Abulia: symptoms and treatments

"I don't have the strength for anything", "I'm not interested", "I try, but I can't". Those are the most frequent phrases that patients say in consultation sessions. At the same time, it is what is known as abulia.

Apathy takes the form of extreme apathy and it manifests itself in the lack of interest, will and energy to carry out any activity. Whether it is something simple or something more complex, depending on the particular case.

Symptoms associated with abulia

Some of the symptoms that allow us to account for the presence of abulia are the following:

• Lack of motivation and interest to carry out any type of activity, both those that gave pleasure and those that are more routine, such as work or academic.
• Loss of the capacity for pleasure.
• Acknowledgment that certain activities must be done or that certain things must be started, but that they are never achieved. Apathy leads to procrastination.
• Loss of interest also manifests itself at the level of relationships. Hence there are difficulties at the communicative level (there is no interaction, it is answered with monosyllables, a dialogue is not started or continued). Similarly, sexual interest decreases or is lost.

• There may also be a neglect or neglect of personal hygiene.
• Emotional dullness: so there may be indifference or difficulties in giving an adequate response to the situations that are experienced.
• There is slowing of movement or motor inhibition.

Regarding the severity of the symptom, its presence is not a problem in itself, since many times in our lives we can experience difficulty in starting an action or feeling motivated. The problem lies in its persistence over time.

On the other hand, it is important to know that abulia is part of mood disorders, such as dysthymic or depressive.

What causes it?

Regarding the causes, like almost all situations or problems in psychology, there is no single origin. On the contrary, it also depends on what disorder we are referring to.

In certain cases we speak of neuroendocrine alterations (due to a greater production of cortisol). Or, at the neurological level, there are findings that refer to structural or functional affectations of different areas of the brain, such as lesions in the basal ganglia.

In mood disorders, such as depression, disturbances in the neurotransmitters serotonin, norepinephrine, and dopamine are known to occur. Therefore, one option is to work on the symptom at a pharmacological level with antidepressants.

But It could also appear alongside psychological or psychosocial factors, when the prolonged and intense presence of stressful situations or experiences of trauma are usually common.

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How is abulia diagnosed?

Starting from recognizing the complexity of the phenomenon and its possible multi-causality, the diagnosis must be comprehensive, inquiring at a neurobiological and psychological level.

It is important to pay attention to the individual aspects, reconstructing the patient's life history and possible adverse events that may be affecting. Also recognize whether or not there are social factors that may have triggered apathy or may be reinforcing it.

For the elaboration of the diagnosis, the interviews with the patient are of utmost importance, but the testimony of relatives can also be enlightening. As long as you can have as much information as possible, you can better guide the treatment plan.

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Available treatments

Treatment depends a lot on the diagnosis that has been reached. As mentioned, abulia is part of different disorders. Usually, a combination of psychotherapy and pharmacology can be done, if deemed necessary.

Regarding the type of therapy, although there are multiple approaches, cognitive is one of the most used, since it works on the restructuring of the beliefs and thoughts that the patient may have about himself and his current state. Likewise, behavioral activation also forms part of the interventions used.

On the other hand, psychoeducation is also very important, both to facilitate understanding of the problem and to make the patient the protagonist of their change. This allows you to take self-care measures and progressively improve your quality of life.

Tips so that apathy does not control your life

One of the greatest difficulties of abulia has to do with the vicious circle that is established. For example, as the person loses interest in their relationships, this causes them to be discouraged, which further reinforces their apathy. It is important take small actions to break that spiral.

Asking for help is already a challenge for people with apathy. In general, the very apathy in which they find themselves, low self-esteem and emotional inhibition work as obstacles.

1. Celebrate small achievements

For people with apathy, anything, however minimal it may seem, is a difficult mission. So try to involve them in small, realistic activities, gradually.

For example, asking you to go for a 30-minute walk a day. If it succeeds, that achievement should be valued and celebrated, motivating and supporting it to continue in the same direction.

2. Introduce new habits

It is also very important to focus on good habits, such as a balanced diet, some physical activity and good sleep hygiene. In psychotherapy they usually work through the scheduling of daily activities, as one of the possible intervention techniques, allowing the patient to receive some reinforcements each time they are able to comply with them.

3. Encourage (and accompany) the performance of activities

People with abulia will not want to participate in any activity, since they have lost motivation. However, those around them should encourage them to accept proposals, even if they are reluctant. That way it is easier to regularize the situation and regain interest.

Family and affections can accompany, providing emotional support, encouraging socialization, encouraging people to speak and expressing their emotions and feelings.

As part of recovery, the plans outlined often include not only the therapist and the patient, but the family system.

Apathy is not solved overnight

Working with abulia requires that we have patience. The steps are small, but getting them started and moving is a huge achievement.

It is essential to be realistic in the goals and in the proposed treatment, so that frustration is not generated. But it is equally important to have a supportive environment that can accompany the person on the path to feeling better, since isolation worsens the picture.