Abulia: What Is It And What Symptoms Indicate Its Arrival?

This psychological symptom appears in people with extreme demotivation and lack of initiative.

Many times we can find ourselves in situations where we don’t feel like doing anything. For example, a large number of patients with major depression report not wanting to get out of bed, or trying to achieve their goals, no matter how rational or even simple they may seem. This lack of motivation and energy is what we know as abulia, an extreme form of apathy.

But … what is this curious psychological phenomenon due to? Next we will see what causes apathy and how it affects us.

Abulia: concept and symptoms

Apathy is understood as the loss or lack of will to make decisions, focus on objectives and have the motivation to achieve them. The person with abulia has a low level of vital energy and a practically non-existent interest in stimuli or activities that would have previously motivated him. It can be considered an extreme form of apathy.

The abĂșlic subject tends to have severe difficulties to start and finish most acts and activities, so it is common for them to postpone them. This applies not only to hobbies but also to work and other responsibilities and even basic activities of daily life, such as eating. It is also common for them to present social difficulties, having no motivation or willingness to relate.

On the other hand, people with apathy have problems when making decisions and organizing their own thinking due to the depressed state that their psychological state supposes, with slowed thinking. The movements of the subject also tend to present alterations, being spontaneous movement reduced and taking longer to respond to stimulation. People with apathy generally feel helpless and indecisive, sometimes suffering great  emotional pain and other times being emotionally numb.

Although at the beginning this term was conceived as a mental disorder, today abulia is considered a symptom or set of symptoms indicative of different types of mental and physical disorders.

Causes

The causes of abulia can be very varied, depending on what disorder it is a symptom of. At the neurological level, it has been found that it can appear in cases of frontal lesions in the brain, in the  basal ganglia or in the anterior cingulate, all of them areas related to motivation and the initiation of movements. These injuries can be caused by different disorders and diseases, as well as strokes or head injuries.

It can also be caused by different types of infections such as syphilis if it ends up affecting the brain. Similarly, apathy-like symptoms can be seen in anemic people, lacking various essential nutrients.

In addition to these biological causes, it is possible to find states of apathy in people who suffer or have suffered prolonged stress over time, with a high level of frustration and suffering that is lived with helplessness and hopelessness.

Disorders in which it appears

Apathy as a symptom can appear in a large number of disorders and diseases. Some of which are as follows.

Dementias

Apathy is a characteristic symptom in people with different dementias such as Alzheimer’s, due to the progressive degeneration of brain structures that occurs in this type of disorder.

Major depression

One of the mental disorders in which apathy occurs most frequently is major depression. The state of demotivation, hopelessness and a feeling of little control can end up generating a lack of desire to act, and many times they occur together with the absence of pleasure from pleasant activities, a phenomenon called  anhedonia.

Schizophrenia

Apathy can also appear in psychotic-type disorder, as in the case of schizophrenia. In this case, we would be faced with a negative symptom that would reduce the normal capacity of the subject to function in life, and it is frequent that it appears alongside the allegiance. If the existence of different types of schizophrenia is considered, the disorganized, simple or catatonic subtype schizophrenias are some in which they can appear more frequently and with greater visibility. It can also be seen as a residual symptom after a psychotic break.

Possible treatments

Treating abulia as a symptom is possible in a large number of cases, although the treatment in question will largely depend on its causes. Treatment can be carried out on both a psychological and a pharmacological level.

On a psychological level, the use of different strategies applied in cases of depression is recommended. These strategies are based on promoting action and carrying out different activities that are pleasant and gradually awaken motivation and the desire to act. Helping and motivating to create and carry out different actions and routines is essential, while working on the beliefs and thoughts that may have caused or maintained the problem.

It may be useful to provide guidelines, tools and information to the patient’s family and close environment, so that they contribute to establishing and maintaining different goals and propositions that generate the desire and will to act. In some cases , physical therapy can be very useful in order to cause an increase in motor activity, as well as sports, which in turn can help generate endorphins.

At the pharmacological level , antidepressants are especially effective, especially those that cause an increase in the level of  dopamine. In this sense, other stimulating substances can also be useful.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Marin, RS & Wilkosz, PA (2005). Disorders of diminished motivation. Journal of Head Trauma Rehabilitation, 20 (4).
  • Santos, JL (2012). Psychopathology. CEDE Preparation Manual PIR, 01. CEDE. Madrid.
  • Vijayaraghavan, L .; Krishnamoorthy, ES; Brown, RG & Trimble, MR (2002). Abulia: A Delphi survey of British neurologists and psychiatrists. [Article]. Movement Disorders, 17 (5), 1052-1057.

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