Coping with apathy

Apathy

Apathy is a symptom or temporary mental condition characterized by indifference, emotional coldness, and indifference. It is manifested by apathy, detachment from what is happening, lack of motivation for any activity, decreased emotions, and slowness of action. Diagnosis depends on the cause of apathy, the main methods are clinical conversation, observation, psychological testing. In addition, an examination by a neurologist and instrumental studies of the brain are appointed. Symptomatic methods of treatment include psychotherapy, pharmacotherapy, and correction of the daily routine.

General characteristics

In the period of apathetic mood, indifference to all external events is formed, emotions become weak or absent altogether, interest and desire for action are reduced. In men, this condition is more pronounced and occurs more frequently: they spend a considerable part of their time at home, do not go out to work, refuse friendly meetings, habitual hobbies, sports. Women’s apathy is formed less often due to their natural emotionality and greater involvement in social interactions – childcare, communication with girlfriends, meetings with parents.

The basic psychological mechanism for the development of apathy is the depletion of mental energy reserves (emotions, urges, involvement). In healthy people, indifference and apathy are the result of prolonged excitation of the central nervous system. The brain begins to induce inhibition processes, protecting the body from further waste of energy, excessive nervous tension. Sometimes apathy, occurring as a defensive reaction, is fixed as part of the personality, and then subconsciously used in certain periods of life.

The key manifestations of an apathetic state are lack of expressed emotions, lack of interest in the events and people around you. As a consequence of these changes, there is a rejection of work, household duties, narrowing of the circle of communication. In men, apathy is accompanied by unwillingness to perform hygienic procedures, get out of bed, and eat. In women, emotional devastation is more noticeable – loss of interest in communication and hobbies, inability to rejoice, be sad, or be angry. Apathetic people are often absent-minded, inattentive, unable to cope with their usual activities: they cannot choose clothes, make a shopping list, or cook dinner.

Other characteristic symptoms that are equally common in both men and women are general weakness, slowness of reactions, a feeling of loneliness, and impaired memory. Laziness and depression should be distinguished from apathy, as symptomatically these conditions are very similar. Laziness is selective – there is no desire to perform certain activities that do not bring pleasure. At the same time, a person could easily begin to do something that he or she enjoys – go for a walk, to meet with friends. Apathetic conditions cause paralysis of any activity and the complete absence of desires.

Depression is characterized by a decrease in mood, the prevalence of negative emotions – sadness, grief, frustration and depression. When apathy develops, positive and negative emotions are subdued, practically absent. Anxiety depression proceeds with motor restlessness; the apathetic state is always accompanied by slowness of movements. Sometimes it becomes a manifestation of severe depression: patients are indifferent to the events that occur, sit or lie still for long periods without moving or talking.

Causes of apathy

Emotional exhaustion develops due to stress, psychotraumatic situations, somatic diseases. In addition, it is a symptom of mental disorders and organic lesions of the nervous system. Apathy may be a temporary condition, a manifestation of other pathologies, or a side effect of taking medications. In men, it is often formed against the background of taking alcohol or drugs. It appears as an independent disorder, in combination with a lack of willpower is an apathetic-abulic syndrome, and in the absence of motor activity – adynamic syndrome.

Psychological causes

In men and women, mild apathy can be a character trait, combined with low social activity, slowness, phlegmatic. Causes of apathy as a state of maladaptation are situations that deplete motivational and emotional resources. Personal qualities or external events, to which a person was not prepared, are seen as provoking psychological factors. Common causes of apathy:

  • Unattainable goals. People with high expectations of themselves tend to set high goals and work hard to achieve them. The causes of apathy in such cases are super-tough, impossible tasks that reduce faith in success, generating dissatisfaction with themselves.
  • Lack of Purpose. The state of emotional desolation and lack of initiative arises in situations where previous goals have been reached, but no new ones have been formed. Strengths are squandered, needs are satisfied, and the person is apathetic for some time. Examples of these situations are: a student after the exam, an entrepreneur who has achieved a high profit.
  • Incompetence. This personality trait is manifested by a passive-defensive strategy of behavior. Reasons for apathy are shifting responsibility to other people, an expectant attitude, fear of failure, and lack of independence.
  • Stress. Sometimes situations of high emotional tension provoke the development of a protective reaction – apathy. The psyche involuntarily shifts into a mode of energy conservation: the patient ceases to defend his or her position, loses interest in activity, and becomes apathetic, indifferent.
  • Frustration. This term refers to a condition that occurs when an urgent and strong need cannot be met. For women, typical causes of apathy are a failed marriage, fear of divorce; for men, it is the performance of a job that they do not like, the lack of prospects of other earnings.
  • The monotony of life. A common cause of apathy in women is a lack of new impressions, a settled routine with a lack of interesting activities. Most of the daily routine is done automatically, events are predictable, and there is no time for hobbies, creativity and research.
  • Emotional turmoil. Apathy as a defensive reaction of the psyche, formed in response to intense positive or negative experiences. In women, it may be provoked by the birth of a child, while among men, the main causes are the loss of a previous social status, dismissal from a high position, refusal of employment.

Mental illness

Possible causes of pathological apathy – mental disorders. In patients, signs of apathy are pronounced, reduce social activity, hinder the implementation of household chores, hygiene procedures. Often, such people need daily outside care, organizing and stimulating assistance from relatives. The most common mental illnesses occurring with apathy include:

  • Depression. The main signs of a depressive disorder are a lowered mood, loss of the ability to derive pleasure, and a sense of the meaninglessness of what is happening. There is apathetic depression – a state of indifference, apathy. It develops more often in women, and is provoked by prolonged stress.
  • Schizoid personality disorder. Schizoid psychopathy is a pathological change of character, manifesting itself as reticence, reticence to emotional experiences, propensity to theorizing and philosophical reflections. More often defined in men. Such people can seem apathetic in the sphere of social contacts, but often have original hobbies.
  • Schizophrenia. This endogenous mental disorder is characterized by decay of thinking processes, flattening, impoverishment of emotional reactions. The longer and more severe the course of the illness, the more pronounced becomes emotional coldness, indifference. More often, apathetic states are observed as manifestation of sluggish schizophrenia with gradual continuous deterioration of the patient’s condition.
  • Hospitalism. When a patient is hospitalized for a long time and does not communicate with close people, a mental disorder – hospitalism – is formed. It is more pronounced in women, children, and the elderly. It is manifested by weight loss, lethargy, apathy, sleepiness, and withdrawnness.

Neurological diseases

Apathy can be a symptom of neurological diseases – dementias, brain tumors, strokes, neuroinfections, craniocerebral injuries. It appears on the basis of organic brain damage (vascular, neurodegenerative, traumatic). It is especially characteristic of pathologies accompanied by damage to the frontal lobe, anterior cerebral artery, pituitary gland or limbic structures. Frequent neurological causes of apathy:

  • Infections. Apathetic symptoms occur in neuroinfections, when pathogens spread to the nervous tissues, as well as in general severe infections with secondary involvement of the nervous system in the pathological process. Thus, for meningitis is characterized by fever with a change of apathetic states of strong anxiety. For HIV infection – a gradual increase in apathy, depression.
  • Dementia. The cause of apathy in patients with dementia are changes in the white matter of the brain that occurs due to age-related degeneration of small blood vessels. In 82% of elderly women and men with lesions of the frontal lobes there are signs of apathy: dulling of emotions, reduction of motivation and initiative. The risk group includes patients with Alzheimer’s disease, Pick’s disease, vascular and mixed dementia.
  • Long-term sequelae of a traumatic brain injury. Mental disorders occur more often in the remote period of the craniocerebral trauma. Apathy is diagnosed in individuals with astheno-neurotic syndrome in whom the consequences of trauma are represented by high fatigability, reduced working capacity, memory disorders.
  • Brain tumors. Indifference and indifference are observed in cases when the neoplasm is localized in the frontal lobes or pituitary gland. Signs of emotional disturbance are already evident in the initial stages of tumor development, and in addition to apathy may include depression, infantilism, tearfulness, irritability.

Taking medications and alcohol

Prolonged use of some medications leads to the development of side effects accompanied by apathy. The risk is highest when taking tranquilizers, antidepressants, sleeping pills, oral contraceptives, antibiotics. Another possible cause of apathy is withdrawal syndrome (alcohol hangover). In both cases, emotional disturbances are caused by biochemical changes in CNS processes in the parts of the brain responsible for emotions. Apathy occurs as part of the following syndromes:

  • Neuroleptic syndrome. Prolonged intake of neuroleptics can cause affective disorders, decreased cognitive functions, social activity. Mental retardation, akinesia, and asthenia develop. Neuroleptic deficits more often affect men and women with bipolar affective disorder, schizophrenia, and endogenous depression.
  • SSRI-induced syndrome. This complication is a consequence of long-term treatment with antidepressants of selective serotonin reuptake inhibitors. It is manifested by a dulling of emotions, decreased emotional sensitivity, and a sensation of “emotional anesthesia. Apathetic syndrome is found in patients with panic disorder, generalized anxiety disorder, depression, and obsessive-compulsive neurosis.
  • Side effect of sleeping pills. Sleeping pills have a depressing effect on the synaptic transmission of CNS signals, so a person feels drowsy and falls asleep. They distort the natural sleep formula, suppressing the fast phase. After waking up there is a feeling of fatigue, a decrease in performance, emotional detachment, indifference is formed.
  • Abstinence syndrome. The cause of apathy of men who abuse alcohol – withdrawal states (hangover). At the first stage of alcoholism, when there is a break in drinking, a feeling of brokenness and drowsiness, apathy or irritable aggressiveness grows. At the second stage vegetative disorders become more pronounced – headaches, blood pressure fluctuations, increased sweating.

Examination

To find out the causes of apathy, it is necessary to see a psychiatrist and neurologist. The examination begins with a clinical questioning of the patient: the duration and severity of apathy, provoking factors are found out. With severe apathy, patients remain indifferent, do not answer the doctor’s questions independently, and the conversation is conducted with relatives. During observation, the absence of external manifestations of emotion, sluggishness, and weakened motivation come to the forefront. For a more exact definition of the cause of apathy, the following methods are indicated:

  • Psychodiagnostic testing. The use of psychodiagnostic techniques allows apathy to be diagnosed as a symptom of mental illness or a state of psychological maladjustment. The set of tests for men and women is selected individually by the psychologist. Various tests of self-esteem are used, for example, the Beck Depression Scale, and complex personality questionnaires – the Quattell Quiz, the SMIL, the Eisenka Questionnaire. If schizophrenia or dementia is suspected, a pathopsychological examination of cognitive functions (thinking, intelligence, memory) is performed.
  • Neurological examination. Apathetic patients with symptoms of lesions of the nervous system are examined by a neurologist. The neurological status is assessed by questioning and special tests, the nature of CNS lesion (focal, diffuse), localization of the focus, and the main pathophysiological mechanism is determined. The data of neurological examination allow the doctor to assume the causes of apathy and select instrumental procedures to clarify the diagnosis.
  • Instrumental examination of the brain. Imaging techniques are used to assess the nature of brain damage, to determine the localization of the focus: MRI of the brain and feeding vessels, ultrasound of the head vessels and brain structures, CT of the brain. Apathy often accompanies lesions of the prefrontal areas, pituitary gland, and limbic system.

Treatment

Apathy is not always a condition that needs to be treated. If a person becomes less emotional and proactive after a period of high stress or a psychotraumatic situation, it is necessary to give the body time to recover – provide adequate sleep, a healthy diet, protect from worries and mental stress. If apathy is pronounced, lasts more than a week, significantly worsens the quality of life of the patient, special treatment is needed, including psychotherapy, taking medications, changes in rest and work regime.

Psychological assistance

Psychotherapy and psychological counseling are necessary for patients with severe apathy. Methods of cognitive-behavioral therapy and psychoanalysis are used to improve the condition. A specialist conducts individual sessions in which the probable causes of apathy are discussed, as well as ways to overcome apathy. With the help of the psychologist, the patient again learns to feel his emotions, set goals and resist stressful influences. At the second stage of therapy it is possible to attend group trainings – interaction with other people increases interest and motivation of the person.

Medication treatment

If the cause of apathy is excessive stress and fatigue, minimal medication support is indicated to help the body recover faster. Prescribed vitamin and mineral complexes, herbal adaptogens such as tincture of ginseng or eleutherococcus. If apathy is pronounced due to mental and neurological diseases, pharmacological drugs are used: psychostimulants, antidepressants, analeptics. Their combination, dosage and duration of intake are determined by the doctor individually.

Lifestyle correction

Along with the main treatment, aimed at eliminating the cause of apathy, it is recommended to bring new activities into the daily plan, even if at first they will seem uninteresting. It is necessary to remember what hobbies were fascinating before – sports, art, self-education. It is worth avoiding stressful situations, alternate periods of work and rest, adhere to a healthy diet and moderate physical activity. It is important to involve close people in the rehabilitation process as their will is the main organizing and motivating factor during the first stages.

Fundamentals of clinical psychology. Textbook for higher education institutions. Kulganov V.A., Belov V.G., Parfenov Y.A. – 2012.

2. apathy in the structure of mental and neurological disorders of late age/ Avedisova A.S., Gecht A.B. et al.// Journal of neurology and psychiatry named after S.S. Korsakov. S.S. Korsakov – 2014 – №6.

What is apathy and how to fight it. Tips of a psychologist.

Amid the ongoing coronavirus pandemic, more and more people are experiencing various psychological problems. One of these conditions can be apathy. We tell you how it manifests itself and how to cope with it.

Anastasia Afanasyeva, psychiatrist, psychotherapist, specialist of psychological services Alter

What is apathy

Apathy is indifference and lack of emotion. The word “apathy” itself comes from the Greek word “pathos” – “emotion, feeling, suffering”, to which the prefix “a” is added, introducing the meaning of negation. Apathy was originally defined as freedom from suffering, but sometime in the eighteenth century the word came to mean a feeling of absence of any emotion or feeling, especially with regard to matters that are important or interesting.

Apathy is often seen to some degree in healthy people, but also serves as a symptom of various mental and physical health problems. It should be understood that apathy is not a separate condition, but a syndrome that can be part of the structure of absolutely different diseases, from depression and Alzheimer’s disease to the initial stages of infectious diseases.

Apathy can vary in severity. Milder forms can manifest themselves in difficulty in choosing actions or some of the most common household steps, unwillingness to do anything. Often, apathy goes hand in hand with anhedonia – the absence of joy and pleasure from activities that used to bring joy. In severe cases, apathy reaches a stage where people have difficulty getting out of bed, taking a shower, even going to the bathroom if necessary, they cannot choose clothes, make a shopping list, or take care of themselves. Those experiencing this condition are indifferent to events, sit or lie still for long periods without moving or talking. This condition is characterized by absent-mindedness and inattention.

In neglected and severe cases, apathy can lead to the fact that a person completely stops taking care of himself, watching the timely consumption of food and personal hygiene. As a result, exhaustion, exacerbation of chronic diseases, and the emergence of infections are possible.

Symptoms of apathy

Apathy can be suspected by the following symptoms:

  • Difficulty performing daily tasks;
  • a sense of indifference;
  • lack of emotion;
  • lack of interest in activities;
  • lack of motivation to achieve goals;
  • low energy level;
  • sharp decrease in social activity (unwillingness to meet with friends, celebrate a birthday, or even go to the store)
  • unemotional reactions to both positive and negative events;
  • frequent shifting of the planning of one’s life, affairs and decisions to others;
  • absence of desire to learn something new, to get acquainted with new people, to receive new experiences;
  • indifference to his or her own problems.

Apathy Test

Answer the following questions:

  • Do you experience a constant feeling of boredom?
  • Do you have a plan of action for the week?
  • Has your productivity and efficiency decreased recently?
  • Have you experienced indifference in response to a pleasant event in your life?
  • Have you experienced indifference in response to a negative event in your life?
  • Do you not want to participate in any activities that you used to enjoy?
  • Do familiar activities require too much effort?
  • Doesn’t anything interest you?
  • Don’t know what you want or how to achieve it?
  • Does getting to know other people not resonate with you emotionally?
  • Do you expect others to make decisions for you?
  • Do you feel empty or empty?
  • Do you feel that everything is meaningless or useless?
  • Do you feel sleepy all the time, and does a long nap not give you a sense of rest?

If you answered yes to many of these questions, you are probably in a state of apathy and should consult a doctor.

Causes of apathy

Psychological causes

  • Harsh demands on yourself – if you set a knowingly unattainable goals or set yourself excessive demands that are impossible to meet, often there is a feeling of “futility” of all the efforts and reluctance to move forward.
  • Inability to understand one’s own goals and values causes a feeling of confusion about what to do and how to act further.
  • Infantilism or immaturity – expecting other people to take responsibility.
  • Learned helplessness – fear of doing things on one’s own because of the expectation of punishment for any actions.
  • Acute stress reaction – “stupor” and insensitivity as a momentary response to a severe traumatic event or stress.

Mental illness

Apathy is a fairly common part of mental health disorders. It is mostly:

  • Depression (it can be either isolated or as part of or due to other illnesses, such as BAR – bipolar affective disorder).
  • Schizophrenia and psychotic disorders. Apathy as part of these illnesses most often appears in the late stages and is extremely difficult to treat.

Taking certain medications, substance abuse, and alcohol abuse

Among such problems:

  • Side effects of neuroleptics (medications to treat psychosis, mood disorders and sleep disorders) – lethargy, asthenia and apathy may develop.
  • Prolonged treatment with antidepressants of the group of selective serotonin reuptake inhibitors (fluoxetine, citalopram and other drugs). This can lead to such complications as SSRI-induced apathy syndrome. It is manifested by a dulling of emotions, decreased emotional sensitivity, a feeling of “emotional anesthesia”.
  • Overuse of tranquilizers also leads to lethargy during the day, apathy, unwillingness to do anything, absence of emotions.
  • Withdrawal syndrome (“withdrawal”) or hangover. Often there is a feeling of brokenness and sleepiness, and apathy or irritable aggressiveness increases.

Neurological disorders

A 2011 study found lesions in the frontal lobes of the brain in people with symptoms of apathy. The “apathy center” is thought to be located in the front part of the brain, which controls our emotions, goals and behavior. So anything that affects the frontal cortex can lead to the development of apathy:

  • Craniocerebral injuries (concussions, contusions);
  • Neuroinfections (meningitis, HIV infection, syphilis of the brain, and others);
  • Alzheimer’s disease;
  • Frontal temporal degeneration;
  • Brain tumors with localization in the frontal area;
  • stroke or cerebral infarction.

How to get rid of apathy

  • Seek a consultation with a psychiatrist or neurologist . You can start with either of the specialists, since the causes of apathy, as mentioned above, can be different – you need to act by method of elimination.
  • It may be necessary to take blood tests or do brain tests (as directed by the doctor).
  • Adjust your lifestyle – spend a lot of time on sleep (preferably according to a schedule, with compliance with sleep hygiene), eat right, try not to overexert yourself.
  • See a psychologist for psychotherapy to learn to better understand your values and goals, take responsibility and experience less stress, and better cope with it.
  • Take therapy prescribed by your doctor for mental disorders or infectious diseases (most likely antidepressants or antiviral medications and antibiotics).

When feeling very apathetic it is important not to give in to it, but to make a list of activities that you, even if not now, but once liked, and do something from this list every day for at least 5-10 minutes. This is called behavioral activation. It is useful to mark your successes (for example, today you went for a walk for 10 minutes).

How to help a person with apathy

It is best to talk the person with apathy into seeing a doctor. Since a person in such a state feels little and it is difficult for him to do anything on his own, this is not an easy task. However, only a doctor, with the help of diagnostics and tests, will be able to determine the cause of apathy and recommend effective treatment, because apathy can be caused by absolutely different causes, from psychological to severe neurological.

If we are talking about psychological and psychiatric causes of apathy, then, in addition to going to the doctor, it is important to activate the person. Take him out for a little walk that will not tire him too much, do things with him that he used to enjoy (for example, watching small movies or commercials), and involve him little by little in family or group activities. The main thing is to do it a little at a time and be happy about any successes. Because, for example, frying eggs for a person with depression and apathy can already be an achievement.

What you should not do with apathy

The main thing not to do with apathy is to succumb to it and lie in bed all day. However, there should be a balance in everything: denying your condition and overloading yourself with things will not help. Start by doing things a little at a time, as far as you will be strong enough – 5, 10, 15 minutes a day.

You should also not delay with the visit to the doctor, letting the condition go on its own, since the causes of its occurrence, as mentioned above, can be serious.

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