We can often find ourselves in situations where we don’t feel like doing anything. For example, a large number of patients with major depression refer to not wanting to get out of bed, or to try to achieve their goals no matter how rational or even simple they may seem. This lack of motivation and energy is what we know as abulia , an extreme form of apathy.

But… why this curious psychological phenomenon? Next we will see what produces abulia and how it affects us.

Abulia: concept and symptoms

It is understood as abulia the loss or unwillingness to make decisions , to focus on objectives and to have the motivation to fulfil them. The person with abulia presents a low level of vital energy and a practically inexistent interest in stimuli or activities that previously would have motivated him/her. It can be considered an extreme form of apathy.

The abulic subject tends to have severe difficulties in starting and finishing most acts and activities, so it is common to postpone them. This applies not only to hobbies but also to work and other responsibilities and even basic activities of daily life, such as eating. It is also frequent that they present social difficulties , as they have no motivation or willingness to relate.

On the other hand, people with abulia have trouble making decisions and organizing their own thinking because of their psychological state of despondency, with slowed down thinking. The subject’s movements also tend to present alterations , with spontaneous movement being reduced and taking longer to respond to stimulation.People with abulia usually feel helpless and indecisive, sometimes suffering great emotional pain and at other times can reach emotional numbness.

Although this term was originally conceived as a mental disorder, today abulia is considered a symptom or set of symptoms indicative of different types of both mental and physical disorders.

Causes

The causes of abulia can be very varied, depending on what disorder it is a symptom of. On a neurological level, it has been found that it can appear in cases of frontal lesions in the brain , in the basal ganglia or in the anterior cingulate, all of them areas related to motivation and the initiation of movements. These injuries can be caused by different disorders and diseases, as well as stroke or head trauma.

It can also be caused by different types of infections, such as syphilis, if it ends up affecting the brain. Similarly, abulia-like symptoms can be seen in people who are anaemic, lacking a number of essential nutrients .

In addition to these biological causes, it is possible to find states of abulia in people who suffer or have suffered prolonged stress over time , with a high level of frustration and suffering that is lived with helplessness and hopelessness.

Disorders in which it appears

Abulia as a symptom can occur in a number of disorders and diseases . Some of these are as follows.

Dementia

Abulia is a characteristic symptom in people with different dementias such as Alzheimer’s , due to the progressive degeneration of brain structures that occurs in this type of disorder.

Major depression

One of the mental disorders in which abulia occurs most often is major depression. The state of demotivation, hopelessness and feeling of little control can end up generating a lack of desire to act, and many times this occurs together with the absence of pleasure in pleasant activities, a phenomenon called anhedonia.

Schizophrenia

Abulia can also appear in psychotic-type disorder, such as schizophrenia . In this case we would be facing a negative symptom that would reduce the subject’s usual vital functioning capacity, and it is frequent to appear together with alogia. If we consider the existence of different types of schizophrenia, schizophrenias of disorganized, simple or catatonic subtype are some of those that may appear more frequently and more visibly. It can also be seen as a residual symptom after a psychotic break.

Possible treatments

Treating abulia as a symptom is possible in a large number of cases, although the treatment in question will depend largely on its causes. Treatment can be done on both psychological and pharmacological levels .

At the psychological level, the use of different strategies applied in cases of depression is recommended. These strategies are based on encouraging action and carrying out different activities that are pleasant and gradually awaken motivation and the desire to act. Helping and motivating to create and carry out different actions and routines is fundamental, while working on the beliefs and thoughts that may have caused or maintained the problem.

It can be useful to provide guidelines, tools and information to the patient’s family and close environment, so that they can contribute to establishing and maintaining different goals and proposals that generate desire and willingness to act. In some cases it can be very useful to carry out physiotherapy in order to provoke an increase in motor activity, as well as sport, which in turn can help to generate endorphins.

At the pharmacological level , antidepressants are especially effective, especially those that cause an increase in the level of dopamine. Other stimulant substances may also be useful in this regard.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Marin, R. S. & Wilkosz, P. A. (2005). Disorders of diminished motivation. Journal of Head Trauma Rehabilitation, 20(4).

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  • Santos, J.L. (2012). Psychopathology. CEDE PIR Preparation Manual, 01. Madrid.
  • Vijayaraghavan, L.; Krishnamoorthy, E. S.; Brown, R. G. & Trimble, M. R. (2002). Abulia: A Delphi survey of British neurologists and psychiatrists. Article]. Movement Disorders, 17(5), 1052-1057.