What is Anhedonia? (No Feelings, Emotional Flatlining)
The clinical definition below states that anhedonia is a loss of interest in activities that used to be enjoyable, and a reduced capacity to feel pleasure. The Diagnostic Manual of the American Psychiatric Association lists it as a symptom of depression, and not a specific disorder by itself. As a result, they are often treated together as one condition.
Emotional Flatlining Explanation
I (Jackie Kelm) am not a doctor or mental health professional, and am simply sharing what I’ve learned from my own personal experience.
Positive Emotional Flatlining is a term I created because anhedonia was close to what I experienced, but not exactly. I found two significant differences as follows.
- With emotional flatlining I experienced a physical inability to produce positive emotions. It was not a reduction in feelings, but the complete absence of them. I believe emotional flatlining is a neurological condition where the brain malfunctions in a way that blocks the ability to feel emotions such as joy, happiness, gratitude, caring, and other positive feelings.
- When I first became emotionally flat I fell into depression from being devastated by the condition. I was able to get rid of the depression over time, but still experienced complete and total emotional flatlining. So I believe they are distinct conditions.
- With emotional flatlining I was still able to experience negative emotions such as anger and frustration. In some cases they seemed less intense than before, but they were there.
Positive Emotional Flatlining Definition
A physical condition that blocks the reward-system positive-feeling neurochemicals while the threat-response mechanisms continue to work and create negative feelings. It is a distinct condition from depression that may or may not co-exist alongside it.
Examples of living with emotional flatlining include:
- Holding your baby and feeling no love or connection at all.
- Hearing your favorite song and being completely unmoved.
- Having no desire for, or enjoyment of intimacy even if you can perform physically
- Not being able to grieve the loss of someone you love.
- Having no interest or motivation to do anything, including hobbies or activities you used to enjoy.
- Faking emotions with other people, such as pretending to care when you don’t.
- Feeling totally flat during special moments such as getting married or watching your favorite sports team win a major championship.
- Having memory issues, trouble concentrating, and other cognitive difficulties.
To learn more about emotional flatlining, including a checklist of common experiences, please sign up for the free report at the top right and bottom of this page.
Clinical Anhedonia Definition
“Anhedonia, a term first used by Ribot in 1896, is a diminished capacity to experience pleasure. It describes the lack of interest and the withdrawal from all usual pleasant activities. Chapman et al. defined two different types of hedonic deficit: physical anhedonia and social anhedonia. Physical anhedonia represents an inability to feel physical pleasures (such as eating, touching and sex). Social anhedonia describes an incapacity to experience interpersonal pleasure (such as being and talking to others).” Source
Types of Anhedonia
Anhedonia definitions include different types, such as social and physical described above, sexual, musical, appetitive or motivational, consummatory, and anticipatory anhedonia. Total or complete anhedonia is having all of them together where there is no positive emotion or interest in any area of life, which is what I refer to as emotional flatlining.
Musical, social, and sexual anhedonia are characterized by having no sense of pleasure in these particular areas. Appetitive or motivational anhedonia is having no motivation or desire to do something, while consummatory anhedonia is not enjoying the activity itself. Anticpatory anhedonia is the inability to experience any excitement about the future.
Causes of Anhedonia
Anhedonia often goes along with other mental conditions such as depression, bipolar disorder, and schizophrenia. It also sometimes occurs in people who have alcohol and drug dependencies. Part of the reason is that it is a common side effect of some narcotic and amphetamine drugs, and of some medications used to treat mental conditions.
It may also be trauma-induced, and has been experienced by people with Post Traumatic Stress disorder. It can also be caused by severe or extended anxiety.
The part of the brain affected with this condition is complex, because it involves a variety of functions. In Neurobiological Mechanisms of Anhedonia (2008), Philip Gorwood, MD, PhD, suggests that “The severity of anhedonia is associated with a deficit of activity of the ventral striatum (including the nucleus accumbens) and an excess of activity of the ventral region of the prefrontal cortex (including the ventromedial prefrontal cortex and the orbitofrontal cortex), with a pivotal, but not exclusive, role of dopamine.” He goes on to say that, “The role of dopamine and the ventral striatum in anhedonia, as a symptom of depression, is never-the-less a largely replicated finding; this does not mean that they explain the trait, but more likely, that they are definitely involved…among others.” Source
There is no clear agreed-upon cause at this time, though researchers are narrowing in on the parts of the brain affected.
Causes of Emotional Flatlining
While I created a new term to distinguish anhedonia from emotional flatlining, I think there are times when the term anhedonia is used appropriately to describe emotional flatlining. So the research above on causes of anhedonia may be relevant for emotional flatlining.
Below is a list of self-reported causes that people have made who have come to this site:
- Certain medications, including antidepressants and especially anti-psychotics.
- Certain recreational drugs
- Severe or prolonged anxiety or stress.
- Inflammation or infection
The Difference Between Flatlining and Depression
The main characteristic that distinguishes emotional flatlining from depression is the complete absence of any positive emotion. With depression you may have occasional, tiny, fleeting moments where you feel some little stir of a good feeling for a brief moment. It might be as simple as seeing your cat and momentarily thinking he is cute. Or hearing a song you like and enjoying it for an instant. With complete anhedonia you feel no positive emotion at all, at any time, with no one, or no thing.
Another characteristic of emotional flatlining is a total loss of interest. You have no motivation or desire to do things you might typically enjoy such as watching certain television shows, playing video games, having dinner with friends, surfing the internet, or listening to music. While loss of interest is also common in depression, the difference with flatlining is the totality of the loss. It is a complete and total loss of interest and no corresponding pleasure at all.
Finally is the experience with grief. A depressed person may not care as much, or feel as deeply when someone close dies, but they will have some sense of sadness or loss. With emotional flatlining their is not only a complete inability to grieve, there is an underlying disturbing or upsetting feeling that you can’t grieve.
Given the differences, the treatment goals for emotional flatlining should potentially be different than for depression. I am not a doctor, so this is simply my opinion. Treating depression would seem to be more about getting rid of negative feelings, while treating emotional flatlining is more about increasing, or re-establishing positive feelings. While they sound similar, the end results that determine treatment success would be different.
The “Pointlessness” of Emotional Flatlining
I initially had emotional flatlining and depression, but was able to get rid of the depression while total anhedonia remained. I was able to clearly see the difference between the two, and hesitate to mention another troubling characteristic of anhedonia that may be different from depression.
I continuously had a disturbing underlying feeling there was no point to my life. It all seemed meaningless because I did not enjoy anything, care about anyone, or look forward to anything. I could not feel the slightest bit of love or connection so I had no desire to be with people or even my cat. I could not experience pleasure in any part of my life, so I had no interest in going on vacation, going out to eat, doing my hobbies, getting together with friends, or doing other normally pleasurable activities. There was nothing I wanted to experience, nowhere I wanted to go, nothing I wanted to learn, and no one I wanted to be with. There was no point to anything, so life seemed completely meaningless.
When I got over depression and was high-functioning with emotional flatlining, I was able to put myself on autopilot and just get things done. But that same sense of meaninglessness continued, and I would break down at times in complete despair that I could not go on like this.
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