstract
ability. As adolescence approaches, child’s verbal
skills and social environment expand. They have
more opportunities and experiences to develop
enhanced self-regulatory methods. These allow to
recognize emotion in others and to modify one’s
behavior accordingly21.
Brain Asymmetries in Emotion
One of the oldest theories of emotion in the
brain is that the left hemisphere is specialized for a
number of cognitive processes, and the right
hemisphere is predominantly involved in processing
emotion. From the beginning of the last century,
several researchers have noted that brain damage
to the left or right hemisphere may differentially
affect emotional behavior. Denny-Brown et al22
observed that patients with damage to the right
hemisphere were often indifferent or emotionally
flat, whereas Goldstein23 noted that patients with
damage to the left hemisphere often showed a
“catastrophic reaction,” i.e., these patients were
depressed, agitated, and anxious. A more recent
conceptualization is that both hemispheres process
emotion, but each hemisphere is specialized for
OCTOBER 2011
particular types of emotion, particularly in the
lateral frontal cortex.
Right hemisphere hypothesis
The right-hemisphere hypothesis proposes that
the right hemisphere is dominant for the experience
and expression of emotions irrespective of valence
24,25,26
. Behavioral studies have shown that in healthy
humans, the left side of the face is emotionally more
expressive27; emotional intonation (prosody) is
more easily recognized when presented to the left
ear28, and stimuli presented in the left visual field
(i.e., first to the right hemisphere) are judged as
more emotional 29 and elicit greater autonomic
responses30. Deficits in prosody have been found
in patients with right hemisphere frontal damage31,
and deficits in recognition of emotional facial
expressions have been linked to right hemisphere
damage.32,33
This hypothesis was subsequently refined by
Gainotti25 who pointed out that both hemispheres
could play a complementary role in emotional
behavior. In particular, the right hemisphere might
be dominant for automatic components of the
emotional response (such as experience, expression,
and autonomic activation), whereas the left
hemisphere is specialized for functions of control
and modulation of the spontaneous emotional
response. This proposal is in line with the
suggestion that a mechanism of contralateral
inhibition regulates the activity of both
hemispheres, and that damage of one hemisphere
disinhibits the other hemisphere34. Thus, damage
to the right hemisphere would diminish and damage
to the left hemisphere would disinhibit the
automatic emotional response, which might explain
the affective sequels of unilateral brain lesions.
Emotional valence lateralization hypothesis
The valence lateralization hypothesis for
cerebral organization of emotion posits that the left
and right hemispheres are specialized for the
experience of positive and negative emotions,
respectively, where positive emotions include cheer,
elation and confidence, and negative emotions
include sadness, grouchiness and distress 35-38.
Support for the hypothesis has been mixed.
Evidence for it has come from research on clinical
and normal populations, including studies of
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DELHI PSYCHIATRY JOURNAL Vol. 14 No.2
emotional displays in persons with unilateral
cerebral lesions27,39-41 and in persons with epilepsy
who undergo the intracarotid amobarbital
procedure35 and studies of asymmetries in cortical
activity in persons induced into emotional states 42
and in persons with clinical depression43. Evidence
against the hypothesis has come from research on
similar clinical and normal populations, including
studies finding that, irrespective of valence,
emotional disturbances are more common following
right- than left-hemisphere injury44, that emotional
changes in persons with temporal lobe epilepsy are
more common in those with right-than with left-
sided foci45, and that emotional responses in normal
persons are stronger to happy and sad films alike
when presented to the right than to the left
hemisphere46.
Further support for valence hypothesis come
from an experiment by Schiff and Lamon47, who
proposed that unilateral face contractions induce
positive or negative changes in emotion depending
on the side of contraction (Schiff & Lamon
hypothesis); left-side contractions were found to
produce more negative changes, right-side
contractions more positive changes in emotional
state. To explain the effects of the contraction
method, Schiff and Lamon47 propose a two-step
mechanism: first, inasmuch as the muscles of the
lower two-thirds of the face as well as the muscles
of the hand are innervated predominantly by the
contralateral hemisphere, unilateral contraction of
these muscles is assumed to predominantly activate
sensory and/or motor areas in the contralateral
hemisphere; second, on the assumption that neural
activation spreads to nearby cortical and limbic
regions, including regions that mediate emotional
states, there is arousal of the emotional state,
positive or negative, primarily associated
(according to the valence hypothesis) with that
hemisphere.
In a metaanalysis of 65 studies, Wager et al48
concluded that there is no evidence for the
hypothesis of overall right-lateralization of
emotional function, and only a limited support for
valence-specific lateralization of emotional activity
in frontal cortex. The lateralization of emotional
activity is more complex and region-specific than
predicted by previous theories.
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Integrative hypothesis
Heller proposed a neuropsychological model
49
of emotion that integrates the competing hypotheses
(integrative hypothesis). Based on evidence from
behavioral, neuropsychological, and psychophysio-
logical studies, she proposed that valence and
arousal are asymmetrically represented in anterior
and posterior brain regions, respectively. In
particular, she suggested that relative left frontal
activity is associated with the experience of pleasant
emotions, whereas relative right-frontal activity is
associated with negative affect. Complementing this
assignment of valence to the anterior regions, she
also proposed that the right parietotemporal regions
play a role in the activation/arousal component of
affect. These regions are believed to play a crucial
role in regulating the autonomic arousal that is
associated with affective states, and may be
involved in the processing of emotional information
and the experience of affect.
Dysfunctional Mood and Emotions: Mood
Disorders and Beyond
Infants and young children typically show
inconsistent regulation of emotions and emotional
lability in the form of crying and tantrums. Normal
infant’s lability may be more consistently related
to a negative stimulus and it serves as a means of
communicating the child’s needs to the caregiver,
which is adaptive. In most cases lability is outgrown
with the development of alternative forms of
communication.
Both emotions and moods become dysfunc-
tional when they occur in inappropriate contexts or
with disproportional intensity. A recurrent, high-
intensity dysfunctional emotion, if occurring
without intervening functional emotions, could
result in a dysfunctional mood, or mood disorder.
Emotional lability can occur in the setting of a mood
disorder, often the chief complaint in children with
mood and behavioral difficulties, in individuals with
developmental disabilities.
The regulation of emotions undergoes a
complex, normal developmental process which is
related to other areas of development but which can
be disrupted, leading to mood and behavioral
problems. A number of neural systems interact and
contribute to the development of emotion
regulation. In fact, children with bipolar disorder
226 Delhi Psychiatry Journal 2011; 14:(2) © Delhi Psychiatric Society
OCTOBER 2011
often present with developmental delays in these
areas.
A better understanding of the relationship
between the regulation of emotion and cognitive
skills, notably attentional control and executive
functioning, could help explain the high
comorbidity between bipolar disorder and attention
deficit hyperactivity disorder (ADHD). Language
and learning disabilities can also contribute to
emotion dysregulation and may provide a possible
area of intervention. A better understanding of the
role of these facilitators in the development of
affective regulation would allow the development
of new strategies to help people with psycho-
pathologies of mood and emotion12 .
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