{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T07:54:05Z","timestamp":1784274845537,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>Low facial expressivity and withdrawal in severe mental illness are often read as trait-like \u201cflat affect\u201d or enduring \u201cnegative symptoms\u201d. In social-psychiatric and rehabilitation services, such labels can be pragmatically useful but clinically risky: they may narrow staff expectations, amplify stigma and self-stigma, and inadvertently shift the person\u2019s narrative from participation and agency to deficit identity. This article proposes a service-level reframing: treat apparent flatness as a potentially state-dependent capacity signal that varies within-person across autonomic load, interpersonal context (including threat attribution to others), culture, and medication. Instead of anchoring interpretation in between-person norms, teams are encouraged to establish within-subject baselines (across contexts and time) and to document function-first impacts using International Classification of Functioning, Disability and Health (ICF)-aligned language. A simple three-zone pacing heuristic (Zones 1\u20133) is offered: proceed when regulated (Zone 1), reduce and structure interpersonal demand when tightening appears (Zone 2), and apply an explicit stop-and-ground pause when cognitive\u2013perceptual disruption (CPD) emerges (Zone 3). The approach is complemented by a brief CPD screen [Cognitive-Perceptual Disruption Screening (COPEDS)] and copy-ready tools for co-regulation and documentation. This is a heuristic training aid, not a guideline and not primary evidence; it is intended to reduce misattribution risk, support continuity of care, and generate testable implementation questions for social psychiatry and psychiatric rehabilitation.<\/jats:p>","DOI":"10.3389\/fpsyt.2026.1717734","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T06:53:06Z","timestamp":1773211986000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Reframing \u201cflat affect\u201d and withdrawal in severe mental illness: a within-subject, culture- and medication-sensitive heuristic for social psychiatry"],"prefix":"10.3389","volume":"17","author":[{"given":"Eik","family":"Niederlohmann","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Kliniken Erlabrunn","place":["Breitenbrunn, 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