Painful lack of will, inability and unwillingness to move, act, make decisions, and communicate with others in psychiatry and neurology is called Abulia.
To date, there is no consensus as to whether Abulia is a manifestation various violations psyche or is it an independent nosological unit, since its manifestations are very diverse.
The inability to force oneself to take any actions when realizing their necessity, the lack of incentives and initiative are often signs of mental pathology, and not laziness and weakness of will, which, if desired, can be overcome with the help of self-discipline and training.
Abulia in combination with a decrease or disappearance of emotions is apatico-abulic syndrome (apatico-abulic), with loss of motor activity is abulic-akinetic.
ICD-10 code
F00-F09 Organic, including symptomatic mental disorders
Epidemiology
Abulia is not considered an independent disease, so its epidemiology has not been described. However, since depression is named one of the main risk factors for its occurrence, this condition is very common: in countries with more high level In the life of the population, the state of depression is familiar first-hand to almost a third of their citizens, with a low fifth – to a fifth.
The prevalence of schizophrenia in the world is about 1%, and strokes are 460-560 cases per 100 thousand population per year, adding head injuries, tumors, infections and stress, we can conclude that many people are likely to encounter abulia.
Causes of abulia
Minor symptoms of abulia (hypobulia) often accompany people with a vulnerable psyche and prone to somatoform disorders.
Abulia occurs as a result of circulatory disorders in the right hemisphere of the frontal zone of the brain due to disease or injury. Its pathogenesis is assumed to be associated with a decrease for some reason in dopaminergic neurotransmission in the frontal lobes of the cerebral cortex, responsible for targeted motor activity, the ability to take initiative, systematic actions aimed at solving certain problems and overcoming obstacles. Patients with lesions of the frontal part of the brain are characterized by inertia and inactivity.
Most experts cite stress as the main factor that triggers the development of abulia.
Abulia deprives a person of the main human quality - he ceases to be a person.
This serious illness, manifested by the disappearance of a person’s motives that prompt him to act to achieve a certain goal.
Abulia is especially dangerous in childhood, since parents may simply not pay attention to the child’s painful condition, mistaking it for banal laziness or weakness of will. The most difficult is hereditary abulia, which manifests itself already in infancy. Sedentary, very calm child, not loud, to the envy of the parents of other kids, should cause parents not joy, but anxiety, because Delayed diagnosis will lead to complications of the disease.
Risk factors
Many psychoneurological pathologies are accompanied by abulia. The main risk factors are post-stroke and post-traumatic conditions, the consequences of intoxication, hypoxia, infectious diseases, brain tumors, Parkinson's, Huttington's, Pick's diseases, congenital dementia, depression, alcohol and drug abuse.
Abulia is an indispensable companion of schizophrenics, in whom mental changes worsen over time, volitional impulses weaken, passivity increases, and reluctance to perform even the simplest and most necessary actions (for example, those related to self-care).
The simple form of schizophrenia is characterized by apatho-abulic syndrome, which is not accompanied by delusions and hallucinations. Schizophrenics often have parabulia - a wide variety of behavioral disorders, an irresistible passion for committing unnatural acts (exhibitionism, pedophilia).
Temporary manifestations of abulia can appear as a reaction to mental trauma (psychogenic stupor), usually do not last long and disappear when the situation traumatic to the psyche is resolved; with depressive and apathetic stupor; with catatonic stupor (hyperbulia) - this condition can last from several months to several years. Symptoms of abulia often appear as side effect long-term use of large doses of antipsychotic drugs.
Symptoms of abulia
Psychoneurologists call abulia a pathological reluctance to make efforts to any, even necessary actions or previously favorite activities, or a significant decrease in energy volitional manifestations. This is noticeable already at the very beginning of any process, since the individual is stressed by the very thought of doing something. Abulia is characterized by a lack of desire, rather than the ability, to make even minimal efforts to achieve any result.
Psychiatrists have described symptoms of abulia as early as early XIX century as behavioral changes characterized by loss of initiative, will, aspirations, inhibition of speech and mental activity. Individuals with abulia suffer from problems with sleep, appetite, memory, chronic fatigue, they are accompanied by a pessimistic mood, reluctance to act causes dependence on other people.
Clinical manifestations of this condition:
- sloppy, sloppy appearance;
- difficult uncoordinated movements;
- inhibited emotional and speech reactions;
- reluctance to contact others, social isolation;
- impoverishment of speech, gestures, facial expressions;
- absence of any manifestations of activity;
- impossibility of acceptance independent decisions;
- lack of interest in previously favorite activities (hobbies);
- long silence before answering a question.
Patients cannot tolerate even minimal stress, any obstacle immediately causes a refusal of the plan, they are impatient, demanding, lazy and inert. Attempts to stir them up and force them to act cause resistance. At the same time, most patients eat with pleasure and allow themselves to be entertained (they can listen to music or watch TV all day long). In cases of more severe abulia, they stop leaving the house, getting out of bed, almost don’t eat, and don’t follow basic hygiene rules.
With apathetic-abulic syndrome, in addition to volitional manifestations, a person’s emotions fade away - conscientiousness, modesty, the ability to love, and compassion disappear.
The often repeated, painfully familiar phrase: “I don’t want,” which develops into: “I can’t,” often becomes the first warning.
Lack of interest in one's own person, what first catches the eye - in appearance (dirty hair, nails, unbrushed teeth, stale clothes) - are the first signs of abulia.
Others are also notable characteristic manifestations: spontaneous, incomprehensible movements, difficulties with coordination, long thoughts before answering questions asked question, the desire to eat, sleep, or communicate with friends may disappear. The child loses interest in his favorite toys and games. Passivity and lack of volitional impulse – characteristic abulia.
Abulia gives rise to the inability to move from the desired to the actual, the feeling that there is not enough strength to implement the plan - it is not worth starting. There is an opinion that abulia is a sign of schizophrenia spectrum disorders, at the same time, similar symptoms are also inherent in other brain pathologies that have nothing to do with schizophrenia.
Still, psychoneurology quite clearly differentiates this mental disorder from laziness and weakness of will as a consequence of shortcomings in upbringing.
Forms
The stages of severity of abulia can be either mild (with slight deviations from the norm, reduced motivation, when the patient can still be involved in any activity), or severe, up to the complete suppression of volitional impulses, reluctance to perform the simplest actions (get out of bed, bring get yourself in order, eat).
Volitional dysfunction is associated with a decrease in the individual’s initiative, his inability to overcome obstacles and systematically achieve results, lack of motivation to perform actions and deviations from social norms behavior.
The following types of volitional disorders are classified:
- hyperbulia is its main symptom: hyperactivity;
- hypobulia – a noticeable decrease in incentives to act;
- parabulia – behavioral deviations from generally accepted norms;
- Abulia is a pathological lack of volitional impulses to act.
The duration of abulia can be short-term, periodic or permanent.
Depressive and asthenic syndrome with elements of adynamia, neuroses, and psychopathic disorders are often accompanied by a short-term lack of volitional impulses and a decline in activity.
Periodic abulia is a companion of drug addicts, alcoholics, people with advanced somatoform disorders, schizophrenics (coincides with periods of exacerbation of the disease). Repetition of periods of lack of will is characteristic of the clinical picture of manic-depressive psychosis.
A constant lack of motivation and volitional impulses is a symptom of the likelihood of catatonic stupor, often occurring in schizophrenic disorders and severe organic brain damage (progressive tumors, traumatic brain injuries).
Abulia is often combined with mutism - a reluctance to speak. Verbal contact with patients is disrupted, and it is impossible to get them to answer questions.
Apathy and abulia often combine to form apatho-abulia syndrome, the symptoms of which are manifested by emotional insufficiency and automaticity of movements. Patients withdraw into themselves, try to avoid communication, demonstrating with their entire appearance indifference to the interlocutor, to close people, and lose interest in their favorite activities and entertainment.
Abulic-akinetic syndrome is a combination of lack of will with partial or complete immobility, often accompanied by a slowdown in the thought process.
If you notice signs of abulia, you need to contact a specialist for professional help. The consequences and complications of the process of volitional inactivation not stopped in time do not bode well not only for the patient, but also for his immediate environment. Depriving a person of aspirations and goals leads to personality degradation, since it is in rational actions that volitional, mental and emotional human functions are realized.
Diagnosis of abulia
Today, the status of abulia (a disease or symptom of other diseases) is still debated, although it is not yet recognized as a separate nosological entity. Pathological lack of will is often found among a set of symptoms inherent in a number of mental illness. The diagnosis is determined by the symptoms of the underlying mental illness, for the diagnosis of which, as a rule, surveys and testing are used to compile a psychoneurological history of the patient; instrumental methods: magnetic resonance and computed tomography, ultrasonography, electroencephalography of the brain; laboratory blood tests.
The main goal of a psychoneurologist is to differentiate abulia (psychopathology) from laziness, apathy (phenomena that are generally within the normal range), as well as apatho-abulic syndrome from conditions with similar symptoms (asthenoanergic syndrome, asthenoapathic depression).
In these cases, differential diagnosis is used, the symptoms of similar conditions are compared according to multiple criteria, and the comparative characteristics of the symptoms are presented in the form of tables for ease of use. Comparison criteria: from patients’ complaints (whether they express them voluntarily and what kind), emotions, motor skills, thinking, to social relationships and behavior with friends, relatives, and loved ones.
The greatest difficulty is in pediatric diagnosis. This is more difficult to figure out. Of course, reluctance to collect toys cannot be considered a sign of abulia, but if a child sits for hours, imitating reading or drawing, then you need to seek help. psychiatric help, because Parents themselves cannot cope with the development of pathology.
Differential diagnosis
Differential diagnostics and instrumental methods make it possible to diagnose accurate diagnosis and prescribe the correct treatment.
Treatment of abulia
First of all, treatment is prescribed that corresponds to the underlying disease, which is complicated by a lack of volitional aspirations.
When schizophrenia manifests itself in this way, drug treatment carried out with atypical neuroleptics. For abulia and depression, antidepressants are used.
Therapy is carried out only according to strict prescriptions and under the supervision of a psychiatrist based on the patient’s medical history and diagnostic results.
In disorders of the schizophrenic type with apato-abulic syndrome, with symptoms of slow mental and physical activity appoint Frenolon. This drug has a psychostimulating effect and does not cause drowsiness in recommended dosages. It is prescribed individually, the dosage is determined by the severity: minimum – 5 mg twice a day, maximum – 10 mg three times a day. Not prescribed for arrhythmia, endomyocarditis, renal and/or liver failure moderate or more severe. As a result of use, there may be autonomic disorders, swelling of the face, tremors of the limbs, coordination motor disorders.
Triftazin also recommended for apatho-abulic conditions in schizophrenics and in old age, start taking 5 mg two to three times a day in combination with piracitam (one capsule twice a day), increasing the dosage of triftazine by about 5 mg daily, bring to daily dosage 30-80 mg. Recommended dosages of triftazine do not cause drowsiness. Contraindicated in acute cardiac disorders (in particular, conduction), renal failure moderate or more severe, acute hepatitis, pregnant women. As a result of use, tremors of the limbs, loss of coordination of movements, allergies, insomnia, dizziness, nausea, and occasionally toxic hepatitis and neutropenia may occur.
Solian has a selective effect on dopamine receptors without affecting other types of receptors, which contributes to the absence of many side effects of other antipsychotics. The effect of the drug depends on its dosage - in small doses (50–300 mg/day) the drug removes the symptoms of apathy and abulia. According to the instructions, it does not cause drowsiness, but, judging by reviews, it promotes sleep, simultaneous use with sleeping pills, narcotic drugs, drugs for local anesthesia enhances their effect. Solian is contraindicated in case of hypersensitivity to it, prolactinoma of the pituitary gland, malignant tumors of the mammary glands, pheochromocytoma, pregnant and lactating women aged 0–17 years, kidney diseases. The treatment regimen is prescribed and changed, if necessary, only by the attending neuropsychiatrist.
Sulpiride Involves use in cases of suppression of volitional impulses caused by depressive syndrome, with manifestations of apathy, slowness, decreased motor and verbal activity, in senile and acute psychoses with alternating excited and depressed states caused by schizophrenia spectrum disorders and other mental pathologies. The average dosage is 0.2–0.4 g per day, the maximum is 0.8 g. Not prescribed for hypertensive patients, in cases of pheochromocytoma and excited states. In addition to tremors of the limbs, loss of coordination of movements, insomnia, dizziness, nausea, it has an stimulating effect, increases blood pressure, and causes malfunctions menstrual cycle, galactorrhea outside the lactation period, enlarged mammary glands in male patients.
To treat abulia and prevent its relapses, physiotherapeutic treatment is used: phototherapy, therapeutic swimming, therapeutic baths, oxygen barotherapy. Physiotherapy today has many techniques that stimulate the central nervous system. As a rule, their combination with sanatorium-resort treatment is more effective. The effect of mineralized waters has a beneficial effect on stabilizing the condition of patients. thermal springs, applying therapeutic mud to the vegetative plexuses. Patients suffering from depressive disorders are advised to rest further south of their permanent place of residence, while schizophrenics are favored in the highlands.
Additionally, individual and group sessions with a psychotherapist are provided. The main goal of individual communication with the patient is to establish trusting relationships. Group classes, starting with minimal joint activities, gradually move to involving the patient in discussions, restoring the ability to communicate in everyday life and communication skills.
In supportive therapy, the role of the family and each of its members and their relationships is very important. The psychotherapist carries out explanatory work with the patient’s loved ones, helps resolve intra-family problems, conflict situations and strives to help establish a harmonious microclimate.
Alternative Treatment
Mental illnesses are generally difficult to treat, however, there is traditional treatment depression and even schizophrenia.
Take a liter of olive oil (you can also use sunflower oil), pour it into a clay container, seal it and bury it in the ground to a depth of about 0.5 m. The oil must lie in the ground for a year. After a year, it is dug up and used for rubbing.
Massage the entire body with gentle movements, including the head with special care. Do not spare oil on your shoulders, neck, and upper back. The duration of rubbing is approximately half an hour, every other day for two months. Then there is a break for a month, and the course of treatment is repeated. The patient can bathe on days when there is no rubbing.
Physical exercise, in particular yoga, and cold showers also have a positive effect on the well-being of schizophrenics.
Instead of a cold shower, you can wipe yourself in the morning with salt water at room temperature: dissolve one teaspoon sea salt for half a liter of water.
At the same time, you still need to eat right. The anti-depressive diet is vegetarian; it also involves the exclusion of tea and coffee, alcoholic drinks and chocolates, and white goods. wheat flour and sweets, chemical additives and spicy seasonings. You need to eat three times a day. Have breakfast - fruits, nuts, a glass of milk. Lunch - dishes made from steamed vegetables, bread from whole grain flour and milk. Dinner - salads of green vegetables, legumes, cheese, kefir or yogurt.
Traditional medicine is replete with phytotherapeutic recipes used for depression and nervous exhaustion to improve vitality. Herbal treatment alone will certainly not help get rid of abulia; however, herbal medicine can also be used in a complex of therapeutic measures. In the treatment of depressive disorders, the roots and leaves of ginseng, aster chamomile flowers, roots with rhizomes of angelica and angelica, knotweed grass and even ordinary straw are used. However, before using any medicinal plant, you should consult your doctor, since interactions with prescribed medications may negatively affect the treatment process.
For more than two hundred years, there has been a special direction of clinical medicine - homeopathy, based on the law of similarity. The selection of homeopathic medicines is very individual, the complex of symptoms in the patient is carefully studied and a drug is prescribed that can cause similar symptoms in healthy person. There are no remedies for cough, hypertension or fever in homeopathic medicine. Homeopathy treats not a disease, but a person, that is, the entire complex of symptoms inherent in a given patient, with one drug. In this case, the drug is prescribed in ultra-low doses.
Correctly selected homeopathic medicine helps to significantly improve health and get rid of chronic diseases. Therapeutic effect from treatment with homeopathy occurs, as a rule, in the interval from three months to two years.
Homeopathy has remedies for conditions whose descriptions are similar to abulia and apato-abulia syndrome.
For example:
- Carbo vegetabilis – deep weakening, loss of vitality;
- Gelsemium – a feeling of exhaustion and slowness of the psyche, you always want to sleep, pseudodementia, tremors, muscle weakness;
- Glonoinum - severe exhaustion, deep reluctance to work, severe irritability; intolerance to bickering, periodically blood rushes to the head;
- Kali phosphoricum – severe exhaustion, loss of strength, especially indicated in at a young age with overexcitation, preoccupation, reluctance to contact others, a state of severe fatigue and depressive disorder, any actions seem very difficult that cannot be completed, absolute disbelief in the success of any enterprise.
As already mentioned, dosages and treatment regimens are prescribed only individually, the recommended doses of the drug, as in traditional medicine, not in classical homeopathy.
In the prevention of abulia in adolescents and middle-aged people, the presence of hobbies, favorite activities, and hobbies plays an important role.
The most common mistake of relatives is pity for the patient, the desire to protect him from difficulties, and indulging his whims. This only aggravates the painful condition. Help from those close to you should consist of attempts to stir up the patient. Organizing trips for a picnic, mushroom picking, excursion to another city, noisy parties. It is necessary to involve the patient with abulia in work, focusing his attention on the fact that he cannot cope without his help. He should feel necessary to younger or older family members, animals, someone or something to take care of. If the process of abulia is just beginning, then acting in this way can successfully bring a person out of it.
If the process is prolonged, then the intervention of specialists and drug therapy will be required.
Abulia is a psychotic condition characterized by pathological lack of will and spinelessness, lack of desire and urge to activity, inability to perform actions and make volitional decisions.
Abulia is one of the signs of apathy. When combined with apathy, they mean apathetic-abulic syndrome; when immobilized, they speak of abulic-akinetic syndrome. This disease, as a pathological condition, must be differentiated from weakness of will, which can be eliminated through training, self-education and education.
The disease manifests itself in the absence of volitional motivation for activity. This condition spares neither the young nor the elderly.
Abulia reasons
The cause of abulia is a consequence of frontal brain damage, however, it is not damage to the cerebellum or brain stem. The presence of brain injuries, stroke can also trigger the disease and cause diffuse lesion right hemisphere.
Abulia and other causes of its occurrence: heredity, infectious diseases, traumatic brain injuries that affect the central nervous system and provoke the occurrence of meningitis and encephalitis. However, most doctors attribute stress to the provoking factors of abulia. Sometimes the cause may be circular psychosis. Rarely, the disease is observed in borderline conditions: psychoneurosis, hysteria, psychasthenia.
Abulia symptoms
The first sign is inattention to one’s personality, in particular to appearance. A person stops taking care of himself, washing, shaving, and changing his underwear.
The disease is characterized by the following symptoms: unexplained sudden movements, passivity; a long period of answering a question; difficulty making targeted movements, loss of interest in simple games in children, reduction in social interactions, loss of appetite.
Abulia is characterized by general lethargy, as well as a violation of the volitional impulse and a lack of desire that encourages any activity. Simply put, it is the inability to make decisions. Sometimes the patient has a desire to act, but he cannot move from desire to action and he does not have enough internal energy for implementation. Some researchers attributed the disease to one of the symptoms of schizophrenia, others defined this phenomenon as the inability to make a choice between impulses.
Psychology clearly distinguishes this condition from weakness of will, attributing the latter to character traits caused by improper upbringing and can be eliminated by training, self-education, external influences from society and family.
Abulia diagnosis
The condition of abulia can be overwhelming or mild. Often this condition refers to disorders volitional regulation behavior. Diagnosing the disease is not so easy, since it occupies an intermediate position between other disorders. The most the best way diagnostics is performed by clinical observation of the patient. The location of the lesion is effectively detected by MRI (magnetic resonance imaging) or CT (computed tomography).
It is very difficult to differentiate the disease from laziness. This is especially difficult to identify among children. Children often do not want to comply with their parents' requests. For example, putting away toys exactly when adults wish. Children, creating their own toy world, do not want to destroy it at the first request. This example is not abulia. Adults should be wary of children's simulation, for example, manifested in reading one page of a book. long time. In this case, you need to consult a doctor, since you cannot figure this situation out on your own.
Abulia treatment
Abulia and how to deal with it – these questions often arise in people’s minds. Treatment of the disease in older people requires a lot of attention from relatives. Average age needs to be involved in various activities and hobbies.
Treatment of abulia in children is carried out only by specialists, so as not to harm the children. The mistake of relatives of patients is often that they themselves allow him to mope, suffer and cherish his abulia. A person suffering from abulia very quickly gets used to such a pitiful attitude and takes it for granted. Once drawn into such a state, it is then very difficult for the patient to get rid of it.
Treatment of abulia includes the sympathy of the immediate environment, which consists in disinhibiting the patient. A trip to interesting place, a noisy banquet, going out into nature, communicating with animals. Involve the patient in work, give him simple instructions, referring to the fact that you cannot do without him. If the condition has not yet protracted, then it is possible to cope on your own, whereas with prolonged abulia, hypochondria is diagnosed.
In case of prolonged flow without drug therapy and an experienced specialist (psychotherapist, psychiatrist) is indispensable. Good effect To improve the condition, psychotherapeutic or psychiatric methods are given, as well as a psychoanalytic course.
Psychiatry distinguishes age-related and senile abulia. Often it is caused by purely psychological reasons. For example, an elderly person feels that they have forgotten about him and no one needs him. Abulia is often the result of drug addiction and alcoholism. Most doctors consider this condition to be the main indicator of latent, that is, secret, drunkenness. Communication and the patient’s awareness that someone needs him help cope with age-related abulia. When the patient feels responsibility and understands that he is needed, he has a strong-willed incentive and desire to act. 
I will not diagnose myself and use medical terms, therefore, further in the text I will use the term “Lack of will”, and the moment when lack of will disappears for a while “Enlightenment”
I am a man, 30 years old. What is disturbing is the state of constant lack of will which lasts for weeks, then can be interrupted for some time for several days or weeks, then again a long-term lack of will.
Description of the Lack of Will phase:
I usually fall asleep at 23.00-0.00 - I wake up at 9-10, i.e. I sleep more than 8 hours, although I usually wake up after 8 hours of sleep, but then I can’t get up for 1-3 hours, at which time I often fall asleep, wake up, and lie half asleep. Although I understand that sleeping for more than 8 hours is harmful and destructive for me. Sometimes there is insomnia, but not often. I don't sleep during the day.
Nutrition:
I usually have no appetite, my physique is thin. I force myself to have breakfast 2-3 hours after waking up, and during the day I also try to cram something into myself, although the quantity is not obvious enough, especially for me with a fast metabolism. That is, there is an understanding that you need to eat more and “better” not only for your own health, but also to have more energy so as not to be so thin (I don’t like this drawback, it makes me not confident in myself) But lack of will wins. I eat in bed.
Job:
I work for myself, remotely, from home. Routine work for which has already been paid, with to varying degrees I'm trying to do well, with delays. Fortunately, this requires minimal physical and mental stress. Something that requires at least some non-standard approach, for example, answering letters or messages from clients, can take a very long time. And then, when “enlightenment” comes from lack of will, I can do all those actions in a couple of hours, answer all the email messages that I could put off for weeks, or even months. Those. Again, I understand that nothing prevents me from working normally and developing in my activities. But I have a hard time forcing myself to do simple routine work, and I procrastinate on doing something simple until I get “enlightened.” I work half sitting, half lying in bed.
Hygiene, Life:
Everything is bad here too, I don’t take care of myself, I accumulate unwashed dishes and a mess. If there is an urgent need to go to the store, then I will force myself: I will take a bath, brush my teeth, iron clean clothes. If, suddenly, someone comes to visit, then I will force myself to put things in order. And so I usually ignore all these questions until the onset of “Enlightenment”. Although, again, I don’t like it and it’s all annoying. I really don’t like the garbage and the dirt on the streets of Russia irritates me, on the other hand, I can’t even solve this issue with myself and my home.
Hobbies, passion:
In the “Lack of Will” phase, there is rarely anything that can please me or captivate me; occasionally I can watch a new season of some series that I watched before. More often I just update 3-4 news resources rather than kill time.
Mood:
The awareness of the need to lead a normal lifestyle, to develop as a person and as a specialist in one’s field on the one hand, and complete lack of will on the other, depresses one’s mood. I can’t call it depression, because... I still believe that I will get off the couch and start leading a normal life. Those. The outlook for the future is still optimistic.
Communications:
In the Phase of lack of will, communications with the outside world cause discomfort, i.e. If I need to go to the store or do something that cannot be postponed, then I feel uncomfortable, “stupid.” If friends call, I can simply not pick up the phone or lie about something so as not to meet with them. On the couch, in principle, I can communicate with someone for quite a long time using social networks.
Attempts to get out of the state of lack of will:
1) Being at a younger age, I actively practiced trying to start “ new life from Monday" from "Tomorrow", etc. Dedicate a certain amount of time (using a stopwatch) to work and household chores. But hundreds of such attempts were unsuccessful, so now such attempts themselves have disappeared.
2) Sometimes, when one of my friends suggests traveling in a couple of months or half a year, I often agree. Even while in a state of lack of will. Because not going tomorrow. And after some time, but now you need to agree and pay for tickets, hotel, without leaving the couch. When the time comes for the trip and it meets me in a state of lack of will, then there is no desire to go, but since you have already agreed with someone a long time ago about traveling with someone and paid for everything, then you have to overpower yourself to prepare for the trip, go, and you are already on the trip You usually lead a normal life: instead of oversleeping, you either sleep normally or lack sleep due to lack of time, eat normally, communicate a lot, move a lot, try to work every free second. But as soon as you cross the threshold of the house, you can’t make out your things even after a month.
Successful attempts to get out of a state of lack of will:
The way out of this state sometimes happens and lasts different quantities time, varies in degree of activity. The output turns out on its own, by at least, I see no reason for it, and my attempts to influence this circumstance, as I already wrote, were never crowned with success.
The state of “Enlightenment” from lack of will, according to the degree of my activity, can be divided into 1) “Active” and 2) “Active +”
State "Active":
1) My sleep is normal, I sleep about 8 hours + -, after waking up I usually get up immediately painlessly.
2) I eat 3 times a day. Or if I start going to Gym, then more often for gaining muscle mass.
3) At work, I fulfill all the debts accumulated during the “Lack of Will”, I work exactly as much as the amount of work requires. I usually don’t leave it for “Tomorrow,” but I usually don’t increase the volume of work and don’t take on new work.
4) I usually start going to the gym with a trainer, because... Without it I'm afraid to give up quickly
5) The mood is usually even, sometimes elevated, sometimes depressed
6) In this state I can already meet with friends, more often on their initiative.
The “Active” state lasts from several days to a couple of months
“Active +” state:
The shorter duration state, usually no more than a few days, differs from the “Active” state by more high mood, more productive work, when I increase the volume of work or take on new types of work, with greater social activity, i.e. here I already take the initiative in meeting with friends, I can plan a trip/trip on my own initiative, etc.
Active states always end and more protracted “weak-willed” states begin.
I would like to find tools to get out of the “weak-willed” state. When going to the store is already a test. And a response to a client’s e-mail that does not require searching new information or some other effort may take weeks.
In psychology, will is considered one of the important mental processes. Will allows us to make decisions and move according to the decisions we make. Moreover, it is with the help of will that we can regulate our actions consciously, overcoming difficulties that arise along the way.
And, of course, disorders associated with the dysfunction of this process can cause a lot of inconvenience. Abulia is a disorder of the will, or rather the inability to perform volitional actions against the backdrop of general emotional and physical apathy. In short, it is weakness of will. This state is associated with a lack of desires, aspirations and a reduced emotional background, as well as a lack of energy.
It is important to understand that periodic laziness or lack of desire to do anything, and even periodic lack of will, is not pathological and is inherent in every person. But abulia is a persistent condition that requires treatment.
How to determine?
This disorder has a number of signs that make it possible to understand that the patient has abulic syndrome. It is also worth paying attention to the fact that abulia is not an independent disorder, it is a consequence of other, more serious diseases.
How does abulia manifest itself, its main symptoms:
1. A person loses interest in his appearance. If in ordinary life in most cases we try to look good, then with abulia the patient does not care, he does not have the strength, desire and motivation to somehow maintain a good appearance. A person may wear dirty clothes, not wash his face, not comb his hair, and be completely indifferent to the recommendations of others about the need to change clothes.
3. There is a loss of appetite and interest in the process of eating something. Interest does not come even if a person is offered his favorite dish.
4. A person moves slowly, tries to remain motionless more. Gets up and moves only when absolutely necessary (for example, to go to the restroom); the rest of the time he can simply lie down or sit without moving.
5. The patient reduces social contacts, tries not to communicate with people, does not answer calls or messages. in social networks. Does not show interest in meetings, does not come to the door if someone comes to visit.
7. Problems arise with thinking, it becomes viscous, and it is difficult for a person to concentrate on something for a long time. Functions such as memory, especially short-term memory, are also affected.
All of these symptoms are accompanied by general pessimism, lack of desire to take action, and resist circumstances. Therefore, abulia often leads to dependence on the people with whom the patient lives.
As mentioned above, abulia is a disorder that accompanies various diseases, mainly associated with brain dysfunction. These can include brain injuries (especially frontal lobes), as well as the consequences of stroke, tumors or Parkinson's syndrome. Therefore, when signs of abulia appear, it is important to do full examination to find out all the reasons.
Abulia is a syndrome that also often manifests itself in older people, usually against the background of senile diseases. But people of all ages can be susceptible to it, although the risk group mainly includes the elderly and children (younger and adolescents).
Diagnosis and treatment
It is also important to study the medical history, as this can also help in identifying the causes. Among the medical methods, tomography is distinguished; it allows you to “see” disturbances in the functioning of the brain.
It is most difficult to diagnose this disorder in early age, since many can mistake a child’s resistance to a parent’s requests for a lack of energy. Here it is important to observe the child for a long time, to pay attention to whether he shows interest in games, sweets, spending time with friends, how much time it takes him to perform this or that action. All these data should be compared with typical of this child behavior, and not with the behavior of other children.
Of the psychotherapeutic methods and techniques, most specialists offer the following:
1. Motivation of a person to act, based on his past experience. Here, in order to “remember” past motives and needs, both journaling and a hypnotic state are used.
2. Gradual introduction of a person into active life. There are two main mistakes that parents make when faced with symptoms of abulia in their child:
- Parents indulge the child, do not touch him, allow him to remain in apathy and do nothing. This behavior will be a positive stimulus (the child will feel that his apathy is something right and natural) and will accelerate the development of the disease.
- Parents, on the contrary, sharply pull the child back, force him to do something through force and scold him for laziness. In addition to the fact that the child’s disorder will progress, a guilt complex will also form.
Thus, a gentle introduction of a person, a child, into life will be most optimal. Also, it is important not to forget about positive motivation, praise, and so on.
It is worth remembering that any disorder can be treated much easier, faster and more effectively with early stages. Therefore, it is extremely important to seek help when signs of the disorder become apparent. Author: Daria Potykan
The study of abulia has been carried out since 1838. Currently, experts consider abulia as a symptom of other diseases and mental disorders, although there are attempts to consider this condition as an independent nosological unit.
Abulia, in which the patient feels a partial or complete lack of desire for any activity, is between:
- apathy - a psychotic state, which is accompanied by a lack of desire for any activity, an indifferent and detached attitude to what is happening around;
- akinetic mutism - a rare condition in which the patient practically does not speak or move, although such a possibility exists from a physical point of view (understanding of the surrounding reality is preserved, the patient follows the people around him with his eyes and finds the sources of sounds).
Abulia is distinguished from weak-willedness and laziness by the awareness of the need for any actions and the inability to force oneself to perform them (laziness and weak-willedness can be fought with the help of training and self-discipline, but with abulia this is impossible).
Since abulia is not an independent disease, its prevalence has not been described. It is believed that this symptom is detected quite often, since the main risk factors for its occurrence include depression, a common condition in countries with a high standard of living.
Kinds
Abulia can be:
- Congenital. Observed in severe cases mental retardation(oligophrenia). This intellectual disability is caused by brain pathology and is manifested by developmental delay or incomplete development of the psyche. Abulia is characteristic of torpid mental retardation (characterized by inhibited reactions).
- Acquired. May be temporarily present with stupor ( movement disorder, which can be catatonic, psychogenic and melancholic), stroke, brain injury. Develops in schizophrenia, depression, borderline states, Parkinson's disease.
The combination of abulia and immobility is called abulic-akinetic syndrome, and when combined with apathy, apathetic-abulic syndrome is diagnosed.
Causes
Abulia develops when there is a lack of blood circulation or damage to the frontal area of the brain (affects the frontal lobe, basal ganglia, anterior cingulate cortex or capsular genu of the corpus callosum).
Observed when:
- traumatic brain injuries;
- brain tumors;
- encephalitis and meningitis;
- oligophrenia;
- borderline states (with circular and senile psychosis, psychoneurosis and hysteria);
- stroke;
- schizophrenia;
- severe depression;
- exposure to toxic substances.
Pathogenesis
Man's conscious organization of his activities and behavior is carried out through will. Abulia is accompanied by a violation of volitional processes.
The main points of the volitional process include:
- the emergence of motivation and goal setting;
- the stage of discussion and struggle of different motives;
- decision-making stage;
- execution of the decision.
The neurophysiological basis of volitional acts is a complex interaction of various brain structures, in which:
- the cortical centers of the frontal lobes are responsible for the purposefulness of actions;
- regulation of voluntary movements is carried out by pyramidal cells;
- The energy supply to the cortical structures is carried out due to the reticular formation.
When one of these structures is damaged, disturbances in volitional processes are observed.
Symptoms
Abulia manifests itself:
- inhibited state;
- decrease in intellectual activity;
- decreased social contacts and tendency to isolation;
- difficulty in making decisions;
- indifference to hygiene and one’s appearance;
- decreased need for food and sleep;
- loss of interest in usual activities;
- passivity and an unreasonable feeling of fatigue;
- indifference (no emotional experiences);
- stiffness or spontaneity of movements.
Diagnostics
The diagnosis of abulia is made when the underlying disease is diagnosed. To diagnose the underlying mental illness, tests and questionnaires are used; if an organic lesion is suspected, the following are done:
- CT and MRI;
- laboratory blood tests.
When making a diagnosis, it is important to distinguish abulia and apatho-abulic syndrome from apathy, asthenopathic depression, asthenoanergic syndrome and other conditions with similar symptoms. It is also important to exclude manifestations of weakness of will, which is a character trait, not a disease.
Treatment
Abulia is a symptom of many pathological conditions Therefore, treatment is aimed at eliminating the underlying disease.
Drug treatment includes the use of:
- atypical antipsychotics for schizophrenia;
- antidepressants for depression;
- correctors of blood circulation in the vessels of the brain during stroke and circulatory disorders;
- glucocorticoids for severe encephalitis, etc.
Physiotherapeutic treatment is also used to treat abulia, which may include:
- phototherapy;
- therapeutic swimming;
- medicinal baths;
- oxygen barotherapy, etc.
Physiotherapy methods are more effective in combination with sanatorium-resort treatment.
Treatment of abulia also requires individual and group classes with a psychotherapist.
Clinical manifestations of the syndrome and its types
Will is a special regulatory factor, a planned ability for productive activity aimed at results. Violation of volitional processes is often associated with pathology of activity, motivation and behavior. Disorders of will are of the following types:
- hyperbulia,
- hypobulia,
- abulia,
- parabulia.
Hyperbulia is an excessive manifestation of activity, and hypobulia is its opposite, a decrease in the function that motivates activity. Parabulia appears directly as a behavioral disorder. Lack of will is characterized by a loss of desire for productive activity and a lack of motivation to achieve results. According to duration, abulia is divided into the following subtypes:
- short-term,
- periodic,
- constant.
A short-term course of the disease is observed in adynamic depression, borderline states (neuroses, asthenia). Patients with depressive disorders are often deprived of active activity, their motivational and volitional sphere is in decline. A person who is in the stage of depression understands the need for volitional direction, but cannot always muster the strength to begin to act. Also, short-term lack of will can be observed in neurosis, psychopathy and manifest itself in the form of an inability to make a decision, decreased motivation and lack of motivation.
Periodic lack of will occurs in drug addiction and advanced somatoform disorders. The recurrent nature of the decline in volitional processes often coincides with the stages of exacerbation in schizophrenia. Recurrent violations of will are often present in the clinical picture of manic-depressive psychosis. A constant lack of motivational base and volitional impulses is a characteristic sign of catatonic schizophrenia and severe brain damage. Lack of will in combination with immobilization in schizophrenia can turn into a catatonic stupor. It is the apato-abulic syndrome in the clinical picture of schizophrenia that is the most severe manifestation violations of will.
Among the main symptoms of the disease are:
- slowness of thought processes,
- difficulties in making decisions,
- reduction in social contacts, up to isolation,
- lack of motivation to take action,
- neglect of hygiene,
- reducing the need for basic human needs (food, sleep),
- loss of interest in usual activities,
- passivity,
- stiffness or spontaneity of movements.
Abulia can occur in combination with mutism, apathy and adynamia. Mutism is understood as speech passivity, which manifests itself in the absence of a verbal speech component. Patients do not answer questions, showing with all their appearance their reluctance to come into contact with others. The French psychiatrist Florenville believed that the “involuntary manifestation of mutism” is combined with lack of will and passivity of motor activity.
Apathy, which is emotional indifference and indifference, is often combined with a lack of volitional activity, forming apatho-abulic syndrome. Clinical picture This condition occurs in the form of emotional impoverishment and automated actions. Patients become withdrawn, often remain silent for long periods of time, and try to avoid contact with others. This condition is characteristic of schizophrenia and bipolar affective disorder.
Adynamia, manifested in the inertia of the incentive function to action, can occur both in the form of inhibition of thought processes and in the complete absence of movements. According to German psychiatrist K. Kleist, this phenomenon is characteristic of lesions frontal regions brain. The scientist called this specific combination of lack of will and inertia of movements “broken feather syndrome.”
Causes of the disease
The causes of this psychopathological syndrome are injuries and brain tumors, hereditary predisposition to schizophrenia and other mental disorders, and dementia. Mild manifestations of the disease can be observed with low stress resistance and a tendency to somatoform disorders. This psychopathological syndrome is observed in the following diseases:
- schizophrenia,
- lesions of the frontal parts of the brain,
- borderline states,
- depression,
- dementia.
Most often, lack of will manifests itself in schizophrenia and organic lesions of the frontal parts of the brain. According to the German scientist E. Bleuler, lack of will, as one of the symptoms of schizophrenia, manifests itself as a kind of “loss of energy potential.” “The need against and despite,” according to the psychiatrist, was the main feature of patients with schizophrenia due to simultaneous presence desire and lack of strength to realize it.
Back in the 50s of the twentieth century. Soviet psychiatrist M. O. Gurevich proved that the frontal part of the brain performs the function of controlling impulses and volitional processes. Patients with lesions of the frontal regions are very inert in their judgments, often unable to make a simple effort to perform primitive actions. If damaged brain regions the disease occurs in the form motor inhibition combined with a weakening of thought processes.
Treatment of abulia
First of all, it is necessary to treat the main disease, within which the lack of will manifests itself. If the lack of volitional effort occurs on the basis of schizophrenia, atypical antipsychotics are widely used as medications. If the cause of abulic syndrome is depression, antidepressants are used. The treatment regimen is determined exclusively by a psychiatrist, who relies on anamnesis and diagnostic criteria.
The prognosis for the treatment of apatho-abulic disorder in combination with schizophrenia is often unfavorable. In psychiatric practice with long-term therapy Only partial remission of the disease was observed; cases of transformation of schizophrenia into progressive stages were noted. In the best cases, there were improvements in social interaction and communication with others.
Psychotherapy is widely used in the treatment of abulia, especially in short-term, mild forms of the disease. The use of psychotherapeutic methods to treat lack of will in schizophrenia is a controversial issue. However, many doctors practice using hypnosis and cognitive behavioral psychotherapy to reduce signs of the syndrome. The main goal psychotherapeutic approach is to establish social adaptation and the formation of a strong-willed and motivational base.
Forms of the disorder
Unlike ordinary weakness of will, which is caused by improper upbringing, apraxia and abulia are directly associated with a lack of willpower, spinelessness, laziness and lack of will by lesions of the brain structure. With lesions of the frontal lobe, apraxia occurs.
There are several forms and types of abulia that make it possible to classify this disease. Psychological analysis identifies two main stages of the severity of abulia.
- Easy. There are slight deviations from normal behavior, a slight lack of will and motivation. At the same time, a person experiences a state when it is possible to involve him in activities.
- Heavy. This condition is accompanied complete refusal from any actions and suppression of volitional impulses. The pathology is characterized by the fact that the patient is unable to perform even the most basic tasks, such as standing up, washing his face or eating.
Apathetic-abulic syndromes are a violation of the will associated with a decrease in initiative, lack of will or desire to overcome obstacles and achieve results. The condition is accompanied by the patient’s deviations from observing norms of social behavior.
There are several types of volitional disorder:
- hyperbulia;
- parabulia;
- hypobulia;
- abulia.
It represents a significant change in the number of motives required to perform a particular action. Hypobulia is a condition in which it is extremely difficult for a person to find the strength within himself and force him to complete a particular task.
Hyperbulia, in contrast to this type of volitional disorder such as hypobulia, has a main characteristic symptom. Hyperbulia is characterized by the fact that it involves increased activity or hyperactivity, but the person very quickly loses interest in the goal.
Represents behavioral deviations directed against existing norms of behavior.
As for abulia, it is defined as a state of pathological lack of will to commit actions. Weakness of will or violation of the volitional sphere, if you like.
Duration of volitional disorder
An important issue in the treatment prescribed for abulia is the duration of the volitional disorder. The disease is divided into three types depending on duration.
- Short-term. Its characteristic features may be periodic neuroses, asthenic and depressive syndromes, as well as psychopathic disorders.
- Periodic. With periodic abulia, symptoms usually accompany drug addicts and patients with severe forms of schizophrenia or somatoform disorder.
- Constant. With constant abulia, there is a high probability of developing the symptom of catatonic stupor. This form of abulia is often formed in schizotypal personality disorder, schizophrenia, or organic brain damage.
Combination with other diseases
Abulia can often be combined with other diseases, forming modified or complicated ailments:
- Mutism. In combination with mutism, that is, a reluctance to talk, serious disturbances occur in verbal contacts with patients. It is extremely difficult to get any response from the patient; the painful syndrome is accompanied by almost constant silence.
- Apathy. The formation of apathetic-abulic syndrome occurs. Distinctive feature Apathetic-abulsic syndrome is a deficit in the expression of emotions and the performance of a number of actions “automatically”. The patient may simply withdraw into himself, actively avoid society, clearly show indifference to his interlocutors, and even ignore loved ones. The syndrome is also characterized by the fact that a person loses all interest in his once favorite hobbies or activities.
- There is a syndrome of abulic-akinetic type. It combines a lack of will as well as immobility. Moreover, mobility can be partial or complete. Thoughts are slow, a person cannot form his answer or thought for a long time.
Reasons for lack of motivation
Abulia is not a spontaneously occurring disease. This psychological disorder is characterized by the presence of certain factors or causes that shape the development of weakness of will. And unlike many others psychological disorders personality, abulia is caused by physiological reasons such as brain damage or predisposition.
Abulia can occur against the background of:
- brain damage due to trauma;
- tumors in the brain;
- hereditary factor;
- predisposition to schizophrenia;
- dementia;
- depressive state;
- borderline state.
Most often, the patient experiences weakness of will when the frontal parts of the brain are affected or signs of schizophrenia develop.
Symptoms
To identify problems and begin treatment, you must first learn to identify the presence of a problem with motivation and will. For these purposes, a certain list of the main symptoms that appear in people with abulia is provided:
- A person has difficulty forming thoughts thinking process slow and does not allow for active conversation or reasoning.
- It is very difficult for the patient to make any decision. Moreover, this can even apply to basic little things, such as buying bread or choosing socks.
- A person actively tries to isolate himself from the surrounding society. Some people simply try to communicate less with their surroundings, while others drive themselves into a state of complete isolation from the outside world.
- Patients with abulia cannot find the motivation to perform a number of actions. Any volitional decision is made with enormous effort and often ends in a quick abandonment of the planned actions.
- People with abulia partially or completely neglect basic hygiene rules, stop taking care of themselves and cannot even just wash their face in the morning. Any such action is accompanied by irresistible bouts of laziness.
- A person diagnosed with abulia gradually reduces his need for basic things and actions necessary for a person. For example, he stops eating normally, often refuses food or sleeps little.
- The patient may completely lose interest in his usual or even favorite activities. At some point, even his life's passion ceases to be interesting.
- There is passivity in all matters, actions, communication and decision making.
- A person tries to avoid any responsibility. He abstracts himself from those around him.
- Actions can be constrained and spontaneous. And sometimes they alternate with each other.
Features of treatment
The essence of treatment for abulia is the need to first overcome the disease against which it develops. volitional disorder. That is, it is not the abulia itself that needs to be treated, but the illness that provoked it:
- If abulia occurs against the background of schizophrenia, the specialist prescribes antipsychotics.
- Abulia associated with depression is usually treated with antidepressants.
- Any appointment is determined only by a psychiatrist.
- The choice of medications and treatment methods for abulia is made only after observation, history and diagnosis of the patient.
- For the purpose of treatment and prevention, the patient is often recommended phototherapy, swimming, medicinal baths and oxygen therapy.
Concerning medicines, then for the treatment of abulia the most common means of drug therapy are:
- Frenol.
- Triftazin.
- Solian.
- Sulpiride.
Unfortunately, the experience of psychologists shows that apato-abulic syndrome is predominantly accompanied by an unfavorable prognosis. Usually treatment ends with only minor disappearance of symptoms. Most often this concerns the patient’s partial or complete return to social contacts. At the same time, the absence of any measures aimed at combating abulia significantly worsens the person’s condition. Therefore, treatment is required at a minimum to prevent complications.
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