The term anhedonia was coined by Ribot in 1897 and since then it has contained several definitions: “Blockage of the capacity for reward in the face of usually reinforcing stimuli” or the one given to us by the DSM III: “Loss of interest or pleasure in all or almost all activities.”
What is anhedonia?
Throughout history, there have been different conceptualizations:
– The inability to experience pleasure, anesthesia or insensitivity to pleasure.
– The inability to be aware of pleasure. In this case, what would be altered is the emotion that should accompany the sensation produced by the pleasurable stimulus. The pleasure would be “blunted” because the person does not recognize the sensation as such.
– The inability to become aware of any type of emotion, not just pleasure.
– People may experience the feeling and the emotion but are unable to express it. It would be a kind of “flattened” pleasure.
– The person loses interest in pleasure and this apathy leads to emotional numbness.
The causes of anhedonia
As can be seen, the understanding of the underlying mechanism of anhedonia varies in each of these definitions. The most recent research hypothesizes that anhedonia could be due to deficiencies in the brain’s reward system, with a particular emphasis on damage to dopaminergic pathways.
One explanatory model suggests that anhedonia arises as follows: the brain structures responsible for reward mechanisms and experiencing pleasure are altered, and this is expressed as changes in the pattern of stimulating signals. This model is often found in people with depression who report an inability to experience pleasure, as well as a marked insensitivity to what usually brought them pleasure. Of course, the person may be aware of this change or be unable to recognize it.
In psychoses (especially schizophrenia), the individual is unaware of this change in the sources of pleasure, so many clinicians consider the anhedonia characteristic of depression and that present in schizophrenia to be not the same phenomenon, not only because of their intensity or frequency but also because of their very nature. The anhedonia that appears in depressed patients is then called “primary” or “true” anhedonia. In contrast, in schizophrenic individuals, there is no inability to enjoy or experience pleasure as a sensation; this would be an introverted or secondary anhedonia.
In reality, the term anhedonia (perhaps due to its association with hedonism) has been given an exclusionary meaning throughout medical history: an inability or incapacity to experience pleasure. But what would happen if we approached anhedonia as a continuum ? What would happen if we understood anhedonia as a spectrum of severity?
This idea would lead us to analyze anhedonia as the inability or incapacity to experience positive feelings. The distinction is not merely terminological but has implications beyond the words used, as it compels us to understand the impact this symptom has on people.
How does anhedonia manifest itself?
In the most severe cases of anhedonia, the person is unable to experience any kind of positive emotion: pleasure, satisfaction, achievement, or benefits; they lose the ability to find positive meaning in the things and situations they experience. However, less severe cases may experience very small positive emotions, although these could not be called pleasure in the broadest sense of the word.
Let’s take an everyday example: we’re coming home from work; we’re tired, probably feeling some physical pain and mental exhaustion, but we know we were able to handle all the day’s work efficiently and even got some tasks done ahead of time, so tomorrow we won’t have as much of a workload. We feel comforted, satisfied; this feeling could hardly be compared to pleasure, but it’s a positive sensation, a small experience of reward and satisfaction.
Of course, there may always be those who question the philosophical implications of the term pleasure, but the essential point in this example is to understand that the most severe anhedonia deprives people of even these small satisfactions, and not just the deepest joy and pleasure.
The inability to feel even minimally good about one’s accomplishments. However, there are others who can perceive these small satisfactions.
In fact, a recent study conducted at the University of Wisconsin-Madison states that, as depression progresses, changes become evident in the brain related to the inability to maintain arousal levels in areas associated with positive emotions and reward. This would indicate that anhedonia is a symptom that gradually worsens; essential information if we truly want to understand what the person is experiencing, because, as one might assume, those who experience the most severe anhedonia are generally unable to do anything to feel better, plunging them into profound hopelessness and helplessness.
At the same time, the people around them cannot understand their problem or their inability to experience positive emotions, so their interpersonal relationships are gradually damaged until the person with anhedonia ends up isolating themselves and experiencing a strong feeling of alienation.
Thus, as can be seen, there is still no consensus in the scientific community on how to conceptualize and understand anhedonia, and this inevitably affects its treatment (primarily pharmacological).
A healthy diet, physical activity, spending time with people in your social support network, and regular sleep are all very beneficial. However, this lifestyle is particularly difficult for people with severe anhedonia to maintain.
References:
Charbonneau, M. (2009) Depression saps endurance of the brain’s reward circuitry. In: University of Wisconsin News.
Olivares, J. M. (2007) Psicopatología de los estados de animo: Anhedonia. Informaciones Psiquiátricas; 189.
Olivares, J.M. & Berrios, G.E. (1998) Anhedonia: clinical and neurobiological aspects. International Journal Of Psychiatry In Clinical Practice; 2: 157-171.
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