At its root, anhedonia is the inability to experience pleasure, but in recent years, the fields of medicine and psychology have expanded this definition. The characteristics of this condition include reduced motivation, a lack of desire for consumable items, and a loss of anticipation for experiences or activities. Some personality disorders include a component of anhedonia. There are two types of anhedonia: physical and social.
Physical anhedonia is a loss of interest and enjoyment related to physical sensations. This condition frequently leads to weight loss and malnutrition because the individual perceives food as bland and tasteless. This type of anhedonia also involves a lack of desire or tolerance for touch from other people. Hugs no longer feel like a sign of affection and sex can become a source of dread instead of joy and intimacy.
Symptoms of anhedonia include negative feelings related to one’s self and other people. Social withdrawal manifests as losing interest in existing relationships and an inability to form new relationships. This condition also reduces a person’s ability to feel and express emotions. A decline in verbal and nonverbal expressions and difficulty adjusting to new social situations is common. People experiencing anhedonia often display fake emotions when at public events such as weddings or funerals.
Anhedonia is linked to depression bipolar disorder. These disorders are related to brain function; dopamine is the neurotransmitter responsible for feelings such as joy and a sense of wellbeing. Medical professionals can sometimes successfully treat depression and other mental health disorders with medications such as antidepressants and antipsychotics. Anhedonia may respond well to those medications, but there is a high risk of increased symptoms instead. Antidepressants and antipsychotics can dull emotions and suppress feelings of any kind, which dramatically worsens anhedonia.
Drug and Alcohol Use
Alcohol and drug use are closely related to anhedonia, but there is disagreement in the medical community as to their exact relationship. The vast majority of people diagnosed with a substance use disorder experience some form of it, but there is no consensus on whether anhedonia causes or triggers the former condition. Both circumstances are possible, and many people with substance use disorders report symptoms before they ever tried recreational drugs or alcohol.
A family history of major depression or schizophrenia increases the likelihood of developing anhedonia. Other risk factors include traumatic or stressful events, abuse or neglect, an illness that reduces one’s quality of life, and a history of eating disorders. Women are more likely to experience this condition than men are. PTSD and conditions that alter brain chemistry such as Parkinson’s disease also appear closely linked to anhedonia.
Feelings of desire or yearning for an object or experience are “conscious reward-related processes” — the desired items or activities are rewards. The feeling of wanting comes from an expectation of positive effects associated with the reward. Liking is defined as pleasure based on consuming the reward. Anhedonia is the disruption or alteration of this process.
Two areas of the brain relate to reward and motivation. One area is in the primitive brain, known as the nucleus accumbens or NA. The other area is in the prefrontal cortex, or PFC, the thin outer layer of the brain behind the forehead. Nerve impulses traveling between these areas produce interest and enjoyment during pleasurable activities. One theory on the occurrence of anhedonia is that impulses fail to send from the PFC or are blocked before reaching the nucleus accumbens.
Risk of Schizophrenia-Spectrum Disorders
Boys displaying symptoms of social anhedonia during adolescence may be at risk for future development of schizophrenia. Depression related to the condition fluctuates and often improves with treatment, while related to psychotic disorders does not improve. Social anhedonia is only one aspect of the interpersonal and social deficits associated with schizophrenia-spectrum disorders. Experts recommend evaluating social anhedonia in young men carefully — treatment for schizophrenia and similar disorders is more successful when individuals receive help from a young age.
To diagnosis anhedonia, a doctor will ask a lot of questions about overall mood, mental health history, symptoms, medications, and recent events. A physical exam and blood tests to evaluate possible vitamin deficiencies or thyroid problems are part of the assessment. A primary care physician can conduct the initial assessment, then provide a referral to a mental health specialist.
Treatment for this type of condition is complex. The individual must first address underlying mental illness, usually with the help of a psychologist or psychiatrist. A doctor can rule out physical illness or conditions, or treat them if they exist. Antidepressants and similar medications can help in some cases, but it is essential to monitor these treatments closely. Transcranial magnetic stimulation or TMS uses a magnetic field to stimulate nerve cells. Vagus nerve stimulation or VNS implants a medical device in the patient’s chest to produce electrical impulses for brain stimulation. Electroconvulsive therapy is a last resort used only after other options have failed.