Diagnostic Criteria for Anhedonia
The fifth edition of the American Psychiatric Association’s Diagnostic & Statistical Manual (DSM-5) defines anhedonia as “markedly decreased interest or pleasure in almost all activities.” This isn’t the same as losing interest in an activity because you’re bored and want to try something new. Instead, it entails a lack of pleasure in most or all activities you once enjoyed. Anhedonia has two distinct components:
A motivational component that entails a decrease in the drive to seek out once pleasurable experiences (e.g., looking forward to a movie coming out or a beloved family member visiting) A consummatory component that entails a reduced ability to experience positive emotions in response to activities that used to bring pleasure (e.g., spending time with friends, eating, or previously enjoyable hobbies)
People may experience one or both components of anhedonia. The DSM-5 identifies anhedonia as one of two core symptoms of major depressive disorder. In addition, anhedonia is often associated with conditions such as:
Bipolar disorder Schizophrenia Substance use disorder Chronic pain Parkinson’s disease Alzheimer’s disease Eating disorders Post-traumatic stress disorder Autism spectrum disorders
The experience of anhedonia may differ based on the condition it’s a symptom of. For example, research has found that those with major depressive disorder and bipolar disorder may experience the motivational component of anhedonia but not the consummatory component. As a result, these individuals are capable of experiencing pleasure in response to enjoyable stimuli but are not motivated to seek out such experiences. Meanwhile, other research has shown that those with major depressive disorder suffer from more severe anhedonia than those with conditions such as schizophrenia, substance use disorder, Parkinson’s disease, and chronic pain.
Types of Anhedonia and Their Symptoms
Many studies divide anhedonia into two categories: physical anhedonia and social anhedonia, These two categories are correlated but each describe deficits in different kinds of pleasure and have separate symptoms.
Physical Anhedonia
Physical anhedonia is defined as reduced interest and pleasure in engaging in physical experiences such as food, exercise, and sexual interactions. Symptoms of physical anhedonia include:
Reduced interest in physical intimacyNo longer finding pleasure in tasting foodDiminished enjoyment in physical sensations, like dancing, the smell of flowers, or watching sunsets
Social Anhedonia
Social anhedonia is defined as reduced interest and pleasure in social engagement. While social anhedonia involves social withdrawal, it isn’t the same thing as social anxiety. Social anxiety stems from a fear of social interactions, while social anhedonia decreases the rewards of social interactions. Symptoms of social anhedonia include:
Social withdrawalFewer personal relationshipsPreference for being aloneReduced social skillsReduced enjoyment of social interaction
Causes of Anhedonia
It’s not entirely clear what causes anhedonia, but scholars suspect it’s the result of changes in the brain. Some studies have suggested that the parts of the brain that enable people to anticipate rewards and motivate them to seek rewards out are compromised in those with anhedonia, which diminishes their ability to make decisions that would lead to pleasurable experiences. One study found that children with anhedonia had lower levels of connectivity between regions of the brain involved with arousal and reward processing as well as decreased activation in certain areas of the brain during reward anticipation.
Diagnosing Anhedonia
In clinical settings, a medical or mental health professional may diagnose anhedonia by asking questions about a patient’s mood and other emotional responses to pleasurable activities. They may also administer a questionnaire such as the Snaith-Hamilton Pleasure Scale (SHAPS), a 14-item measure commonly used to assess anhedonia in people with depression and other mental health issues. Because anhedonia is often a symptom for other conditions, patients may also be assessed for underlying mental health or physical conditions. As a result, a physical exam or blood tests may be done to determine if there are other medical problems that could be leading to anhedonia.
Treatment of Anhedonia
Anhedonia is difficult to treat. While drugs may be prescribed to treat the various mental health issues it often occurs with, research has found that the medications typically used to treat depression actually reduce the brain’s ability to process rewards, blunting emotions, and do little to relieve anhedonia.
Ketamine
Recently, there have been some promising developments in treatments aimed specifically at anhedonia. For example, one study showed that a single infusion of the anesthetic ketamine reduced anhedonia in people with treatment-resistant bipolar depression, representing a potential avenue for helping people with the condition.
Talk Therapy
Clinical trials are currently underway to develop a customized talk therapy for anhedonia. The therapy involves giving patients weekly tasks such as attending a party or inviting a friend over for dinner. The goal of the therapy is to override the lack of motivation and anticipation people with anhedonia feel by having them engage in activities that will feel rewarding or important. Despite this progress, currently, there still aren’t specific ways to treat anhedonia directly. If you feel you are suffering from anhedonia, the best option is to seek out a mental health professional who can assess you for the condition and develop a course of treatment that will help you work toward experiencing interest and pleasure in activities you used to enjoy.
