Anhedonia: The Inability To Feel Pleasure

Causes, symptoms and possible solutions of anhedonia.

The concept of anhedonia is widely used in both psychology and psychiatry, because it refers to a strange phenomenon that is very relevant to the person who experiences it: the inability to feel pleasure and a sense of satisfaction.

This makes this a blow to the quality of life of patients who manifest it, because everything that can be linked to motivation, the feeling of well-being or interest in things is nullified.

Next we will see what anhedonia consists of and how it has an impact on the quality of life of people.

What is anhedonia?

In general terms, anhedonia is the total absence of pleasant and satisfying sensations regardless of the context in which one is.  

In other words, anhedonia is the inability to fully experience pleasure and feelings associated with it, such as joy or the appreciation of humor in our surroundings, and which has as one of its main causes an alteration in the mental processes of person. This means that it does not only manifest itself in a specific area, such as sports or intimate relationships, but in all possible experiences that the person in question lives.

It must be borne in mind, however, that in certain cases anhedonia is not entirely global, and manifests itself in certain areas of life, as we will see. Musical anhedonia, for example, would be one of these variants, although little is known about this in particular beyond that it appears in people who cannot enjoy listening to music.

Anhedonia can be understood as if it were a reverse anesthesia : instead of all painful experiences being canceled, those that produce pleasure or a feeling of well-being are canceled. Ultimately, experiencing anhedonia means living without pleasure, whatever we do.

Anhedonia is not a disorder

This may seem confusing, since anhedonia reveals a serious disorder that should be treated, but the truth is that  it is not in itself a mental disorder. It is a symptom, not a syndrome or psychological disorder, although it is usually one of the forms of expression of different types of mental illness. In other words, it is the expression of a pathology that produces this effect, but that can also generate other mental problems.

Disorders in which it is present

The disorders in which anhedonia is more common to appear are, especially, depressive disorders : in depression there is usually an emotional flattening and a low level of anticipatory and consummatory pleasure, and a feeling that patients describe as an inability to enjoy of things that should stimulate them in a positive way. Something similar happens with the disorder known as dysthymia.

However , anhedonia is also relatively common in cases of schizophrenia, as well as in people who have become so addicted to one substance (alcohol, cocaine, and other drugs) that they have become used to it and have become insensitive to other forms. of satisfaction.

On the other hand, there is evidence that anhedonia is not expressed in the same way in people with depression as in people with schizophrenia: in the first group, this symptom tends to weaken over time, while as a general rule this does not occur in the case of patients with schizophrenia who have manifested this symptom.

What causes can produce the absence of pleasure?

The biological causes of anhedonia are not well understood, but theories do exist. One of the most widely assumed is that this symptom arises from an alteration in the brain’s reward system, located in structures related to the limbic system.

In normal situations, certain situations cause a process to be triggered in our brain that will make us try to repeat that experience. For this, these parts of the brain generate the sensation of pleasure, in which hormones such as dopamine play a fundamental role. In anhedonia, this reward system would be unable to activate the mechanism to repeat behaviors, and from that the absence of pleasure would derive.

Among the parts of the brain that have been related to anhedonia (due to abnormalities in many patients who present this symptom) we find the amygdala, the orbitofrontal cortex and the hypothalamus, structures that intervene in goal setting and motivation, and be it promoting or inhibiting the desire to satisfy the need for pleasure.

Some types of anhedonia

Here you will see some relatively common specific anhedonia variants.

Social anhedonia

There is a phenomenon known as social anhedonia in which lack of interest and lack of pleasure appear specifically in social experiences. People with social anhedonia find no reason to interact with others unless it responds to very specific material needs.

Furthermore, social anhedonia is often one of the first signs of the appearance of schizophrenia in some of its forms.

In addition, from what has been observed from research in which brain scans have been used, in the brains of people with strong anhedonia there are also alterations in parts of the cerebral cortex responsible for carrying out cognitive processes related to representation of “I” and of others.

Sexual anhedonia

This form of anhedonia generally occurs in men who, when ejaculating, do not feel pleasure. In women there is also an analogous form of this symptom, but it is less frequent.

It is an alteration that not only damages the quality of life of those who experience sexual anhedonia in the first person, but it also represents a relationship problem that must be managed. This makes it not only a phenomenon to be treated psychologically in the patient, but often it is also necessary to intervene through couples therapy.

Possible treatments

As anhedonia is a symptom, to know how to deal with it you must first know its root, that is, the neurological disorder or disorder that produces it. 

This will make it possible to detect external factors that favor and maintain their appearance (such as strongly stressful elements) and will also make it easier that, in the case of opting for a treatment in which psychotropic drugs are used, the appropriate ones are used.

Bibliographic references:

  • Beck, AT and Freeman, A. (1995). Cognitive therapy of personality disorders . Barcelona: Paidós.
  • Blanchard JJ; Horan WP; Brown SA (2001). Diagnostic differences in social anhedonia: A longitudinal study of schizophrenia and major depressive disorder. Journal of Abnormal Psychology . 110 (3): pp. 363-371. 
  • Der-Avakian, A .; Markou, A. (2011). The neurobiology of anhedonia and other reward-related deficits. Trends in Neurosciences . 35 (1): pp. 68 – 77.
  • Jaspers, K. (1946/1993). General Psychopathology . Mexico: FCE. 
  • Vallejo-Riuloba, J. (1991): Clinical cases. Psychiatry . Barcelona: Salvat.
  • Vallejo-Riuloba, J. (2002): Introduction to psychopathology and psychiatry . Barcelona: Masson.

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