WHAT IS ANHEDONIA: UNDERSTANDING SYMPTOMS & TREATMENT CONSIDERATIONS

Apr 15, 20246 min
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Anhedonia is a reduced capacity to experience pleasure and interest, often caused due to a mental health disorder. It is one of the core features of Major Depressive Disorder (MDD) where an individual reports a “depressed mood” and/or “markedly diminished interest or pleasure in all or almost all activities” (DSM 5, 2013). 

The experience of anhedonia includes a wide range of hedonic deficits (i.e., de-prioritization of pleasure) and their consequences. A person may cancel, avoid, or withdraw from activities that bring them joy. Along with depleting their capacity, it may also cause additional stressors and conflicts in their lives. For example, due to anhedonia symptoms, a person who enjoys dancing may stop going to their dance class. In addition to missing out on a joyous routine, they may also lose the opportunity to socialize and engage in physical activity.    

The symptom of Anhedonia can also be present in people experiencing anxiety (Sandman & Craske, 2022), borderline personality disorder, attention-deficit/hyperactivity disorder, autism, eating disorders, substance use disorders, and schizophrenia (Murtoff, 2024). 

The presence of anhedonia causes a significant negative impact on a person’s quality of life. The research suggests that anhedonia symptoms can cause a person to experience mental health-related symptoms with more intensity and for a longer period of time (Whitton & Pizzagalli, 2022). Seeking treatment for anhedonia symptoms can be very helpful! - a loss of pleasure is often linked to multiple factors in our lives, and with the help of a therapist, we can start making sense of our struggles with anhedonia and working on it.

SIGNS AND SYMPTOMS OF ANHEDONIA

Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), and research findings, anhedonia can include a loss of: 

  • pleasure,
  • motivation, 
  • purpose, and
  • connection. 

Unlike DSM 5, which has been critiqued for offering an incomplete list of signs and symptoms (Abramowitz & Jacoby, 2015), phenomenological studies center on the lived experiences of people suffering from mental illness and offer valuable insights into the most prominent and/or incapacitating aspects of mental health-related disorders (Whitton & Pizzagalli, 2022).

While symptoms of Anhedonia are easy to spot, they may be missed in some individuals who seem to be adequately functioning in their daily lives. For example, we may be upset with a friend who has lately been declining multiple social plans and not consider that they are struggling with a loss of pleasure in social engagements they previously used to enjoy due to poor mental health. 

Based on the research findings by Watson et al. (2020), people experiencing anhedonia may experience:

  • A lack of joy
  • A general sense of disinterest, boredom, apathy, or inability to experience the ‘highs & lows’ of an emotion (flattening of emotions)
  • Reduced motivation 
  • Reduced interest in daily tasks
  • Growing indifference to previously enjoyable activities
  • Feeling a sense of lack in most aspects of life
  • Loss of drive, connection, and purpose 
  • Reduced motivation 
  • Feeling detached from oneself (depersonalization), as if one is existing on autopilot without a purpose
  • Feeling detached from the world (derealization) where people and surroundings have taken an unfamiliar, dreamlike, foggy-like quality.

The participants in the Watson et al. (2020) study specifically mentioned feeling monotonous, bored, and unaffected by what was going on around them. There were recurring themes about doubting one's identity and purpose in life and losing one's sense of connection and belonging. The participants felt disconnected from their social environment and were losing sight of what matters to them in life. 

TYPES OF ANHEDONIA

The anhedonia symptoms can be categorized in multiple ways. The symptoms of anhedonia can be:

  • Physical: An individual experiences loss of pleasure experienced via sense organs. For example, touching, eating, engaging in sex-related activities, etc.
  • Social anhedonia is marked by the loss of interest and pleasure in relationships and social situations. For example, low relational satisfaction, not enjoying oneself at parties, etc.

Based on the individual’s expectations, the symptoms of anhedonia can be: 

  • Anticipatory: here, an individual might not look forward to doing something that previously brought them joy. For example, a sudden lack of interest in their favorite sport.
  • Consummatory: here, an individual may not experience pleasure when engaging in something they usually enjoy. For example, eating their favorite meal. 

Based on the individual’s interests, the symptoms of anhedonia can be:

  • Motivational: reduced drive to pursue a joyful activity. For example, they may experience indifference towards work which previously brought a sense of purpose.
  • Decisional: feeling a lack of momentum to pursue pleasurable activities. For example, the inability to decide if to go out with a friend (Murtoff, 2024). 

While the phenomenological studies emphasize that there is a reduction of motivation in anhedonia,  how this happens remains unclear (Murtoff, 2024). 

Recent advances in affective neuroscience propose that individuals experiencing symptoms of anhedonia are unable to “feel good” whilst pursuing, engaging, and experiencing the benefits of a typically pleasurable activity due to some malfunctioning in bodily systems (specifically, deficits in the appetitive reward system) (Craske et al., 2016). 

ANHEDONIA TREATMENT 

The current treatment protocols for mental health disorders where anhedonia is present, like anxiety and depression, largely focus on treating or reducing unpleasant experiences (e.g., restlessness, insomnia) rather than increasing capacity for experiencing pleasant feelings (e.g., joy, purpose, connection, etc.). 

There is a need to find treatment options for anhedonia that can help us rebuild our capacity to “feel good” when engaging in activities that previously brought joy (for example, talking with friends, eating our favorite meal, etc). 

Lately, some new treatments have shown promising signs in treating anhedonia (for example, Positive Affect Treatment (PAT), Craske et al., 2019). However, the testing for these interventions is in the initial stages and requires a lot more research to be considered valid treatment options. 

While symptoms of anhedonia can be difficult to treat, usually a combination of therapy and psychiatric medications is helpful. The treatment of the underlying mental health condition, like depression, can decrease the negative impact of anhedonia symptoms. 

Some practices that may help in countering anhedonia are: 

  • Emotional Regulation: learning how to identify, regulate, and reframe our feelings around pleasure.
  • Behavioral activation: Taking intentional and manageable steps towards pleasurable and nourishing activities, even though it seems counterintuitive. Often, people experiencing anhedonia may be waiting to feel better to make lifestyle changes. However, it works the other way around! Our actions can help us to make changes to how we are feeling - taking small steps towards our goals can help us rebuild the capacity to experience joy in our lives. For example, going out to sit in the sun if going for a walk feels overwhelming. 
  • Cognitive Reframing: understanding our thought patterns that contribute towards anhedonia symptoms and considering new ways of thinking that can reduce anhedonia symptoms. 
  • Savoring: Based on the practice of mindfulness, savoring involves intentionally enjoying something in the present moment by engaging your 5 senses. For example, while you are sipping your daily cup of coffee, notice how it looks, smells, tastes, and feels in your body. Be completely present in the moment, enjoying every sip by engaging your 5 senses. Savoring can help to build excitement and gratitude toward what is already accessible to us at the moment (Psychology Today, n.d.). 
  • Seek connection: Consider reaching out to family and friends to help you feel grounded, connected, and loved. You can also work with a therapist to figure out how you would like to be supported by others as you move through the anhedonia symptoms.

While anhedonia symptoms can take a significant toll on an individual’s life, please know that you are not alone in your journey and help is available. With the right support and care, it is possible to navigate anhedonia symptoms to live a purposeful and connected life.

If you are looking to consult a therapist for anhedonia symptoms, you can check out Mave Health’s Therapy Club! – India’s largest mental health platform that makes good mental health a priority. Find a professional who can meet your needs and start your mental health journey today.

References: 

Abramowitz, J. S., & Jacoby, R. J. (2015). Obsessive-compulsive and related disorders: A critical review of the new diagnostic class. Annual Review of Clinical Psychology, 11, 165-186.

American Psychiatric Association, D. S. M. T. F., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5, No. 5). Washington, DC: American Psychiatric Association.

Anhedonia. (n.d.). Retrieved from Psychology Today: https://www.psychologytoday.com/us/basics/anhedonia

Craske, M. G., Meuret, A. E., Ritz, T., Treanor, M., & Dour, H. J. (2016). Treatment for anhedonia: A neuroscience driven approach. Depression and anxiety, 33(10), 927-938.

Murtoff, J. (2024, February 10). Anhedonia. Retrieved from Encyclopedia Britannica: https://www.britannica.com/science/anhedonia

Sandman, C. F., & Craske, M. G. (2022). Psychological Treatments for Anhedonia. Current topics in behavioral neurosciences, 58, 491–513. https://doi.org/10.1007/7854_2021_291

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Prachi Gangwani
Therapist | Yoga Teacher | Author of Dear Men: Masculinity and Modern Love in #MeToo India