Abulia: A complete guide to beating a lack of motivation

 

Have you ever been so tired that you just didn’t want to do anything? Even things you usually enjoy doing? Have you ever lost the motivation to continue living life? Or ever had a friend experience this feeling? Some may refer to this feeling as laziness, however, this lack of willpower is actually a symptom of a having a mental health illness. In this article, you will find out everything you need to know about abulia. What is abulia, symptoms, causes, diagnosis, and treatment of abulia?

abulia

Abulia

What is Abulia?

Abulia, which can be spelled either abulia or aboulia, is recognized as a disorder of diminished motivation. It is not found in the DSM, however, it is seen as a neurological disorder. In layman terms, Abulia is primarily categorized as a disorder of motivationPeople with this experience no desire to partake in any activities. They simply say no when asked to join in on activities. It can be seen as just not wanting to go out anymore or it can be as extreme as akinetic mutism and no longer speaking, however, these cases are typically very rare.

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Coming from the Greek language, the word itself translates to mean “Will”. It has often been challenging to distinguish this disorder in individuals due to the lack of communication in the patient. It is especially difficult to distinguish abulia in elderly patients because caretakers often expect to see the “lack of will” and often assume that the individual just wants to relax and take time alone. Also, many other disorders can be comorbid with abulia when seen in the elderly. It is seen as a symptom of various psychotic disorders such as schizophrenia. The number of reported individuals who have reported this symptom is undeclared.

Abulia in Children

The number of childhood cases of abulia is unclear. However, doctors warn parents that this symptom is dangerous and they urge parents to pay closer attention to their child.  It is easy and quick for parents to assume that a child is simply just experiencing a lazy spell or is “just tired”. However, it is important to keep an eye out on the little ones. Abulia can also be hereditary, which can be seen in infancy, it usually manifests as being calm most of the time, they don’t cry or misbehave, and not playful. These symptoms can manifest into something much greater in the future if not treated immediately.

Symptoms of Abulia

Abulia is a deficit in a person’s motivation. People who have this symptom typically exhibit a lack of will to partake in activities and such. They tend to have “flat” emotions and/or emotionless facial expressions.

The severity of the disorder varies from person to person. As mentioned before, the disorder can range from mild apathy to extreme akinetic mutism. Abulia seems to fall right in the middle of the spectrum!

  • Apathy, the milder stages can be seen as lack of motivation through behaviors or an individual’s thoughts and achievements.
  • The severe end of the spectrum has akinetic mutism which is when a person does not physically move anymore and does not speak/communicate with individuals due to the lack of will and motivation.

Apathy and abulia can often be seen as combined words which form the syndrome Apato-Abulian. Apato-Abulian is caused by emotional insufficiency and movements which happen automatically. People often describe the syndrome as being trapped in a situation where they are faced trying to avoid communication at all means regardless of the closeness they may have to the person in the situation. The syndrome results in a loss of happiness in everyday activities and can be similar to anhedonia. On the other end of the spectrum, the Abulian-akinetic syndrome is a mixture of a lack of will and immobilization.

 

Abulia

Abulia on the scale of motivational deficits and disorders

Other symptoms are passivity and a lack of caring about anything that may happen, lack of spontaneity, emotional remoteness, indecisiveness and/or the chewing of food without swallowing, for a window of time, that is seen as longer than usual.

People with this disorder or symptom may have an untidy appearance and have trouble keeping themselves physically appealing. They may exhibit social isolation and take long pauses when speaking. They have trouble maintaining normal levels of hygiene and may face nutritional deficits in the long run because of the lack of will to do as much as eat. Emotions may begin to fade away the longer the disorder goes untreated, however, this is seen in the extreme cases of akinetic mutism.

Forms of Abulia

Abulia falls under the category of a strong-willed disorder, some other disorders seen under this category are:

  • Hyperbulia, which is a disorder that is primarily concerned with hyperactivity.
  • Hypobulia which is similar to abulia in the case that there is a decrease in motivation to take initiatives.
  • Parabulium which is when an individual’s behavior deviates from what is seen as “normal” and socially accepted.

Causes of Abulia

Abulia can be caused by various injuries to the brain and/or other diseases. The primary cause distinguished of abulia is seen as brain damage. Most cases of abulia are seen in dementia patients because of the interference in the brain fibers and circuits.

Damage specifically to the anterior cingulate circuit can result in this disorder or symptom. Recent studies have shown that damage to the frontal lobe results in the motivation disorder because it indirectly interferes with the dopaminergic system which is the system of brain chemicals responsible for providing the body with feelings of positivity and happiness.

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Damage to the capsular genu can also lead to this disorder. The genu is located in the corpus callosum of humans and is enclosed in a capsule-like form to protect it from any damage. Damage to this area affects the motor coordination of individuals and can harm fibers as well. It also causes cognitive deficits which can be seen through an individuals motivation.

Damage to the basal ganglia can also lead to this disorder. The basal ganglia is a part of the frontal lobe which has various functions. One of its important functions is that it controls the ability of individuals to interact with others socially and initiates movement.

Many psychologists and scientists today are linking the cause of abulia to be stress. They believe it deprives a person of the ability to simply be human, it takes away the will to do something and can be linked to an overwhelming rush of emotions. It can also be hereditary, which can be seen in infancy.

Diagnosis of Abulia

Many individuals who have had abulia or have shown symptoms of having it, have also experienced a stroke, degenerative diseases such as Parkinson’s disease and Huntington disease, schizophrenia or a psychotic disorder, brain injury resulting from a head trauma or cancer, Alzheimer’s disease, and Dementia.

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It may take some time to be diagnosed in individuals due to the similarities with other disorders. While abulia does have many common features of depression, it is very different. Individuals living with depression typically tend to have negative thoughts or extreme sadness throughout their day, while those with abulia may not. However, they tend to exhibit a lack of concern with everyday life situations.

In some cases, it can be diagnosed by using brain imaging scans and identifying any lesions or injuries to the frontal lobe and/or neurological testing. However, it is not seen as an independent disease and is not placed in the DSM, therefore the epidemiology is unknown.

Having depression is one of the biggest risk factors for abulia and according to the statistics, 40 million people in America over the age of 18 has been diagnosed with depression, it is safe to assume that maybe 1/3 of these patients have been diagnosed with abulia.

Abulia can be short-term, periodic or even chronic. The individuals who seem to exhibit short-term most often are drug addicts and alcoholics, these individuals are seen to have periods of highs and lows which are similar to the characteristics of bipolar disorder. These people have periods where they face manic episodes then exhibit abulia and the lack of will to do continue with anything.

Treatment of Abulia

Abulia, like many other disorders, can have several treatment options, some treatments may work well, while others may not. According to psychiatrists, it all depends on the patient and their mindsets.

Medications that are typically given are dopamine agents and medications that will restore the body’s dopaminergic system. Medications such as carbidopa and levodopa often help treat the symptoms of patients with abulia because it is a dopamine agent and helps aid the bodies central nervous system. According to a recent study, the patients who received carbidopa and levodopa had increased levels of dopamine in their prefrontal cortex.

Cognitive behavior therapy has also been seen to be effective in treating patients. Training individuals to think clearer and understand the importance or life again helps them overcome this heartbreaking disorder and helps them to regain their life again.

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Prevention of Abulia

Abulia does not have a preference. It can happen to anyone, of any race, gender or age without a warning. It can be prevented in children and adolescents by allowing them to pick up interest in a hobby, specifically music! It can also be prevented by trying to avoid danger situations which may and can result in possible head injuries.

Abulia

Abulia effects all ages and is known as a lack of motivation

Abulia is a serious medical condition which should not go untreated. In today’s society, there is so much negative stigma surrounding mental health which causes individuals to feel ashamed to get the proper treatment that is needed. It is a rare disorder but it is seen throughout many states. I think it is safe to assume that abulia can be one of the disorders that have gone untreated in many individuals because of the fact that it is so hard to diagnose and to be seen.

Instead of looking at your siblings or your coworkers and saying that they are lazy and never do anything and being quick to call them names, you should look at the bigger picture. Are they always like this? Do they want to do work? Are the interested in anything specific? Ask them these questions. Heck, ask everyone these questions! Everyone is fighting a battle that we may know nothing about, YOU can be the light in their life and make a difference.

If you find or a loved one, finds yourself feeling under the weather or lacking the initiative to get up and get out into this beautiful world (especially after suffering a minor or major a head injury) please consult your local doctor or psychiatrist immediately! Abulia is not caused by laziness and it is not your fault. Abulia is a serious mental health condition which should not go untreated. You can regain your life again with help!

 

References

Atkin, Melanie (2014). When get up and go is gone, lack of initiation and motivation after Brain Injury. Changed Lives and New Journeys.

Bakker, A., & Demerouti D. (2008). The Job Demands-Resources model: state of the art. Department of Work and Organizational Psychology, 15(3), 113-116

Bergland, C. (2016) Zero motivation to exercise? Dopamine Receptors could be the reason why. Psychology Today.

D’Souza, G., Kakoullis, A., Hegde, N & Tadros, G. (2010). Recognition and Management of Abulia in the Elderly. Progress in Neurology, 2(22), 4-5.

Fisher, C (1983). Honored Guest Presentation: Abulia minor vs. agitated behavior. Clinical Neurosurgery, 31(2), 9-31.

Gagne, M., & Deci, E. (2005) Self Determination Theory and Work Motivation. Journal of Organizational Behavior, 26(4), 331-362.

Miller, L., Chang, L., Mena, I., et al. (1993) Progressive right frontotemporal degeneration: Clinical, neuropsychological and SPECT characteristics. Psychology Journal, 4(3), 204-13.

Ryan, R., & Deci, E. (1985). Intrinsic and Extrinsic Motivations: Classic Definitions and New Directions. Contemporary Educational Psychology, 3(2), 233-241.

Nalini is currently working towards her Bachelors degree in Psychology and English, at Hunter College, the University of New York. She aspires to become a mental health counselor in the near future and a Clinical Psychologist in the long run. She is an advocate for the mental health community and believes that everyone deserves a chance to live a happy life, she believes that individuals should not feel ashamed of their mental states and hopes to alter the negative stigma surrounding mental health. Nalini is highly interested in the comorbidity of depression and substance related disorders as well. She is a friendly young lady who aspires to positively impact the lives of many!