Apathy is a symptom or temporary mental state characterized by indifference, emotional coldness, indifference. It is manifested by indifference, detachment from what is happening, lack of motivation for any activity, a decrease in emotions, slowness of actions. Diagnosis depends on the cause of apathy, the main methods are clinical conversation, observation, psychological testing. Additionally, a neurologist’s examination, instrumental brain studies are prescribed. Symptomatic treatment methods include psychotherapy, pharmacotherapy, correction of the daily routine.
During the period of apathetic mood, indifference to all external events is formed, emotions become weakly expressed or absent at all, interest and desire for action decreases. In men, this condition manifests itself more clearly, occurs more often: they spend a significant part of the time at home, do not go out to work, refuse friendly meetings, habitual hobbies, sports. In women, apathy is formed less often due to their natural emotionality and greater involvement in social interactions – caring for children, communicating with friends, meeting with parents.
The basic psychological mechanism for the development of apathy is the depletion of reserves of mental energy (emotions, motives, involvement). In healthy people, indifference and indifference 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, arising as a defensive reaction, is fixed as part of the personality, and then subconsciously used in certain periods of life.
The key manifestations of the apathetic state are the lack of expressed emotions, interest in the events taking place and the people around them. As a result of these changes, there is a rejection of work, household duties, a narrowing of the circle of communication. In men, apathy is accompanied by an 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, be angry. Apathetic people are often scattered, inattentive, unable to cope with their usual tasks: they cannot choose clothes, make a shopping list, cook dinner.
Other characteristic symptoms that are equally common in both men and women are general weakness, slow reactions, a feeling of loneliness, memory impairment. Laziness and depression should be distinguished from apathy, since these conditions are very similar symptomatically. Laziness is selective – you do not want to perform certain actions that do not bring pleasure. At the same time, a person can easily start doing what he likes – going for a walk, meeting with friends. Apathetic states cause paralysis of any activity, complete lack of desires.
Depression is characterized by a decrease in mood, the predominance of negative emotions – sadness, sadness, disappointment, depression. When apathy develops, positive and negative emotions are smoothed out, practically absent. Anxiety depression occurs with motor anxiety, an apathetic state is always accompanied by slowness of movement. Sometimes it becomes a manifestation of severe depression: patients are indifferent to the events taking place, they sit or lie for a long time without moving, without talking.
Causes of apathy
Emotional exhaustion develops as a result of stress, traumatic situations, suffered somatic diseases. In addition, it is a symptom of mental disorders and organic lesions of the nervous system. Apathy can be a temporary condition, a manifestation of another pathology, a side effect of taking medications. In men, it is often formed against the background of alcohol and drugs. It occurs as an independent disorder, in combination with lack of will, it is an apathetic-abusive syndrome, and in the absence of motor activity – an adynamic syndrome.
In men and women, mild apathy can be a character trait combined with low social activity, slowness, phlegm. The causes of apathy as a state of maladaptation are situations that exhaust motivational and emotional resources. Personal qualities or external events for which a person was not prepared are considered as provoking psychological factors. Common causes of apathy:
- Unattainable goals. People with a high level of self-demands tend to set high goals and make every effort to achieve them. The reasons for apathy in such cases are super-difficult, impossible tasks that reduce faith in success, generate dissatisfaction with oneself.
- Lack of purpose. The state of emotional emptiness and lack of initiative arises in situations when previous goals have been achieved, but new ones have not been formed. The forces are spent, the needs are satisfied, the person is apathetic for a while. Examples of such situations: a student after passing a session, an entrepreneur who has achieved a high profit.
- Lack of independence. This personality trait is manifested by a passive-defensive behavior strategy. The reasons for apathy are shifting responsibility to other people, a wait-and-see attitude, fear of failure, lack of independence.
- Stress. Sometimes situations of high emotional tension provoke the development of a defensive reaction – apathy. The psyche involuntarily goes into energy-saving mode: the patient ceases to defend his position, loses interest in activity, becomes indifferent, indifferent.
- Frustration. This term refers to a condition that occurs when it is impossible to satisfy an urgent and strong need. For women, the typical causes of apathy are an unsuccessful marriage, the fear of divorce; for men, the performance of an unloved job, the lack of prospects for other earnings.
- The monotony of life. A common cause of apathy in women is a lack of new experiences, an established regime with a lack of interesting activities. Most everyday things are done automatically, events are predictable, and there is no time for hobbies, creativity and research.
- Emotional shock. Apathy as a defensive reaction of the psyche, is formed in response to intense positive or negative experiences. For women, it is provoked by the birth of a child, for men, the main reasons are the loss of their former social status, dismissal from a high position, refusal to accept a job.
Possible causes of pathological apathy are 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 help from relatives. The most common mental illnesses occurring with apathy include:
- Depression. The main signs of depressive disorder are low mood, loss of the ability to have fun, a sense of meaninglessness of what is happening. There is apathetic depression – a state of indifference, indifference. It develops more often in women, provoked by prolonged stress.
- Schizoid personality disorder. Schizoid psychopathy is a pathological change in character, manifested by isolation, stinginess of emotional experiences, a tendency to theorize and philosophical reflections. It is more often determined in men. Such people may seem apathetic in the sphere of social contacts, but often have peculiar hobbies.
- Schizophrenia. This endogenous mental disorder is characterized by the disintegration of thinking processes, flattening, impoverishment of emotional reactions. The longer and more severe the disease, the more pronounced the emotional coldness, indifference becomes. More often apathetic states are observed as a manifestation of sluggish schizophrenia with a gradual continuous deterioration of the patient’s condition.
- Hospitalism. With a long stay of the patient on inpatient treatment, lack of communication with loved ones, a mental disorder is formed – hospitalism. It is more pronounced in women, children, and the elderly. It is manifested by weight loss, lethargy, apathy, drowsiness, isolation.
Apathy can be a symptom of neurological diseases – dementia, brain tumors, strokes, neuroinfections, traumatic brain injuries. It manifests itself on the basis of organic brain damage (vascular, neurodegenerative, traumatic). It is especially characteristic for pathologies accompanied by damage to the frontal lobe, anterior cerebral artery, pituitary gland or limbic structures. Common neurological causes of apathy:
- Infections. Apathetic symptoms appear in neuroinfections, when pathogens spread in nerve tissues, as well as in general severe infections with secondary involvement of the nervous system in the pathological process. So, meningitis is characterized by fever with a change of apathetic states with strong anxiety. For HIV infection – a gradual increase in apathy, depression.
- Dementia. The cause of apathy in dementia patients are changes in the white matter of the brain, which occur due to age-related degradation of small blood vessels. 82% of elderly women and men with frontal lobe lesions have signs of apathy: dulling of emotions, decreased motivation and initiative. The risk group includes patients with Alzheimer’s disease, Pick’s disease, vascular and mixed dementia.
- Long-term consequences of TBI. Mental disorders often occur in the long-term period of traumatic brain injury. Apathy is diagnosed in people with astheno-neurotic syndrome, in whom the consequences of trauma are represented by high fatigue, reduced performance, memory disorders.
- Brain tumors. Indifference and indifference are observed in cases where the neoplasm is localized in the frontal lobes or pituitary gland. Signs of emotional disturbance appear already at the initial stages of tumor development, in addition to apathy, they may include depression, infantilism, tearfulness, irritability.
Taking medications and alcohol
Prolonged use of some drugs leads to the development of side effects accompanied by apathy. The highest risk is when taking tranquilizers, antidepressants, sleeping pills, oral contraceptives, antibiotics. Another possible cause of apathy is withdrawal syndrome (alcohol hangover). In both cases, emotional disorders are caused by biochemical changes in the processes of the central nervous system in the parts of the brain responsible for emotions. Apathy occurs within the following syndromes:
- Neuroleptic syndrome. Prolonged use of neuroleptics can cause affective disorders, decreased cognitive functions, and social activity. Mental retardation, akinesia, asthenia develops. Neuroleptic deficiency is more common among men and women with bipolar affective disorder, schizophrenia, and endogenous depression.
- SSRIs-induced syndrome. This complication is a consequence of long-term treatment with antidepressants of the group of selective serotonin reuptake inhibitors. It is manifested by dulling emotions, reduced emotional sensitivity, a feeling of “emotional anesthesia”. Apathetic syndrome is found in patients with panic disorder, generalized anxiety disorder, depression, obsessive-compulsive neurosis.
- A 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 deform the natural sleep formula, suppress the fast phase. After waking up, there is a feeling of fatigue, decreased performance, formed emotional detachment, indifference.
- Withdrawal syndrome. The reason for the apathy of men who abuse alcohol is withdrawal states (hangover). At the first stage of alcoholism, when alcohol consumption is interrupted, a feeling of weakness and drowsiness appears, apathy or irritable aggressiveness increases. At the second stage, vegetative disorders become more pronounced – headaches, blood pressure drops, increased sweating.
To find out the causes of apathy, it is necessary to consult a psychiatrist and a neurologist. The examination begins with a clinical survey 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 on their own, a conversation is held with relatives. During the observation, the absence of external manifestations of emotions, slowness, and weakening of motivation come to the fore. To more accurately determine the cause of apathy, the following methods are shown:
- Psychodiagnostic testing. The use of psychodiagnostic techniques makes it possible to diagnose apathy as a symptom of a mental illness or a state of psychological maladaptation. A set of tests for men and women is selected individually by a psychologist. Various self-assessment tests are used, for example, the Beck depression scale, and complex personality questionnaires – the Kettell questionnaire, the Eysenck questionnaire. If schizophrenia or dementia is suspected, a pathopsychological study of cognitive functions (thinking, intelligence, memory) is carried out.
- Neurological examination. Apathetic patients with symptoms of nervous system damage are examined by a neurologist. With the help of a survey and special samples, the neurological status is assessed, the nature of the central nervous system lesion (focal, diffuse), the localization of the focus is determined, the main pathophysiological mechanism is established. The neurological examination data allow the doctor to guess the causes of apathy and select instrumental procedures to clarify the diagnosis.
- Instrumental study of the brain. To assess the nature of brain damage, to determine the localization of the focus, imaging research methods are used: MRI of the brain and feeding vessels, ultrasound of the vessels of the head and brain structures, CT of the brain. Apathy often accompanies the defeat of the prefrontal zones, pituitary gland, limbic system.
Apathy is not always a condition that needs to be treated. If a person has become less emotional and proactive after a period of high loads or a traumatic situation, it is necessary to give the body time to recover – to ensure a full sleep, a healthy diet, to protect from experiences, mental stress. If the apathy is pronounced, lasts for more than a week, significantly worsens the quality of life of the patient, special treatment is necessary, including psychotherapy, taking medications, changing the rest and work regime.
Psychotherapy and psychological counseling are necessary for patients with severe apathy. Methods of cognitive behavioral therapy and psychoanalysis are used to improve the condition. The specialist conducts individual sessions at which the probable causes of apathy, ways to overcome apathy are discussed. The patient, with the help of a psychologist, learns again 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 a person’s interest and motivation.
If excessive exertion and overwork become the cause of apathy, minimal medical support is shown to help the body recover faster. Vitamin and mineral complexes, plant adaptogens are prescribed, for example, tincture of ginseng or eleutherococcus. With pronounced apathy due to mental and neurological diseases, pharmacological drugs are used: psychostimulants, antidepressants, analeptics. Their combination, dosage and duration of administration are determined by the doctor individually.
Along with the main treatment aimed at eliminating the cause of apathy, it is recommended to introduce new activities into the daily plan, even if at first they will seem uninteresting. It is necessary to remember which hobby was fascinating before – sports, art, self-education. It is necessary to avoid stressful situations, alternate periods of work and rest, adhere to a healthy diet, moderate exercise regime. It is important to involve close people in the rehabilitation process, at the first stages their will is the main organizing and stimulating factor.