What Is Anhedonia?
Anhedonia is defined as an inability to experience pleasure. The term is used, above all, to designate a loss of pleasure in activities that we did enjoy before.
It’s a typical symptom of depression, but also of schizophrenia. It can even appear in isolation, that is, without any underlying mental disorder. But what else do we know about anhedonia? We must differentiate it from other symptoms, such as abulia (a lack of excitement, motivation, and enthusiasm) and apathy (a lack of will or energy).
“How much you enjoy your life is more important than how much you have in life.”
What is anhedonia?
Anhedonia is a word that comes from Greek, from the words ἀv- (meaning ‘lack of’) and ἡδονή ( hedoné meaning ‘pleasure’). That is why we can define it as the inability to experience pleasure, as well as a loss of interest or satisfaction in almost all activities.
In this sense, it’s also considered a lack of reactivity to habitually pleasant stimuli. It’s a very typical symptom of depression, but it can also appear in isolation, at a specific moment or time in life, or as a consequence of another disorder other than depression.
The first definitions of anhedonia emphasized the idea of a lack of pleasure, but recent models have highlighted another key element, which would be the need to consider different aspects of fun behavior, such as the motivation or desire to participate in a certain activity.
Causes of anhedonia
The causes of anhedonia are diverse. From a physiological point of view, this symptom has been related to an alteration in the brain that would prevent the segregation of dopamine, the substance related to pleasant sensations. There is some research, such as Gorwood’s (2008), that talks about it.
How to evaluate anhedonia?
An appointment with a specialist will be the key tool to diagnose anhedonia. This will let the expert get to know the patient’s subjective perception of their symptoms. Observation will also allow us to investigate.
If we look for a more objective tool, we find some scales. In 1976, L. Chapman and M. Raulin proposed two of them to evaluate anhedonia. They receive the name Chapman scales.
Specifically, they evaluated physical anhedonia and social anhedonia. These scales were reviewed and disseminated, although they were never officially published. Some of the characteristics, as cited by Chapman & Chapman (1978) and Eckblad et al. (1982) are as follows:
- Revised physical anhedonia scale: This is a 61-question self-administered questionnaire that assesses the ability to experience pleasure through typical physical stimuli, such as sex, touch, or food.
- Revised scale for social anhedonia: This is also a self-applied questionnaire, in this case with 40 questions, which assesses the ability to experience pleasure through social stimuli, such as chatting, exchanging opinions, and dealing with other people.
Social anhedonia in different disorders
In investigations subsequent to the creation of these two scales, it was possible to verify how the social anhedonia scale was the most useful of the two. Furthermore, it was shown to be a reliable indicator for later schizoid spectrum disorders. On the other hand, it was also detected that the results were maintained over time in people diagnosed with schizophrenia.
Finally, social anhedonia has also been shown to be a characteristic feature of people with autism spectrum disorder. As a result, studies have emerged to investigate these issues, such as that of Hurst et al. (2007), who tried to find out the diagnostic overlap between Asperger syndrome and schizotypal personality disorder.
How to treat anhedonia? The important thing will always be to analyze the cause and work on it. In cognitive behavioral therapy, for example, there are techniques such as the programming of pleasant activities that allow you to work on this symptom and others (it’s considered an effective treatment for depression).
The patient, together with the therapist, develops a series of ideas about activities that he used to like to do and that now he no longer likes to do. The objective of the technique, which is actually behavioral, is to fight against the person’s state of non-enjoyment, but above all to reduce apathy.
In other words, it’s about breaking that vicious circle of not doing anything and not feeling like anything, which is used in very depressed patients, especially at the beginning of therapy. As for pharmacological treatment, antidepressant drugs that improve mood are used.
Differences between apathy and abulia
To make a good differential diagnosis, we mustn’t confuse anhedonia with apathy or abulia, two symptoms that are also typical of depression and which aren’t the same. So, apathy refers to the lack of motivation, emotion, or enthusiasm; it would be a psychological state of indifference.
A person with apathy wouldn’t respond to the stimuli in their life. On the other hand, in anhedonia, there’s no indifference, but a lack of enjoyment in what we used to enjoy.
In the case of apathy, it refers to the lack of will or energy to do something or to be active. In this case, it isn’t that the person doesn’t enjoy things, but rather that they don’t have the energy to do them. Actually, apathy, abulia, and anhedonia are three phenomena that usually appear together in depression.
Know the reasons why
As we can see, anhedonia is a symptom that can cause a lot of discomfort in someone’s life, as the person feels they have lost the ability to enjoy things and to excited. However, that ability isn’t lost. We must ask for professional help, as very often it’s not easy to overcome.
On the other hand, knowing the cause of the symptom is essential in order to be able to delve into the reason for this lack of enjoyment; perhaps it’s depression or just a symptom that appears due to specific circumstances in life. Everything has its reasons, especially in psychology.
- American Psychiatric Association (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid: Panamericana.
- American Psychiatric Association (2002). Manual Diagnóstico y Estadístico de los Trastornos Mentales DSM-IV-TR. Barcelona: Masson.
- Ayuso, J.L. y Carulla, L.S. (1994). Manual de psiquiatría. Vol. I. McGraw-Hill. Madrid.
- Belloch, A., Sandín, B. y Ramos, F. (2010). Manual de Psicopatología. Volumen I y II. Madrid: McGraw-Hill.
- Chapman, L. J., Chapman, J. P., & Raulin, M. L. (1976). Scales for physical and social anhedonia. Journal of Abnormal Psychology, 85(4), 374–382. https://doi.org/10.1037/0021-843X.85.4.374.
Gorwood, P. (2008). Neurobiological mechanisms of anhedonia. Dialogues Clin Neurosci, 10(3): 291–299.