What is anhedonia, and why is it so important?
First, let's consider what it is not. Those of you who tend to derive the meaning of a word from the Greek roots will recognize the similarity to the word, hedonism (1 2), which is commonly understood to be a focus, perhaps excessive, upon pleasure. Thus anhedonia is commonly defined as the inability to experience pleasure. That, in my opinion, is an inadequate definition, and the source of misunderstanding.
The
reason is this: symptoms occur on a spectrum of severity. In
order to appreciate the dreadful impact that anhedonia can have, you
need to understand how bad it can get. In mild depression,
a patient may have impaired hedonic capacity,
meaning that the patient
has difficulty experiencing pleasure. This is somewhat akin
to a loss
of appetite. Mildly depressed patients may say that they just
don't
feel like eating, that nothing appeals to them.
More severely depressed patients take that a step father. It becomes an actual distortion of perception. They say that nothing tastes good, everything tastes the same; perhaps they say that everything tastes like cardboard. In the most severe cases, a patient might literally starve to death.
Likewise, impaired hedonic capacity occurs upon a spectrum of severity. If you question persons with severe depression, you find that the inability to experience pleasure is only part of the problem. Reduced hedonic capacity is on the mild end of the spectrum. Anhedonia is on the severe end of the spectrum.
A more complete understanding of anhedonia comes from an expanded definition, taking into account the full breadth of the spectrum. I would say that anhedonia is not only the inability to experience pleasure, it is the inability to experience any positive feeling whatsoever. It may seem like a slight distinction, but it is crucial to understanding both the experience of the patient, and the impact that this particular symptom has upon the patient.
In the most severe cases, patients are unable to experience anything positive: no pleasure, no satisfaction, no fulfillment, no sense of accomplishment, no sense of worth, no sense of meaningfulness. Just nothing.
Many positive experiences have little, if anything, to do with pleasure.
Ordinarily, when a person goes through a day, there are innumerable little positive feelings. You wash the dishes after breakfast, so you know you'll come home to a clean kitchen. On the way to work, you notice how the light filters through the trees. You leave work, knowing you have done all your paperwork; it's done. You stop and fill the tank with gas, and feel good knowing you won't have to be inconvenienced by it tomorrow. You have a good workout. Your legs hurt, your arms hurt, you can hardly breathe. It would be odd to call that pleasure, but it can be a rewarding experience, even if it is not pleasurable.
I realize that different people may define "pleasure" in different ways. The point is not to get hung up on what is and what is not pleasure. The point is that anhedonia, in its most severe form, involves the loss of all positive feelings. In other words, it involves the complete loss of any kind of positive reinforcement.
One consequence of this, is that the person with anhedonia cannot do anything to make himself or herself feel better. This can lead to a sense of hopelessness and/or helplessness. It also can lead to problems in relationships. Other people do not understand why the patient is acting the way she or he is acting. The patient knows that others do not understand, which adds to the experience of alienation.
Thus, we come to understand why anhedonia is one of the core symptoms of depression. The presence of anhedonia is likely to be the cause, or part of the cause of many of the other symptoms: loss of appetite, impaired libido, low motivation, loss of interest, and so forth. Furthermore, the presence of anhedonia ofter leads a depressed person to do exactly the opposite of what he or she should do to try to get out of depression.
Aside from formal treatment with medication and psychotherapy, a depressed person could benefit from eating right, getting some exercise, spending time with supportive people, pursuing meaningful activities, and getting the right amount of sleep at the right time. All of these are difficult or impossible in the presence of anhedonia. So it is one symptom that, once established, tends to draw the patient further into the illness.
The neurochemical basis of anhedonia is being elucidated, but is beyond the scope ofa "basic concepts" post. Interested readers may wish to visit this article: Neural systems underlying affective disorders. A more person, human-interest view can be found here: No Pleasure, No Reward - Plenty of Depression:
Emphasis added.
More severely depressed patients take that a step father. It becomes an actual distortion of perception. They say that nothing tastes good, everything tastes the same; perhaps they say that everything tastes like cardboard. In the most severe cases, a patient might literally starve to death.
Likewise, impaired hedonic capacity occurs upon a spectrum of severity. If you question persons with severe depression, you find that the inability to experience pleasure is only part of the problem. Reduced hedonic capacity is on the mild end of the spectrum. Anhedonia is on the severe end of the spectrum.
A more complete understanding of anhedonia comes from an expanded definition, taking into account the full breadth of the spectrum. I would say that anhedonia is not only the inability to experience pleasure, it is the inability to experience any positive feeling whatsoever. It may seem like a slight distinction, but it is crucial to understanding both the experience of the patient, and the impact that this particular symptom has upon the patient.
In the most severe cases, patients are unable to experience anything positive: no pleasure, no satisfaction, no fulfillment, no sense of accomplishment, no sense of worth, no sense of meaningfulness. Just nothing.
Many positive experiences have little, if anything, to do with pleasure.
Ordinarily, when a person goes through a day, there are innumerable little positive feelings. You wash the dishes after breakfast, so you know you'll come home to a clean kitchen. On the way to work, you notice how the light filters through the trees. You leave work, knowing you have done all your paperwork; it's done. You stop and fill the tank with gas, and feel good knowing you won't have to be inconvenienced by it tomorrow. You have a good workout. Your legs hurt, your arms hurt, you can hardly breathe. It would be odd to call that pleasure, but it can be a rewarding experience, even if it is not pleasurable.
I realize that different people may define "pleasure" in different ways. The point is not to get hung up on what is and what is not pleasure. The point is that anhedonia, in its most severe form, involves the loss of all positive feelings. In other words, it involves the complete loss of any kind of positive reinforcement.
One consequence of this, is that the person with anhedonia cannot do anything to make himself or herself feel better. This can lead to a sense of hopelessness and/or helplessness. It also can lead to problems in relationships. Other people do not understand why the patient is acting the way she or he is acting. The patient knows that others do not understand, which adds to the experience of alienation.
Thus, we come to understand why anhedonia is one of the core symptoms of depression. The presence of anhedonia is likely to be the cause, or part of the cause of many of the other symptoms: loss of appetite, impaired libido, low motivation, loss of interest, and so forth. Furthermore, the presence of anhedonia ofter leads a depressed person to do exactly the opposite of what he or she should do to try to get out of depression.
Aside from formal treatment with medication and psychotherapy, a depressed person could benefit from eating right, getting some exercise, spending time with supportive people, pursuing meaningful activities, and getting the right amount of sleep at the right time. All of these are difficult or impossible in the presence of anhedonia. So it is one symptom that, once established, tends to draw the patient further into the illness.
The neurochemical basis of anhedonia is being elucidated, but is beyond the scope ofa "basic concepts" post. Interested readers may wish to visit this article: Neural systems underlying affective disorders. A more person, human-interest view can be found here: No Pleasure, No Reward - Plenty of Depression:
Readers may recall Hall of Fame quarterback Terry Bradshaw’s public disclosure in 2003 of a decades-long depression. Out came the startling revelation that "I didn't understand that after every Super Bowl victory, I could never find pleasure in what I'd done."
Emphasis added.
Comments
No discussion of anhedonia is complete without the inclusion of various Woody Allen references, and at least one suggestion to watch Annie Hall.
So consider this comment the cherry on top :)
(Allen's working title for the movie was Anhedonia. Diane Keaton's real last name is Hall, so, for marketing reasons, the title morphed.)
Posted by: Garrett | March 9, 2007 8:51 PM
Woody Allen did have a fondness for psychological themes, but I do not recall that particular movie well enough to recommend it. I notice it came out in 1977, the year I was taking organic chemistry.
Almost anything that happened that year, that was not related to the carbon atom, has been forgotten.
Posted by: Joseph j7uy5 | March 9, 2007 11:48 PM
This time in 1977, I don't think my parents had even met yet, so I'm not sure your seemingly valid excuse is quite sufficient. :0) Sounds like somebody needs to fire up a netflix account.
As part of a psych interest group at UofM, we've been trying to run something of a film series this past year. So far Zoolander (narcissistic PD), Donnie Darko (paranoid schizophrenia), and as soon as I can get my act together, As Good As It Gets (OCD and OCPD).
If we do Annie Hall in April, I'll be sure to let you know.
Posted by: Garrett | March 10, 2007 12:42 AM
Yeah, let me know.
I must say, one of my favorite films depicting psychopathology is Sid and Nancy. Intentional or not, the film is a vivid portrayal of the relationship dynamics between a person with narcissistic PD and one with borderline PD.
The only problem with it, is that watching it is too much like being at work.
Posted by: Joseph j7uy5 | March 10, 2007 9:55 AM
I found this page while searching for content for my site, The Ultimate Fibromyalgia Resource Center. I found your explaination more applicable to what FM sufferers go through than most definitions, (because most of us are not drug addicts, etc.) I did see Annie Hall years ago and can recommend it if you haven't seen it...LOL! I wish that doctors would refer to this more often in their discussions on Fibromyalgia and CFS as it would help those of us who suffer from these diseases better understand exactly what is happening to us. At least more that a broad statement that we become "depressed". Thank you for your insight.
Posted by: Tammy Elaine | February 3, 2008 9:10 AM