Diagnosing and Treating Anhedonia: Loss of Pleasure Explained

Medically Reviewed By Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT

Anhedonia is a loss of interest or pleasure in usual activities. It is a symptom of mental health disorders such as depression, schizophrenia, and substance use disorder. Anhedonia can also result from other health conditions, such as Parkinson’s disease, diabetes, and chronic pain. Many people at some times in their lives experience mild waxing and waning of interest in activities they previously enjoyed. However, anhedonia refers to a clinical impairment in the ability to feel pleasure or enjoyment.

This article explains what anhedonia is, how it makes you feel, and how it may impact your life. This article also discusses causes and treatment options.

What is anhedonia?

A teenager sits in a locker room wearing a sports kit and looks into the distance.
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The Diagnostic and Statistic Manual of Mental Disorders, 5th edition defines anhedonia as “markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.”

For example, people who have anhedonia may no longer enjoy getting together with loved ones. They may cancel plans with others due to a severe, lasting lack of motivation or reward in participating in activities.

Are there different types of anhedonia?

Research suggests that there are different types of anhedonia. The type depends on how the loss of pleasure affects people.

Types of anhedonia include:

  • Social anhedonia: A person has little interest in, or gets little pleasure from, spending time with others or from social interactions.
  • Physical anhedonia: A person does not enjoy physical sensations, such as a hug or eating favorite foods. This type also includes sexual anhedonia, which is loss of interest or pleasure in sex or physical intimacy. People with sexual anhedonia may experience a lower libido.
  • Appetitive anhedonia: “Appetitive” refers to behavior that supports the fulfillment of the body’s needs. A person with appetitive anhedonia experiences reduced pleasure or interest in need fulfillment.
  • Motivational anhedonia: A person has little motivation in obtaining rewards.
  • Consummatory anhedonia: Consummatory pleasure is the momentary pleasure a person experiences while in the moment and engaged with an activity. Consummatory anhedonia refers to not enjoying this activity.
  • Anticipatory anhedonia: A person has an inability to experience excitement about the future.

Clinicians acknowledge further types of anhedonia. For example, musical anhedonia is a rare condition in which you derive no pleasure or reward responses from a musical experience.

What are the symptoms of anhedonia?

Common symptoms of anhedonia include:

  • inability or reduced ability to experience pleasure
  • reduced motivation or not caring anymore
  • loss of interest or finding less pleasure in activities or hobbies
  • decreased amount of time spent on activities
  • fatigue and loss of mental energy
  • reduced libido, sexual interest, or desire for intimacy
  • social withdrawal or impaired social functioning
  • feelings of loneliness
  • loss of feeling
  • derealization, feeling detached from your surroundings
  • depersonalization, feeling like a detached observer of yourself

The symptoms of anhedonia may be in addition to symptoms that stem from the underlying cause.

If you have symptoms of anhedonia or other symptoms of mood changes, contact your doctor or a mental health professional. They will help you explore diagnosis and treatment options.

What does anhedonia feel like?

There are many things in life that give people pleasure or joy, or that may be emotionally rewarding. With anhedonia, these things lose their luster. You are still able to experience emotion, but the things you once enjoyed no longer make you happy.

This does not necessarily mean you are unable to experience any joy at all. Research Trusted Source JAMA Peer reviewed journal Go to source has observed that some people with anhedonia experience decreased enjoyment of only a minority of the things they once enjoyed. Alternatively, people may find their positive emotions are dulled, rather than missing altogether.

What causes anhedonia?

Anhedonia may be related to changes in brain activity.

The brain produces feelings of pleasure from a large number of processes. These processes include detecting pleasurable input and expressing this emotion.

The impaired function of different parts of the brain can interfere Trusted Source American Journal of Clinical Nutrition Peer reviewed journal Go to source with how the brain processes feelings of reward. These feelings of reward lead to pleasure and other emotions.

Underlying conditions that affect the brain and cognitive processes may contribute to these brain changes and lead to anhedonia.

Conditions that may lead to anhedonia include:

  • depressive disorders
  • post-traumatic stress disorder
  • bipolar disorder
  • schizophrenia
  • sleep disorders or lack of sleep
  • eating disorders
  • Parkinson’s disease
  • chronic pain
  • substance use disorder
  • addiction

Not everyone who experiences these conditions develops anhedonia. However, you may be at increased risk if you have a related chronic illness or underlying condition.

How do doctors diagnose anhedonia?

Diagnosing anhedonia can be challenging because tests for it often rely on the subjective experience of pleasure.

A doctor will ask about your symptoms and medical history. They may also ask if you experience addiction or substance use disorder.

Clinicians may measure anhedonia with self-reports and questionnaires such as the Snaith-Hamilton Pleasure Scale (SHAPS). According to researchers of a 2020 meta-analysis Trusted Source JAMA Peer reviewed journal Go to source , some consider the SHAPS to be “the gold standard for measuring anhedonia in depression.” Clinicians also use the SHAPS to assess anhedonia in people with other conditions.

The SHAPS consists of 14 statements about enjoyable situations typically encountered in daily life. These situations may include food and drink, pastimes, social interactions, and pleasurable sensory experiences. A person indicates their level of agreement with each statement based on their recollection of the previous few days.

Examples of statements from the SHAPS are:

  • “I would enjoy my favorite television or radio program.”
  • “I would enjoy being with family or close friends.”
  • “I would be able to enjoy my favorite meal.”
  • “I would get pleasure from helping others.”

Clinicians may also run physical examinations, such as blood tests, to check for underlying conditions.

What is the treatment for anhedonia?

Treatment for anhedonia can include treating the underlying cause of your symptoms. For example, if you experience anhedonia as a symptom of major depressive disorder, treatment options may include therapy and medication to treat the depression.

Clinicians outline Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source that anhedonia may at times be difficult to treat. This is because current treatments for anxiety and depression focus on reducing negative affect, rather than solving a lack of positive affect. Negative affect refers to feelings of dissatisfaction. Positive affect refers to feelings of satisfaction.

However, research Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source from 2021 suggests that behavioral approaches and cognitive therapies can be effective in reducing anhedonia. These therapies focus on addressing reward anticipation, responsiveness, and learning.

One such therapeutic approach is positive affect treatment (PAT), which aims to increase reward sensitivity. A 2019 clinical trial Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source observed that PAT resulted in improvements in positive affect and lower negative affect.

If you experience symptoms of anhedonia, contact your doctor or mental health professional to determine the most helpful treatment for you.

Learn more about treating different types of depression.

What is the outlook for people with anhedonia?

Living with anhedonia can impact your quality of life.

A 2016 study Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source suggests that anhedonia may lead to adverse long-term outcomes. These include a risk of suicide and lack of response to treatment.

However, treatment of the underlying cause may help you manage and even reduce symptoms of anhedonia. Additionally, therapies such as PAT show promise in treating anhedonia and lowering the probability of adverse outcomes.

By improving your symptoms, you can also begin to improve your quality of life and bring back feelings of pleasure and joy again.

Suicide awareness

If someone you know is at immediate risk of harming themselves or others, or at risk of suicide: 

  • Ask the question, “Are you considering suicide?” even if it is tough.
  • Listen without judgment.
  • Call 911 or your local emergency number. 
  • Stay with them until emergency services arrive.
  • Try to remove any weapons, medications, or other potentially harmful items.

If you or someone you know is having suicidal thoughts, contact the National Suicide Prevention Lifeline:

  • Call 800-273-8255 (or 988 after July 16, 2022).
  • Chat with the lifeline.

This service is available 24/7.

FAQ

Below are questions people also ask about anhedonia.

Does anhedonia go away?

Anhedonia symptoms may improve with treatment, including medication and other therapies designed to increase reward sensitivity and feelings of satisfaction.

Treating the underlying illness or condition causing anhedonia may alleviate symptoms.

What can anhedonia lead to?

Without treatment, anhedonia can negatively impact your quality of life. Anhedonia may lead to emotional or social withdrawal, or suicidal thoughts for some people.

However, treatment can help to resolve anhedonia and improve your quality of life.

Summary

Anhedonia is an inability or reduced ability to experience pleasure. Types of anhedonia include physical and social anhedonia. Physical anhedonia affects your interest or enjoyment in physical sensations. Social anhedonia affects your enjoyment in spending time with others.

Anhedonia may relate to changes in brain activity that impact the way you experience rewards. Behavioral and cognitive therapies, and treatments targeting underlying conditions can help relieve symptoms of anhedonia.

Without treatment, anhedonia may lead to adverse health outcomes, including a risk of suicide. If you are experiencing symptoms of anhedonia, persistent mood changes, or self-harming behavior, contact a doctor or mental health professional promptly.

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Medical Reviewer: Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT
Last Review Date: 2022 Jul 15
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