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 experiencing it: the inability to feel pleasure and pleasure.because it refers to a strange phenomenon that is very relevant to the person experiencing it: the inability to feel pleasure and a sense of satisfaction.

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

In the following we will see what anhedonia consists of and how it has an impact on people's quality of life.

What is anhedonia?

In general terms, anhedonia is the total absence of pleasurable and satisfying sensations regardless of the context in which it occurs.. 

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

It should be borne in mind, however, that in certain cases anhedonia is not entirely global, and manifests itself in certain areas of life, as we shall see. Musical anhedonia, for example, would be one of these variants, although hardly anything is known about it beyond the fact 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 annulled, those that produce pleasure or a sense of well-being are annulled. In short, 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. is not in itself a mental disorder. It is a symptom, not a syndrome or psychological disorder, although it is often one of the forms of expression of different types of mental illness. That is to say, 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 appears most frequently are, especially, depressive disorders: in depression there is often 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 stimulate them in a positive way.and a feeling that patients describe as an inability to enjoy things that should stimulate them in a positive way. Something similar occurs with the disorder known as dysthymia.

However, anhedonia is also relatively common.However, anhedonia is also relatively common in cases of schizophrenia, as well as in people who have been diagnosed with schizophrenia.as well as in people who have become so addicted to one substance (alcohol, cocaine, and other drugs) that they have become habituated 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 usually weakens with the passage of time, while as a 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 known, but there are theories. One of the most widely accepted theories is that this symptom arises from an alteration in the brain's reward system, located in structures related to the lymphatic system.located in structures related to the limbic system.

In normal situations, certain situations trigger a process in our brain that will make us try to repeat that experience. To do 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 this would result in the absence of pleasure.

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

Some types of anhedonia

Here you will see some specific variants of relatively common anhedonia.

Social anhedonia

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

Social anhedonia, moreover, is often one of the first signs of the onset of schizophrenia in one of its forms.

In addition, from what has been observed from research using brain scans, 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 "self" and others.

Sexual anhedonia

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

It is a disorder that not only impairs the quality of life of those who experience sexual anhedonia first hand, but also represents a problem for the couple 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 couple therapy.

Possible treatments

As anhedonia is a symptom, in order to know how to deal with it, it is first necessary to know its root cause, i.e. the neurological disorder or disorder that produces it.

This will make it possible to detect external factors that favor and maintain its appearance (such as strong stressors) and will also make it easier to use the appropriate drugs in the event of opting for a treatment in which psychotropic drugs will be used.

Bibliographical 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. Psiquiatría. Barcelona: Salvat.
• Vallejo-Riuloba, J. (2002):Introduction to psychopathology and psychiatry.. Barcelona: Masson.