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Apathy is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as concern,
excitement Excitation, excite, exciting, or excitement may refer to: * Excitation (magnetic), provided with an electrical generator or alternator * Excite Ballpark, located in San Jose, California * Excite (web portal), web portal owned by IAC * Electron exc ...
,
motivation Motivation is the reason for which humans and other animals initiate, continue, or terminate a behavior at a given time. Motivational states are commonly understood as forces acting within the agent that create a disposition to engage in goal-dire ...
, or passion. An apathetic individual has an absence of interest in or concern about emotional, social, spiritual, philosophical, virtual, or physical life and the world. Apathy can also be defined as a person's lack of
goal orientation Goal orientation, or achievement orientation, is an "individual disposition towards developing or validating one's ability in achievement settings". In general, an individual can be said to be ''mastery'' or ''performance'' oriented, based on whethe ...
. Apathy falls in the less extreme spectrum of diminished motivation, with
abulia In neurology, abulia, or aboulia (from grc, βουλή, meaning "will"),Bailly, A. (2000). Dictionnaire Grec Français, Éditions Hachette. refers to a lack of will or initiative and can be seen as a ''disorder of diminished motivation'' (''DDM'' ...
in the middle and
akinetic mutism Akinetic mutism is a medical term describing patients tending neither to move (akinesia) nor speak (mutism). Akinetic mutism was first described in 1941 as a mental state where patients lack the ability to move or speak. However, their eyes may fo ...
being more extreme than both apathy and abulia.Marin, R. S., & Wilkosz, P. A. (2005)
Disorders of diminished motivation
. Journal of Head Trauma Rehabilitation, 20(4), 377-388.
The apathetic may lack a sense of purpose, worth, or meaning in their life. People with severe apathy tend to have a lower quality of life and are at a higher risk for mortality and early
institutionalization In sociology, institutionalisation (or institutionalization) is the process of embedding some conception (for example a belief, norm, social role, particular value or mode of behavior) within an organization, social system, or society as a who ...
. They may also exhibit insensibility or
sluggishness Lethargy is a state of tiredness, sleepiness, weariness, fatigue, sluggishness or lack of energy. It can be accompanied by depression, decreased motivation, or apathy. Lethargy can be a normal response to inadequate sleep, overexertion, overwo ...
. In
positive psychology Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being. It studies "positive subjective experience, positive individual traits, and positive institutions...it aims t ...
, apathy is described as a result of the individuals' feeling they do not possess the level of skill required to confront a challenge (i.e. " flow"). It may also be a result of perceiving no challenge at all (e.g. the challenge is irrelevant to them, or conversely, they have
learned helplessness Learned helplessness is the behavior exhibited by a subject after enduring repeated aversive stimuli beyond their control. It was initially thought to be caused by the subject's acceptance of their powerlessness, by way of their discontinuing atte ...
). Apathy is something that all people face in some capacity and is a natural response to disappointment, dejection, and stress. As a response, apathy is a way to forget about these negative feelings. This type of common apathy is usually felt only in the short term, but sometimes it becomes a long-term or even lifelong state, often leading to deeper social and psychological issues. An extreme form of apathy may be someone being numb to different stressful life events such as losing a job. Apathy should be distinguished from
reduced affect display Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings ( affect display) either verbally or nonverba ...
, which refers to reduced
emotional expression An emotional expression is a behavior that communicates an emotional state or attitude. It can be verbal or nonverbal, and can occur with or without self-awareness. Emotional expressions include facial movements like smiling or scowling, simple b ...
but not necessarily reduced emotion. Pathological apathy, characterized by extreme forms of apathy, is now known to occur in many different brain disorders, including neurodegenerative conditions often associated with
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
such as
Alzheimer's disease Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
,
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
, and psychiatric disorders such as
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. Although many patients with pathological apathy also have depression, several studies have shown that the two syndromes are dissociable: apathy can occur independently of depression and vice versa.


Etymology

Although the word ''apathy'' was first used in 1594 and is derived from the
Greek Greek may refer to: Greece Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group. *Greek language, a branch of the Indo-European language family. **Proto-Greek language, the assumed last common ancestor ...
(''
apatheia Apatheia ( el, ἀπάθεια; from ''a-'' "without" and ''pathos'' "suffering" or "passion"), in Stoicism, refers to a state of mind in which one is not disturbed by the passions. It might better be translated by the word equanimity than the word ...
''), from (''apathēs'', "without feeling" from ''a-'' ("without, not") and ''
pathos Pathos (, ; plural: ''pathea'' or ''pathê''; , for "suffering" or "experience") appeals to the emotions and ideals of the audience and elicits feelings that already reside in them. Pathos is a term used most often in rhetoric (in which it is c ...
'' ("emotion")), it is important not to confuse the two terms. Also meaning "absence of passion," "apathy" or "insensibility" in Greek, the term ''apatheia'' was used by the
Stoics Stoicism is a school of Hellenistic philosophy founded by Zeno of Citium in Athens in the early 3rd century BCE. It is a philosophy of personal virtue ethics informed by its system of logic and its views on the natural world, asserting that th ...
to signify a (desirable) state of indifference towards events and things which lie outside one's control (that is, according to their philosophy, all things exterior, one being only responsible for one's own representations and judgments). In contrast to ''apathy'', ''apatheia'' is considered a
virtue Virtue ( la, virtus) is moral excellence. A virtue is a trait or quality that is deemed to be morally good and thus is valued as a foundation of principle and good moral being. In other words, it is a behavior that shows high moral standard ...
, especially in
Orthodox monasticism The degrees of Eastern Orthodox and Eastern Catholic monasticism are the stages an Eastern Orthodox monk or nun passes through in their religious vocation. In the Eastern Orthodox Church, the process of becoming a monk or nun is intentionally slo ...
. In the
Philokalia The ''Philokalia'' ( grc, φιλοκαλία, lit=love of the beautiful, from ''philia'' "love" and ''kallos'' "beauty") is "a collection of texts written between the 4th and 15th centuries by spiritual masters" of the mystical hesychast trad ...
the word ''dispassion'' is used for ''apatheia'', so as not to confuse it with ''apathy''.


History and other views

Christians Christians () are people who follow or adhere to Christianity, a monotheistic Abrahamic religion based on the life and teachings of Jesus Christ. The words ''Christ'' and ''Christian'' derive from the Koine Greek title ''Christós'' (Χρι ...
have historically condemned apathy as a deficiency of love and devotion to
God In monotheism, monotheistic thought, God is usually viewed as the supreme being, creator deity, creator, and principal object of Faith#Religious views, faith.Richard Swinburne, Swinburne, R.G. "God" in Ted Honderich, Honderich, Ted. (ed)''The Ox ...
and his works. This interpretation of apathy is also referred to as
Sloth Sloths are a group of Neotropical xenarthran mammals constituting the suborder Folivora, including the extant arboreal tree sloths and extinct terrestrial ground sloths. Noted for their slowness of movement, tree sloths spend most of their li ...
and is listed among the
Seven Deadly Sins The seven deadly sins, also known as the capital vices or cardinal sins, is a grouping and classification of vices within Christian teachings. Although they are not directly mentioned in the Bible, there are parallels with the seven things ...
.
Clemens Alexandrinus Titus Flavius Clemens, also known as Clement of Alexandria ( grc , Κλήμης ὁ Ἀλεξανδρεύς; – ), was a Christian theology, Christian theologian and philosopher who taught at the Catechetical School of Alexandria. Among his pu ...
used the term to draw to Christianity
philosopher A philosopher is a person who practices or investigates philosophy. The term ''philosopher'' comes from the grc, φιλόσοφος, , translit=philosophos, meaning 'lover of wisdom'. The coining of the term has been attributed to the Greek th ...
s who aspired after virtue. The modern concept of apathy became more well known after
World War I World War I (28 July 1914 11 November 1918), often abbreviated as WWI, was one of the deadliest global conflicts in history. Belligerents included much of Europe, the Russian Empire, the United States, and the Ottoman Empire, with fightin ...
, when it was one of the various forms of "
shell shock Shell shock is a term coined in World War I by the British psychologist Charles Samuel Myers to describe the type of post-traumatic stress disorder (PTSD) many soldiers were afflicted with during the war (before PTSD was termed). It is a react ...
". Soldiers who lived in the trenches amidst the bombing and machine gun fire, and who saw the battlefields strewn with dead and maimed comrades, developed a sense of disconnected numbness and indifference to normal
social interaction A social relation or also described as a social interaction or social experience is the fundamental unit of analysis within the social sciences, and describes any voluntary or involuntary interpersonal relationship between two or more individuals ...
when they returned from combat. In 1950, US novelist
John Dos Passos John Roderigo Dos Passos (; January 14, 1896 – September 28, 1970) was an American novelist, most notable for his ''U.S.A.'' trilogy. Born in Chicago, Dos Passos graduated from Harvard College in 1916. He traveled widely as a young man, visit ...
wrote: "Apathy is one of the characteristic responses of any living organism when it is subjected to stimuli too intense or too complicated to cope with. The cure for apathy is comprehension."


Technology

Apathy is a normal way for humans to cope with stress. Being able to "shrug off" disappointments is considered an important step in moving people forward and driving them to try other activities and achieve new goals. Coping seems to be one of the most important aspects of getting over a tragedy and an apathetic reaction may be expected. With the addition of the handheld device and the screen between people, apathy has also become a common occurrence on the net as users observe others being bullied, slandered, threatened or sent disturbing images. The bystander effect grows to an apathetic level as people lose interest in caring for others who are not in their "circle" and may even participate in their harassment.


Social origin

There may be other factors contributing to a person's apathy. Apathy has been socially viewed as worse than things such as hate or anger. Not caring whatsoever, in the eyes of some, is even worse than having distaste for something. Author
Leo Buscaglia Felice Leonardo Buscaglia (March 31, 1924 – June 12, 1998), also known as "Dr. Love", was an American author, motivational speaker, and a professor in the Department of Special Education at the University of Southern California. Life and car ...
is quoted as saying "I have a very strong feeling that the opposite of love is not hate-it's apathy. It's not giving a damn." Helen Keller stated that apathy is the "worst of them all" when it comes to the various evils in the world. French social commentator and political thinker
Charles de Montesquieu Charles Louis de Secondat, Baron de La Brède et de Montesquieu (; ; 18 January 168910 February 1755), generally referred to as simply Montesquieu, was a French judge, man of letters, historian, and political philosopher. He is the principal ...
stated that "the tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in the democracy." As can be seen by these quotes and various others, the social implications of apathy are great. Many people believe that not caring at all can be worse for society than individuals who are overpowering or hateful.


In the school system

Apathy in students, especially those in high school, is a growing problem. It causes teachers to lower standards in order to try to engage their students. Apathy in schools is most easily recognized by students being unmotivated or, quite commonly, being motivated by outside factors. For example, when asked about their motivation for doing well in school, fifty percent of students cited outside sources such as "college acceptance" or "good grades". On the contrary, only fourteen percent cited "gaining an understanding of content knowledge or learning subject material" as their motivation to do well in school. As a result of these outside sources, and not a genuine desire for knowledge, students often do the minimum amount of work necessary to get by in their classes. This then leads to average grades and test grades but no real grasping of knowledge. Many students cited that "assignments/content was irrelevant or meaningless" and that this was the cause of their apathetic attitudes toward their schooling, leading to teacher and parent frustration. Other causes of apathy in students include situations within their home life, media influences, peer influences, and school struggles and failures. Some of the signs of apathetic students include declining grades, skipping classes, routine illness, and behavioral changes both in school and at home. In order to combat this, teachers have to be aware that students have different motivation profiles; i.e. they are motivated by different factors or stimuli.


Bystander

Also known as the
bystander effect The bystander effect, or bystander apathy, is a social psychological theory that states that individuals are less likely to offer help to a victim when there are other people present. First proposed in 1964, much research, mostly in the lab, has f ...
, bystander apathy occurs when, during an emergency, those standing by do nothing to help but instead stand by and watch. Sometimes this can be caused by one bystander observing other bystanders and imitating their behavior. If other people are not acting in a way that makes the situation seem like an emergency that needs attention, often other bystanders will act in the same way. The diffusion to responsibility can also be to blame for bystander apathy. The more people that are around in emergency situations, the more likely individuals are to think that someone else will help so they do not need to. This theory was popularized by social psychologists in response to the 1964
Kitty Genovese In the early hours of March 13, 1964, Kitty Genovese, a 28-year-old bartender, was raped and stabbed outside the apartment building where she lived in the Kew Gardens neighborhood of Queens in New York City, New York, United States. Two weeks ...
murder. The murder took place in New York and the victim, Genovese, was stabbed to death as bystanders reportedly stood by and did nothing to stop the situation or even call the police. Latane and Darley are the two psychologists who did research on this theory. They performed different experiments that placed people into situations where they had the opportunity to intervene or do nothing. The individuals in the experiment were either by themselves, with a stranger(s), with a friend, or with a confederate. The experiments ultimately led them to the conclusion that there are many social and situational factors that are behind whether a person will react in an emergency situation or simply remain apathetic to what is occurring.


Communication

Apathy is one psychological barrier to
communication Communication (from la, communicare, meaning "to share" or "to be in relation with") is usually defined as the transmission of information. The term may also refer to the message communicated through such transmissions or the field of inquir ...
. An apathetic listener creates a communication barrier by not caring or paying attention to what they are being told. An apathetic speaker, on the other hand, tends to not relate information well and, in their lack of interest, may leave out key pieces of information that need to be communicated. Within groups, an apathetic communicator can be detrimental. Their lack of interest or passion can inhibit the other group members in what they are trying to accomplish. Within
interpersonal communication Interpersonal communication is an exchange of information between two or more people. It is also an area of research that seeks to understand how humans use verbal and nonverbal cues to accomplish a number of personal and relational goals. Inter ...
, an apathetic listener can make the other feel that they are not cared for or about. Overall, apathy is a dangerous barrier to successful communication. Apathetic speakers and listeners are individuals that have no care for what they are trying to communicate, or what is being communicated to them.


Measurement of Apathy

Several different questionnaires and clinical interview instruments have been used to measure pathological apathy or, more recently, apathy in healthy people.


Apathy Evaluation Scale

Developed by Robert Marin in 1991, the Apathy Evaluation Scale (AES) was the first method developed to measure apathy in clinical populations. Centered around evaluation, the scale can either be self-informed or other-informed. The three versions of the test include self, informant such as a family member, and clinician. The scale is based around questionnaires that ask about topics including interest, motivation, socialization, and how the individual spends their time. The individual or informant answers on a scale of "not at all", "slightly", "somewhat" or "a lot". Each item on the evaluation is created with positive or negative syntax and deals with cognition, behavior, and emotion. Each item is then scored and, based on the score, the individual's level of apathy can be evaluated.


Apathy Motivation Index

The Apathy Motivation Index (AMI) was developed to measure different dimensions of apathy in healthy people.
Factor analysis Factor analysis is a statistical method used to describe variability among observed, correlated variables in terms of a potentially lower number of unobserved variables called factors. For example, it is possible that variations in six observed ...
identified three distinct axes of apathy: behavioural, social and emotional. The AMI has since been used to examine apathy in patients with
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
who, overall, showed evidence of behavioural and social apathy, but not emotional apathy. Patients with
Alzheimer’s disease Alzheimer's disease (AD) is a neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As t ...
,
Parkinson’s disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
, subjective cognitive impairment and
limbic encephalitis Limbic encephalitis is a form of encephalitis, a disease characterized by inflammation of the brain. Limbic encephalitis is caused by autoimmunity: an abnormal state where the body produces antibodies against itself. Some cases are associated with ...
have also been assessed using the AMI, and their self-reports of apathy were compared with that of caregivers using the AMI caregiver scale.


Dimensional Apathy Scale

The Dimensional Apathy Scale (DAS) is a multidimensional apathy instrument for measuring subtypes of apathy in different clinical populations and healthy adults. It was developed using
factor analysis Factor analysis is a statistical method used to describe variability among observed, correlated variables in terms of a potentially lower number of unobserved variables called factors. For example, it is possible that variations in six observed ...
, quantifying Executive apathy (lack of motivation for planning, organising and attention), Emotional apathy (emotional indifference, neutrality, flatness or blunting) and Initiation apathy (lack of motivation for self-generation of thought/action). There is a self-rated version of the DAS and an informant/carer-rated version of the DAS. Further a clinical brief DAS has also been developed. It has been validated for use in
stroke A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
,
Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is a neurodegenerative disease that is mostly inherited. The earliest symptoms are often subtle problems with mood or mental abilities. A general lack of coordination and an unst ...
,
motor neurone disease Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND) or Lou Gehrig's disease, is a neurodegenerative disease that results in the progressive loss of motor neurons that control voluntary muscles. ALS is the most comm ...
,
Multiple Sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This d ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
and
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, showing to differentiate profiles of apathy subtypes between these conditions.


Medical aspects


Depression

Mental health journalist and author John McManamy argues that although
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
s do not explicitly deal with the condition of apathy, it is a psychological problem for some depressed people, in which they get a sense that "nothing matters", the "lack of will to go on and the inability to care about the consequences".". He describes depressed people who "...cannot seem to make hemselvesdo anything", who "can't complete anything", and who do not "feel any excitement about seeing loved ones". He acknowledges that the ''
Diagnostic and Statistical Manual of Mental Disorders The ''Diagnostic and Statistical Manual of Mental Disorders'' (DSM; latest edition: DSM-5-TR, published in March 2022) is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common langua ...
'' does not discuss apathy. In a ''
Journal of Neuropsychiatry and Clinical Neurosciences ''The Journal of Neuropsychiatry and Clinical Neurosciences'' is a quarterly peer-reviewed medical journal in the field of neuropsychiatry. It was established in 1989 by Stuart Yudofsky and Robert Hales, with its first issue published that winter ...
'' article from 1991, Robert Marin, MD, claimed that pathological apathy occurs due to brain damage or neuropsychiatric illnesses such as Alzheimer's, Parkinson's, Huntington's disease, or stroke. Marin argues that apathy is a syndrome associated with many different brain disorders. This has now been shown to be the case across a range of neurological and psychiatric conditions. A review article by Robert van Reekum, MD, et al. from the
University of Toronto The University of Toronto (UToronto or U of T) is a public research university in Toronto, Ontario, Canada, located on the grounds that surround Queen's Park. It was founded by royal charter in 1827 as King's College, the first institution ...
in the ''Journal of Neuropsychiatry'' (2005) claimed that an obvious relationship between depression and apathy exists in some populations. However, although many patients with depression also have apathy, several studies have shown that apathy can occur independently of depression, and vice versa. Apathy can be associated with depression, a manifestation of negative disorders in schizophrenia, or a symptom of various somatic and neurological disorders. Sometimes apathy and depression are viewed as the same thing, but actually take different forms depending on someone's mental condition.


Alzheimer's disease

Depending upon how it has been measured, apathy affects 19–88% percent of individuals with
Alzheimer's disease Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
(mean prevalence of 49% across different studies). It is a neuropsychiatric symptom associated with functional impairment. Brain imaging studies have demonstrated changes in the
anterior cingulate cortex In the human brain, the anterior cingulate cortex (ACC) is the frontal part of the cingulate cortex that resembles a "collar" surrounding the frontal part of the corpus callosum. It consists of Brodmann areas 24, 32, and 33. It is involved ...
,
orbitofrontal cortex The orbitofrontal cortex (OFC) is a prefrontal cortex region in the frontal lobes of the brain which is involved in the cognitive process of decision-making. In non-human primates it consists of the association cortex areas Brodmann area 11, 12 ...
,
dorsolateral prefrontal cortex The dorsolateral prefrontal cortex (DLPFC or DL-PFC) is an area in the prefrontal cortex of the primate brain. It is one of the most recently derived parts of the human brain. It undergoes a prolonged period of maturation which lasts until adultho ...
and ventral striatum in Alzheimer's patients with apathy.
Cholinesterase inhibitors Cholinesterase inhibitors (ChEIs), also known as anti-cholinesterase, are chemicals that prevent the breakdown of the neurotransmitter acetylcholine or butyrylcholine. This increases the amount of the acetylcholine or butyrylcholine in the syn ...
, used as the first line of treatment for the cognitive symptoms associated with dementia, have also shown some modest benefit for behavior disturbances such as apathy. The effects of
donepezil Donepezil, sold under the brand name Aricept among others, is a medication used to treat dementia of the Alzheimer's disease, Alzheimer's type. It appears to result in a small benefit in mental function and ability to function. Use, however, ha ...
,
galantamine Galantamine is used for the treatment of cognitive decline in mild to moderate Alzheimer's disease and various other memory impairments. It is an alkaloid that has been isolated from the bulbs and flowers of ''Galanthus nivalis'' (Common snowdro ...
and
rivastigmine Rivastigmine (sold under the trade name Exelon among others) is a cholinesterase inhibitor used for the treatment of mild to moderate Alzheimer's disease. The drug can be administered orally or via a transdermal patch; the latter form reduces th ...
have all been assessed but, overall, the findings have been inconsistent, and it is estimated that apathy in ~60% of Alzheimer's patients does not respond to treatment with these drugs.
Methylphenidate Methylphenidate, sold under the brand names Ritalin and Concerta among others, is the most widely prescribed central nervous system (CNS) stimulant medication used to treat attention deficit hyperactivity disorder (ADHD) and, to a lesser extent, ...
, a dopamine and noradrenaline reuptake blocker, has received increasing interest for the treatment of apathy. Management of apathetic symptoms using methylphenidate has shown promise in randomized placebo controlled trials of Alzheimer's patients. A phase III multi-centered randomized placebo-controlled trial of methylphenidate for the treatment of apathy has reported positive effects.


Parkinson's disease

Overall, ~40% of Parkinson’s disease patients suffer from apathy, with prevalence rates varying from 16-62%, depending on the study. Apathy is increasingly recognized to be an important non-motor symptom in Parkinson’s disease. It has a significant negative impact on quality of life. In some patients, apathy can be improved by
dopaminergic Dopaminergic means "related to dopamine" (literally, "working on dopamine"), dopamine being a common neurotransmitter. Dopaminergic substances or actions increase dopamine-related activity in the brain. Dopaminergic brain pathways facilitate d ...
medication. There is also some evidence for a positive effect of
cholinesterase inhibitor Cholinesterase inhibitors (ChEIs), also known as anti-cholinesterase, are chemicals that prevent the breakdown of the neurotransmitter acetylcholine or butyrylcholine. This increases the amount of the acetylcholine or butyrylcholine in the syn ...
s such as
Rivastigmine Rivastigmine (sold under the trade name Exelon among others) is a cholinesterase inhibitor used for the treatment of mild to moderate Alzheimer's disease. The drug can be administered orally or via a transdermal patch; the latter form reduces th ...
on apathy. Diminished sensitivity to reward may be a key component of the syndrome in Parkinson’s disease.


Anxiety

While apathy and
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
may appear to be separate, and different, states of being, there are many ways that severe anxiety can cause apathy. First, the emotional fatigue that so often accompanies severe anxiety leads to one's emotions being worn out, thus leading to apathy. Second, the low
serotonin Serotonin () or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter. Its biological function is complex and multifaceted, modulating mood, cognition, reward, learning, memory, and numerous physiological processes such as vomiting and vas ...
levels associated with anxiety often lead to less passion and interest in the activities in one's life which can be seen as apathy. Third, negative thinking and distractions associated with anxiety can ultimately lead to a decrease in one's overall happiness which can then lead to an apathetic outlook about one's life. Finally, the difficulty enjoying activities that individuals with anxiety often face can lead to them doing these activities much less often and can give them a sense of apathy about their lives. Even behavioral apathy may be found in individuals with anxiety in the form of them not wanting to make efforts to treat their anxiety.


Other

Often, apathy is felt after witnessing horrific acts, such as the killing or maiming of people during a
war War is an intense armed conflict between states, governments, societies, or paramilitary groups such as mercenaries, insurgents, and militias. It is generally characterized by extreme violence, destruction, and mortality, using regular o ...
, e.g.
posttraumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
. It is also known to be a distinct psychiatric syndrome that is associated with many conditions, some of which are:
CADASIL syndrome CADASIL or CADASIL syndrome, involving cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, is the most common form of hereditary stroke disorder, and is thought to be caused by mutations of the '' Notch 3'' ...
, depression,
Alzheimer's disease Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
,
Chagas disease Chagas disease, also known as American trypanosomiasis, is a tropical parasitic disease caused by ''Trypanosoma cruzi''. It is spread mostly by insects in the subfamily ''Triatominae'', known as "kissing bugs". The symptoms change over the cou ...
,
Creutzfeldt–Jakob disease Creutzfeldt–Jakob disease (CJD), also known as subacute spongiform encephalopathy or neurocognitive disorder due to prion disease, is an invariably fatal degenerative brain disorder. Early symptoms include memory problems, behavioral changes, ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
(and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia),
Korsakoff's syndrome Korsakoff syndrome (KS) is a disorder of the central nervous system characterized by amnesia, deficits in explicit memory, and confabulation. This neurological disorder is caused by a deficiency of thiamine (vitamin B1) in the brain, and it is ...
, excessive vitamin D,
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland does not produce enough thyroid hormone. It can cause a number of symptoms, such as po ...
,
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormones by the thyroid gland. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism ...
, general fatigue,
Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is a neurodegenerative disease that is mostly inherited. The earliest symptoms are often subtle problems with mood or mental abilities. A general lack of coordination and an unst ...
,
Pick's disease Frontotemporal dementia (FTD), or frontotemporal degeneration disease, or frontotemporal neurocognitive disorder, encompasses several types of dementia involving the progressive degeneration of frontal and temporal lobes. FTDs broadly present as ...
,
progressive supranuclear palsy Progressive supranuclear palsy (PSP) is a late-onset degenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty ...
(PSP),
brain damage Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating t ...
,
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
,
schizoid personality disorder Schizoid personality disorder (, often abbreviated as SzPD or ScPD) is a personality disorder characterized by a Asociality, lack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotion ...
,
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
,
autism spectrum The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental condition (or conditions) characterized by difficulti ...
disorders,
ADHD Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by excessive amounts of inattention, hyperactivity, and impulsivity that are pervasive, impairing in multiple contexts, and otherwise age-inapp ...
, and others. Some medications and the heavy use of drugs such as
opiate An opiate, in classical pharmacology, is a substance derived from opium. In more modern usage, the term ''opioid'' is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain (including antagonis ...
s may bring apathy as a side effect.


See also

*
Callous and unemotional traits Callous-unemotional traits (CU) are distinguished by a persistent pattern of behavior that reflects a disregard for others, and also a lack of empathy and generally deficient affect. The interplay between genetic and environmental risk factors m ...
*
Compassion fatigue Compassion fatigue is a condition characterized by emotional and physical exhaustion leading to a diminished ability to empathize or feel compassion for others, often described as the negative cost of caring. It is sometimes referred to as seconda ...
*
Detachment (philosophy) Nonattachment, non-attachment, or detachment is a state in which a person overcomes their emotional attachment to or desire for things, people or worldly concerns and thus attains a heightened perspective. It is considered a wise virtue and ...
*
Reduced affect display Reduced affect display, sometimes referred to as emotional blunting or emotional numbing, is a condition of reduced emotional reactivity in an individual. It manifests as a failure to express feelings ( affect display) either verbally or nonverba ...


Notes


References

*


External links


''The Roots of Apathy''
– Essay By David O. Solmitz

– McMan's Depression and Bipolar Web, by John McManamy {{Narcissism Problem behavior Emotions Narcissism Psychological attitude