The anhedonia is the loqueo of the capacity of reward before stimuli habitually reinforcing and the loss of the interest or pleasure in all or almost all the activities.
Both definitions refer to the same thing: the loss of the ability to experience pleasure. This term was coined by Ribot in the year 1897.
Thus, a person who suffers anhedonia is reduced ability to enjoy the things of their environment.
It is very common to confuse this problem with a depression, because the person shows no desire to do things, when he does them without appetite, and never seems to have any motivation or is happy or happy.
However, although anhedonia is usually a symptom present in depression, (a person with depression may lose their ability to experience pleasure), the fact of suffering anhedonia by itself does not imply suffering depression.
Characteristics of anhedonia
It is important to define that anhedonia is characterized by the inability to experience pleasure, nothing more.
In the same way, it is important to differentiate the anhedonia from the lack of motivation ( apathy ).
Apathy is characterized by a lack of will or interest in daily activities and leisure activities. The loss of interest in these activities is marked by a total lack of motivation.
A person suffering from anhedonia may also show little interest in leisure activities (apparently pleasurable) but the reason that leads to losing interest in them is knowing that they will not experience any pleasure in doing them.
Not having any pleasure in anything, it is understandable that the person with anhedonia chooses to remain inactive instead of doing activities.
If we think about it … Would you go to the cinema if you were there when you were not experiencing any kind of pleasure? Would you stay with friends if you could not enjoy it?
These may be the thoughts of a person with anhedonia, so it is very likely that he will also appear apathetic and without any motivation, but his main problem will remain the inability to experience pleasure.
In other words: loss of motivation is usually a consequence of anhedonia.
To continue defining the term of anhedonia well, we must ask ourselves another question:
Does a person who does not experience pleasure in various activities but have some who enjoy themselves get rid of suffering from anhedonia? The answer is no, since there are different typologies of anhedonia.
On the one hand we would have the total anhedonia (which we have explained so far), which, apart from being the most serious type of anhedonia, is characterized by losing the ability to experience pleasure in absolutely all areas of life, and in all the activities.
However, there is what could be called ” partial anhedonias “, that is, the inability to experience pleasure in some activities or in some specific aspects.
Among them, we find social anhedonia, when the person does not enjoy contact with others and is totally unable to experience pleasure when related to people.
In these cases, the person chooses to avoid social contacts and isolates himself socially.
There are also sexual anhedonia, where pleasure is lost by love activities, appetite anhedonies, where interest in food is lost , or anhedonia in leisure activities and situations that were previously pleasurable for the person.
So, in the anhedonia there are degrees. There are people who can suffer a total inability to enjoy anything, and there are people who suffer a decline in enjoyment for some activities.
However, whenever there is an alteration in the ability to experience pleasure in a person, this is a case (of greater or lesser severity) of anhedonia.
Symptoms of anhedonia
Anhedonia is not considered today as a disease in itself, but a symptom that can appear in different mental illnesses.
However, there are a number of characteristics that can be associated with anhedonia and there are a series of symptoms that can appear alongside it.
In order to delimit a little better the concept of anhedonia, I will comment below on some of what are, in my opinion, more relevant.
Inability to experience pleasure: as we have said, this would be the definition of anhedonia, so it is the main symptom that appears when we refer to this psychological problem .
Loss of interest: not being able to experience pleasure with activities, people with anhedonia lose interest in them.
Inactivity: the inability to experience pleasure in activities produces a decrease in the activity of the person.
Decreased expressiveness: people with anhedonia often have difficulty expressing positive emotions such as enthusiasm or happiness.
Changes in appetite: alterations in appetite and intake can occur due to the inability to experience pleasure when they eat.
Isolation: people with anhedonia are often separated from their social circle because they do not enjoy their personal relationships or social activities.
Sexual problems: the loss of interest and the inability to enjoy sexual activities can be accompanied by other problems such as erectile dysfunction.
Absence of energy: people with anhedonia may see their ability to do things and become tired more easily.
Lack of attention: people with this problem can be less active, less attentive and with problems to pay attention and concentrate.
Generalized malaise: Anhedonia can produce a global feeling of discomfort.
Diagnosis of anhedonia
According to researchers, it seems that anhedonia is caused by an alteration in the reward system of the brain.
The reward system would be like “a network of neurons” inside our brain, which fulfills the function of producing sensations of pleasure.
For example: when we do an activity that we like, we eat when we are hungry or drink when we are thirsty, the reward system of our brain is activated, and we immediately experience the sensation of pleasure.
This system of reward of our brain works with the neurotransmitter dopamine (a chemical that modulates the activity of our brain), so that research on the appearance of anhedonia focuses on possible alterations of these substances.
However, today no mechanism has been found to detect this phenomenon clearly in the brain of people suffering from anhedonia, so the diagnosis of this problem remains purely clinical.
To be able to diagnose anhedonia, a mental health professional must assess the patient’s actual ability to experience pleasure by examining the patient’s personal relationships, daily activity, thoughts and behavior.
Disorders related to anhedonia
The inability to experience pleasure is a symptom that is often present in a series of mental disorders.
Not all cases of anhedonia are related to one of these diseases, however, the inability to experience pleasure is especially important in these contexts.
Let’s see what they are:
The depression is psychopathology in which anhedonia, in fact, is more common in these cases anhedonia is an important symptom of depressive symptoms.
Depression is characterized by the presence of a depressed mood and the decrease of doing things, so the ability to enjoy in these situations is often complex.
The bipolar disorder is characterized by depressive episodes followed suffer from manic episodes, which would be the opposite of depression: the mood rises above normal and activity is much higher.
People with bipolar disorder can suffer anhedonia in their depressive episodes, presenting similarly to unipolar depression.
The Schizophrenia is a psychotic disorder in which symptoms such as delusions, hallucinations, disorganized behavior or increase the rate of speech (positive symptoms).
However, along with these symptoms also appear opposite symptoms such as impoverishment of language, apathy, loss of energy, and evidently anhedonia (negative symptoms).
The addiction to certain substances can also cause anhedonia.
Of all the substances, cocaine is the one that usually causes a greater number of cases, due to the direct alteration that it makes on dopamine and on the reward system of our brain.
Causes of anhedonia
As we have said before, the origin of anhedonia seems to be in the functioning of dopamine, especially in its participation within the reward system of the brain.
It seems quite clear that losing the ability to experience pleasure has to be related to those areas of the brain that are responsible for “generating” that sensation.
As we have just seen, there are certain mental illnesses that can cause this dysfunction in the brain and produce anhedonia.
However, not all cases of anhedonia have to be directly related to one of these psychopathologies.
So, regardless of these diseases, what are the causes and what are the mechanisms that our brain has to do to suffer from anhedonia?
As is usually the case among mental illnesses, due to its complexity, a universal explanation for this question has not yet been discovered , although there are certain aspects that seem to be important.
1. The fact of feeling guilty of being happy when other people are not and suffering from stressful situations such as hunger or pain, can be a factor involved in the appearance of anhedonia.
2. Having suffered repression to express emotions as a child may predispose to suffer anhedonia. For example, having received an educational style that prevents expressing positive emotions such as joy or humor, emphasizing in a serious and inexpressive way of behaving.
3. Usually experience feelings of guilt, sexual anxiety, having a personality governed by the need for success or recognition can help to distort thoughts and feelings about pleasure.
4. Having suffered traumatic events during childhood can impoverish the ability to experience pleasure.
These four aspects do not create anhedonia by themselves, but they are factors that can make us build a personality with difficulties or distortions regarding pleasure and enjoyment, a fact that could lead (or not) to anhedonia.
It can be cured?
Yes, anhedonia can be cured, or at least improved.
When the origin is one of the mental disorders we have discussed (depression, schizophrenia, bipolar disorder and substance addiction), anhedonia usually improves through the treatment of the underlying disease.
Likewise, anhedonia can be treated with pharmacology, antidepressants usually help to alleviate this problem.
However, normally, overcoming anhedonia involves more than just pharmacological treatment.
Learning to recognize and experience your own negative emotions is usually beneficial. You can spend some time each day imagining situations that make you experience certain emotions. When you feel negative emotions you will value more positive ones.
Likewise, it is vitally important that you force yourself to perform activities. If you stay all day in bed you will never get over anhedonia. Stay with friends, go for a walk, exercise … Even if you do not enjoy it now, there will come a day that you will.