Anhedonia: the inability to feel pleasure

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.

That 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 remains canceled.

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

What is anhedonia?

Generally speaking, anhedonia is the total absence of pleasant and satisfying sensations regardless of the context in which it is.

In other words, anhedonia is the inability to fully experience pleasure and associated feelings, such as joy or happiness. appreciation of humor in what surrounds us, and that has as one of its main causes an alteration in the mental processes of the person. This means that it does not only manifest itself in a specific area, such as the

sports practice 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 it 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 being nullified all painful experiences, 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, as anhedonia reveals a serious condition that should be treated, but the truth is that 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. That is, 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 most common are, especially, those 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 things that should positively stimulate them. Something similar happens with the disorder known as dysthymia.

However, anhedonia is also relatively common in cases of schizophreniaAs well as in people who have become so addicted to a 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 The symptom tends to weaken over time, while this generally does not occur in 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 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 for repeating behaviors, and the absence of pleasure would derive from that.

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

Some types of anhedonia

Here are 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 do not find any reason to interact with others unless this responds to very specific material needs.

Furthermore, social anhedonia is often one of the first signs of the appearance of schizophrenia in any 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 the representation of the "I" and the the rest.

Sexual anhedonia

This form of anhedonia usually 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 first experience sexual anhedonia, but it is also a relationship problem that you have to know manage. This makes it not only a phenomenon to be treated psychologically in the patient, but it is also often 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 allow to detect external factors that favor and maintain their appearance (such as strongly stressful elements) and It will also make it easier that, in the case of opting for a treatment in which psychotropic drugs are used, the suitable.

Bibliographic references:

• Beck, A.T. and Freeman, A. (1995). Cognitive therapy of personality disorders. Barcelona: Paidós.
• Blanchard J.J.; Horan W.P.; Brown S.A. (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.