Anhedonia refers to a condition in which those affected are unable to feel joy or pleasure. It can occur in the context of mental disorders, for example in depression, schizoid personality disorder or as part of the negative symptoms of psychoses, or be a symptom of a physical illness. For this reason, the treatment depends on the underlying disease.
What is anhedonia?
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Anhedonia is a psychological symptom that describes the inability to experience joy or pleasure. It can appear as a normal condition in healthy people who temporarily feel disinterested and not interested in most things. In most cases, however, strongly pronounced or long-lasting anhedonia indicates a psychological or organic clinical picture.
This is especially the case when other symptoms accompany the joylessness or the anhedonia results in restrictions in everyday life. The opposite of anhedonia is hedonia, which is characterized, among other things, by an increased sense of pleasure, exuberant joy and increased interests.
It can also appear as a temporary, normal condition or manifest as signs of psychosis, mania, intoxication, neurological and other diseases. For this reason, medical clarification may be advisable even in the case of hedonistic abnormalities.
causes
Anhedonia can occur in the context of various physical illnesses and mental disorders. For example, it represents a cardinal symptom of clinical depression, where it can also express itself as a complete loss of interest: The patient loses his interest in activities that previously gave him pleasure.
In addition, a depressive mood occurs. Other typical symptoms of depression are changes in weight and appetite, insomnia or an increased need for sleep, psychomotor abnormalities, fatigue, loss of energy, feelings of worthlessness and guilt, problems concentrating, difficulties in making decisions, thoughts of death or suicidality. Similar, but weaker and longer-lasting symptoms can show up in dysthymia.
Another mental disorder that can lead to anhedonia is schizoid personality disorder. This is a psychological abnormality that lasts for at least two years and is characterized by a flattened affect. Schizoid personality disorder should not be confused with schizophrenia, which is a psychotic disorder and can be characterized, for example, by hallucinations and delusions.
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With schizophrenia, however, negative symptoms occur, including anhedonia. The negative symptoms appear in many cases before positive symptoms such as hallucinations. In addition, anhedonia can also have physical causes, such as iron deficiency or an underactive thyroid.
Some neurological and other diseases also manifest themselves in conditions characterized by joylessness and displeasure. Only a medical and / or psychiatric or psychological investigation can determine the cause in each individual case.
Diagnosis & course
Persistent anhedonia can indicate a serious physical illness or mental disorder and requires professional clarification. The chances of successful treatment depend, among other things, on the cause of the disease and the individual severity. In order to obtain the most reliable psychological diagnosis possible, those affected should seek the help of a psychiatrist or psychological psychotherapist.
These specialists are particularly trained in the diagnosis and treatment of corresponding clinical pictures. For example, in order to be able to diagnose depression, a patient must show certain characteristics. While a variety of disorders can be responsible for the development of a symptom such as anhedonia, the characteristic pattern of different symptoms is crucial for the diagnosis.
Anhedonist people cannot therefore automatically assume that they are suffering from depression, as other clinical pictures can be considered as explanations. For more precise delimitation, experts can use special questionnaires such as "Beck's Depression Inventory (BDI)" as well as structured or standardized interviews.
A blood test is usually necessary to rule out a physical cause or to make a diagnosis. The results may show deficiencies in certain nutrients that can also lead to anhedonia. Examples of this are iron deficiency or an undersupply of thyroid hormones.
Complications
The types of complications that are possible with anhedonia depend on their cause. If the anhedonia is due to a temporary deficiency such as iron or vitamin deficiency, there are often no complications with appropriate treatment. Without treatment, however, general health may deteriorate.
Iron deficiency, for example, can lead to anemia, which in severe cases can lead to circulatory and heart problems and often causes problems with concentration and memory, tiredness and fatigue. Anhedonia can be a temporary condition triggered by certain life events. The grief immediately after the death of a loved one is not an illness in the strict sense.
However, grief can also lead to psychological complaints, especially if there are no coping options. Chronic grief, depression, anxiety, and obsessive-compulsive disorder are possible complications that can arise as the disease progresses. In addition, such critical life events can trigger other mental illnesses for which the affected person is already predisposed.
Anhedonia can also precede schizophrenia or psychosis. Often, however, it is not possible to tell in advance whether the anhedonia and other psychological symptoms are the beginning of a psychotic disorder. However, if someone else in the family has schizophrenia or a similar condition, appropriate warning signs should be observed. In this case, it makes sense to seek medical advice even if prolonged anhedonia occurs (even without hallucinations and delusions).
When should you go to the doctor?
Anhedonia should be discussed with the responsible therapist or family doctor. Patients who suffer from listlessness or a general lack of interest in the context of depression do not necessarily have to clarify this medically.
However, if the anhedonia leads to problems in everyday life and work (e.g. neglect of professional duties or loss of earnings), treatment should be considered. Without the help of a psychiatrist and appropriate medication, the joylessness can develop into severe depression and cause serious mental and physical problems.
It is therefore advisable to seek help if there are signs of anhedonia. As an alternative to seeing a doctor, talking to friends or family members can sometimes help identify the symptoms of a mental illness. People who have schizoid personality disorder should speak to a doctor or therapist immediately if they suspect anhedonia. Patients with an underactive thyroid, iron deficiency or neurological diseases should discuss a lack of joy or drive with the doctor responsible, as there may be a physical cause.
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Treatment & Therapy
Treatment for anhedonia depends on the condition in which it occurs and on personal factors. In the case of physical causes, the focus is on medical therapy and aims to treat the respective underlying disease. If the anhedonia is due to a mental illness, psychiatric and / or psychotherapeutic treatment can bring relief.
There are currently three psychotherapeutic guideline procedures in Germany, which differ both in terms of the length of the therapy and the methods used: They include cognitive behavioral therapy, psychoanalysis and depth psychological methods. In the case of depression, dysthymia or schizoid personality disorder, all three approaches can be considered.
Under certain circumstances, medical support for treatment may be necessary, even if a patient is already in psychotherapy. In the case of acute danger to oneself or others, or in the event of excessive demands in everyday life, an inpatient stay may also be necessary, with the focus being on acute support and stabilization.
Outlook & forecast
Anhedonia generally has a rather unfavorable prognosis. Without therapeutic support or medical care, the patient seldom succeeds in healing or at least relieving the symptoms with their own efforts.
The outlook is particularly poor for people with a serious personality disorder. Since with these diseases the patient usually lacks insight into the disease, there are no ways in which the person affected can be helped without their consent. The state of joylessness remains permanently in these cases.
For other mental disorders such as depression, there are different approaches to therapy that help improve the symptoms. A slight depression can last for several weeks and then, through spontaneous healing, completely relieve symptoms.
The administration of medication is also possible. It is not anhedonia that is treated with medication, but the underlying disease. With a change in the psychological state, a reduction in the symptoms of anhedonia occurs at the same time. In moderate or recurring depressive states, there is also a prospect of relief. Accompanied by psychotherapy, in the case of joylessness, a better quality of life can be achieved in the long term. This requires a change in the way you experience your own feelings and a rethinking of developments in the patient's life.
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In some cases, patients can prevent organic anhedonia with a balanced diet and a healthy lifestyle. However, specific prevention is not possible for some diseases. Learning appropriate coping strategies can help prevent depressive illness.
With their help, those affected can deal more easily with critical life events and stressors and thus tend to reduce the risk of developing them. However, a complete, guaranteed avoidance of mental disorders is not possible. In addition to psychological and social factors, genetic and other biological framework conditions also play a role.
Aftercare
The loss of joie de vivre and pleasure is difficult to treat for many patients. The disease must therefore be accepted. Aftercare is becoming an ongoing issue. Those affected have to see a doctor several times a year. He discusses their intersubjective experience with them and derives statements about the progression of the disease.
Psychotherapy is one of the aftercare measures that are regularly prescribed. Weekly outpatient sessions are not uncommon. In addition, doctors also order the use of mood-enhancing medication. Since anhedonia usually occurs in combination with depression and schizophrenia, therapy is expanded accordingly. If the patient feels his life is extremely stressful, inpatient accommodation may be indicated.
If a cure is successful, patients are by no means immune to a new disease. In the previous psychotherapy, they experienced coping strategies that prevent the symptoms from breaking out again. They have to implement these independently in everyday life. In general, activity can prevent the mental illness from recurring.
Sports, club activities and social contacts ensure well-being. Physical deficiency symptoms can be remedied with a varied diet. Certain people have hereditary predispositions. They can only be expected to improve temporarily.
You can do that yourself
Persistent joylessness can indicate a serious physical illness or a severe mental disorder and must be clarified by a specialist. If the cause is of a psychological nature, not only a doctor but also a psychotherapist should be consulted, since an improvement in the condition cannot usually be achieved through drug treatment alone, but psychotherapy is required.
Occasional mood swings can also be treated by those affected by behavioral adjustments or naturopathic methods.
Anhedonia is often the first sign of a beginning burnout due to permanent overwork. Those affected who no longer enjoy their life due to an excessive workload should first analyze the causes of the overload. If the workload is simply too great, the supervisor must be made aware of the situation. However, the causes often lie in the inability to organize themselves or to delegate tasks. In these cases, those affected should consider attending a seminar that teaches the skills they lack.
For mild, unspecific depressive moods, preparations based on St. John's wort are used in naturopathy, which are supposed to have a mood-enhancing, anxiolytic and antidepressant effect. Anyone considering therapy with St. John's wort should know that this remedy increases sensitivity to light. Extensive sunbathing and visits to the solarium should be avoided while taking it. There is also a suspicion that St. John's wort affects the effectiveness of hormonal contraceptives. Women using contraceptive pills should therefore consult their gynecologist.
