View source for Apathy

{{short description|State of indifference, or the suppression of emotions}}
{{Other uses}}
{{distinguish|Antipathy}}
{{Use dmy dates|date=November 2020}}
{{Mental state}}
{{Emotion}}

'''Apathy''', also referred to as '''indifference''', is a lack of feeling, emotion, interest, or concern about something. It is a state of indifference, or the suppression of emotions such as [[Worry|concern]], [[Psychomotor agitation|excitement]], [[motivation]], or [[Passion (emotion)|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]].<ref name = "Fahed_2021">{{cite journal | vauthors = Fahed M, Steffens DC | title = Apathy: Neurobiology, Assessment and Treatment | journal = Clinical Psychopharmacology and Neuroscience | volume = 19 | issue = 2 | pages = 181–189 | date = May 2021 | pmid = 33888648 | pmc = 8077060 | doi = 10.9758/cpn.2021.19.2.181 }}</ref> Apathy falls in the less extreme spectrum of [[disorders of diminished motivation|diminished motivation]], with [[abulia]] in the middle and [[akinetic mutism]] being more extreme than both apathy and abulia.<ref name="DDM">Marin, R. S., & Wilkosz, P. A. (2005). [http://yaroslavvb.com/papers/marin-disorders.pdf Disorders of diminished motivation] {{webarchive|url=https://web.archive.org/web/20121122130417/http://yaroslavvb.com/papers/marin-disorders.pdf |date=2012-11-22 }}. Journal of Head Trauma Rehabilitation, 20(4), 377-388.</ref>

The apathetic may lack a sense of purpose, worth, or [[Meaningful life|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 [[Involuntary commitment|institutionalization]].<ref name = "Fahed_2021" /> They may also exhibit insensibility or [[sluggishness]].<ref name=":1">{{Cite web |title=Apathy |url=https://my.clevelandclinic.org/health/symptoms/24824-apathy |access-date=2023-12-30 |website=Cleveland Clinic |language=en}}</ref> In [[positive psychology]], 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 (psychology)|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]]). 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.<ref>{{Cite journal |last1=Pishghadam |first1=Reza |last2=Faribi |first2=Maryam |last3=Kolahi Ahari |first3=Mahtab |last4=Shadloo |first4=Farzaneh |last5=Gholami |first5=Mohammad Javad |last6=Shayesteh |first6=Shaghayegh |date=2022-08-29 |title=Intelligence, emotional intelligence, and emo-sensory intelligence: Which one is a better predictor of university students' academic success? |journal=Frontiers in Psychology |volume=13 |doi=10.3389/fpsyg.2022.995988 |doi-access=free |pmid=36106040 |issn=1664-1078|pmc=9465416 }}</ref><ref name=":1" />

Apathy should be distinguished from [[reduced affect display]], which refers to reduced [[Affect display|emotional expression]] but not necessarily reduced emotion.

Pathological apathy, characterized by extreme forms of apathy, is now known to occur in many different brain disorders,<ref name=HusainRoiser2018>{{cite journal | vauthors = Husain M, Roiser JP | title = Neuroscience of apathy and anhedonia: a transdiagnostic approach | journal = Nature Reviews. Neuroscience | volume = 19 | issue = 8 | pages = 470–484 | date = August 2018 | pmid = 29946157 | doi = 10.1038/s41583-018-0029-9 | s2cid = 49428707 | url = https://discovery.ucl.ac.uk/id/eprint/10053434/1/Roiser_34220_3_art_file_251826_p5qy5c%20%281%29.pdf }}</ref> including neurodegenerative conditions often associated with [[dementia]] such as [[Alzheimer's disease]],<ref name="NobisHusainAD">{{cite journal | vauthors = Nobis L, Husain M | title = Apathy in Alzheimer's disease | journal = Current Opinion in Behavioral Sciences | volume = 22 | pages = 7–13 | date = August 2018 | pmid = 30123816 | pmc = 6095925 | doi = 10.1016/j.cobeha.2017.12.007 }}</ref> [[Parkinson's disease]],<ref name="den Brok 759–769">{{Cite journal |last1=den Brok |first1=Melina G. H. E. |last2=van Dalen |first2=Jan Willem |last3=van Gool |first3=Willem A. |last4=Moll van Charante |first4=Eric P. |last5=de Bie |first5=Rob M. A. |last6=Richard |first6=Edo |date = May 2015 |title=Apathy in Parkinson's disease: A systematic review and meta-analysis |journal=Movement Disorders|volume=30 |issue=6 |pages=759–769 |doi=10.1002/mds.26208 |issn=1531-8257 |pmid=25787145|s2cid=35664376 }}</ref> and psychiatric disorders such as [[schizophrenia]].<ref>{{cite journal | vauthors = Bortolon C, Macgregor A, Capdevielle D, Raffard S | title = Apathy in schizophrenia: A review of neuropsychological and neuroanatomical studies | journal = Neuropsychologia | volume = 118 | issue = Pt B | pages = 22–33 | date = September 2018 | pmid = 28966139 | doi = 10.1016/j.neuropsychologia.2017.09.033 | s2cid = 13411386 }}</ref> Although many patients with pathological apathy also have depression, several studies have shown that the two syndromes are dissociable: apathy can occur independent of depression and vice versa.<ref name=HusainRoiser2018 />

==Etymology==
Although the word ''apathy'' was first used in 1594<ref>{{cite web|url=https://www.merriam-webster.com/dictionary/apathy |title=Apathy - Definition and More from the Free Merriam-Webster Dictionary |publisher=Merriam-webster.com |access-date=25 February 2014}}</ref> and is derived from the [[Ancient Greek|Greek]] {{lang|grc|ἀπάθεια}} (''[[apatheia]]''), from {{lang|grc|ἀπάθης}} (''apathēs'', "without feeling" from ''a-'' ("without, not") and ''[[pathos]]'' ("emotion")),<ref>{{cite web|url=https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Da)pa%2Fqeia |title=Henry George Liddell, Robert Scott, A Greek-English Lexicon, ἀπάθ-εια |publisher=Perseus.tufts.edu |access-date=25 February 2014}}</ref> 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]] to signify a (desirable) state of indifference toward events and things that 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).<ref>{{cite book | vauthors = Fleming W | orig-date = 1857 | title = The vocabulary of philosophy, mental, moral, and metaphysical | url =https://archive.org/details/bub_gb_S-MYAAAAYAAJ/page/n63 <!-- quote=Fleming Stoics apathy.--> | page = 34 | publisher = [[Kessinger Publishing]] | date = 2006 | isbn = 978-1-4286-3324-7 }} and in hardcover (2007; {{ISBN|978-0-548-12371-3}}).</ref> In contrast to ''apathy'', ''apatheia'' is considered a [[virtue]], especially in [[Orthodox monasticism]].<ref>{{cite book | vauthors = Linjamaa P | chapter = Emotions, Demons, and Moral Ability |date=2019 | title = The Ethics of The Tripartite Tractate (NHC I, 5) |pages=71–111 |series=A Study of Determinism and Early Christian Philosophy of Ethics |publisher=Brill |jstor=10.1163/j.ctv1sr6hq6.7 |isbn=978-90-04-40775-6 }}</ref>  In the [[Philokalia]] the word ''dispassion'' is used for ''apatheia'', so as not to confuse it with ''apathy''.<ref>{{Cite journal | vauthors = Carey J |date=2018 |title=Dispassion as an Ethical Ideal |journal=Ergo: An Open Access Journal of Philosophy |volume=5 |issue=20201214 |doi=10.3998/ergo.12405314.0005.024 |hdl=2027/spo.12405314.0005.024 |s2cid=59323805 |issn=2330-4014|doi-access=free |hdl-access=free }}</ref>

== History and other views ==
[[Christians]] have historically condemned apathy as a deficiency of love and devotion to [[God]] and his works.<ref>{{cite web |url=http://v3.blueletterbible.org/lang/Lexicon/Lexicon.cfm?strongs=G543&t=KJV |title=Greek Lexicon :: G543 (KJV) |publisher=V3.blueletterbible.org |access-date=25 February 2014 |archive-url=https://web.archive.org/web/20171002220049/http://v3.blueletterbible.org/lang/Lexicon/Lexicon.cfm?strongs=G543&t=KJV |archive-date=2 October 2017 }}</ref> This interpretation of apathy is also referred to as [[Sloth (sin)|Sloth]] and is listed among the [[Seven Deadly Sins]]. [[Clemens Alexandrinus]] used the term to draw to gnostic Christianity [[philosopher]]s who aspired after virtue.<ref>{{Cite journal |last=Maier |first=H.O. |date=1994 |title=Clement of Alexandria and the Care of the Self |journal=Journal of the American Academy of Religion |volume=62 |issue=3 |pages=720–721}}</ref>

The modern concept of apathy became more well known after [[World War I]], when it was one of the various forms of "[[shell shock]]", now better known as [[post-traumatic stress disorder]] (PTSD).<ref>{{cite journal | vauthors = Webb TE | title = 'Dottyville'--Craiglockhart War Hospital and shell-shock treatment in the First World War | journal = Journal of the Royal Society of Medicine | volume = 99 | issue = 7 | pages = 342–346 | date = July 2006 | pmid = 16816263 | pmc = 1484566 | doi = 10.1177/014107680609900716 }}</ref> 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]] when they returned from combat.

In 1950, US novelist [[John Dos Passos]] 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 [[Understanding|comprehension]]."<ref>{{Cite book |last=Passos |first=John |title=The Prospect Before Us |publisher=Houghton Mifflin |year=1950 |isbn=978-1-199-71694-1}}</ref>

=== Social origin ===
Apathy has been socially viewed as worse than things such as hate or anger.  Not caring whatsoever, in the eyes of some,{{who|date=March 2025}} is even worse than having distaste for something.{{citation needed|date=March 2025}}{{original research inline|date=March 2025}}  Author [[Leo Buscaglia]] 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."<ref>{{Cite book |last=Buscaglia |first=Leo |title=Love: A Warm and Wonderful Book About the Largest Experience in Life |year=1972 |publisher=Fawcett Books |isbn=978-0-449-23452-5}}</ref> [[Helen Keller]] stated that apathy is the "worst of them all" when it comes to the various evils in the world.<ref>{{cite book |vauthors = Keller H | author-link1 = Helen Keller |title=[[Light in My Darkness]] | chapter = Chapter 6 |date=1994 | orig-date = 1927|publisher=Chrysalis Books |location=West Chester, Pa. |isbn=978-0-87785-146-2 | quote = But if we listen to the best men and women everywhere ... they will say that science may have found a cure for most evils; but it has found no remedy for the worst of them all—the apathy of human beings. }}</ref> French social commentator and political thinker [[Charles de Montesquieu]] 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."<ref>{{Cite web |title="The tyranny of a prince in an oligarchy is not so dangerous to the public welfare as the apathy of a citizen in a democracy."--Montesquieu, Spirit of the laws, 1748. From the series Great Ideas. {{!}} Smithsonian American Art Museum |url=https://americanart.si.edu/artwork/tyranny-prince-oligarchy-not-so-dangerous-public-welfare-apathy-citizen-democracy |access-date=2024-03-15 |website=americanart.si.edu |language=en}}</ref>

===In the school system===
Apathy in students, especially those in high school, is a growing problem. It can cause teachers to lower their standards in order to try to engage their  students.<ref name=":0">{{Cite journal| vauthors = Bishop JH |date=January 1989 |title= Perspective: Why the Apathy in American High Schools? |journal=Educational Researcher|language=en|volume=18|issue=1|pages=6–42|doi=10.3102/0013189X018001006|s2cid=145803015|issn=0013-189X}}</ref> 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 external motivations rather than having a genuine desire for knowledge, students often do the minimum amount of work necessary to get by in their classes.<ref name=":0" /> This then leads to average grades and test scores, but little real grasp of knowledge.<ref name=":0" /> Many students stated 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.<ref>{{cite web | vauthors = Sanders J, Ticktin R |url=http://pan.intrasun.tcnj.edu/501/projects/Sanders/inquiry%20project.htm |title=Finding the Root Cause of Student Apathy | quote = Apathy in High School Students: An Examination Into Causes and A Suggested Plan for Change |publisher=Pan.intrasun.tcnj.edu |access-date=25 February 2014 |archive-url=https://web.archive.org/web/20130324024245/http://pan.intrasun.tcnj.edu/501/projects/Sanders/inquiry%20project.htm |archive-date=24 March 2013 }}</ref> 

Other causes of apathy in students include situations within their home life, media influences, peer influences, 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;<ref>{{Cite journal| vauthors = Korpershoek H, Kuyper H, van der Werf G |date=2015-03-01|title=Differences in students' school motivation: A latent class modelling approach|journal=Social Psychology of Education|language=en|volume=18|issue=1|pages=137–163|doi=10.1007/s11218-014-9274-6|s2cid=145228051|issn=1573-1928|url=https://research.rug.nl/en/publications/9a4704c0-8df1-4039-bf75-08495db940e5 }}</ref> i.e. they are motivated by different factors or stimuli.

===Bystander===
Also known as the [[bystander effect]], 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.<ref name="Latané_1969" /> 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]] 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.<ref name="Latané_1969">{{cite journal | vauthors = Latané B, Darley JM | title = Bystanders "apathy" | journal = American Scientist | volume = 57 | issue = 2 | pages = 244–68 | date = 1969 | pmid = 5797312 | doi = | url = http://www.psychologytoday.com/basics/bystander-effect |archive-url= https://archive.today/20131104200127/http://www.psychologytoday.com/basics/bystander-effect |archive-date=4 November 2013 }}</ref> [[Bibb Latané|Latané]] and [[John M. Darley|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.{{citation needed|date=November 2024}}

==Measurement==
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.<ref>{{Cite journal |last1=Marin |first1=Robert S. |last2=Biedrzycki |first2=Ruth C. |last3=Firinciogullari |first3=Sekip |date=1991-08-01 |title=Reliability and validity of the apathy evaluation scale |url=https://linkinghub.elsevier.com/retrieve/pii/016517819190040V |journal=Psychiatry Research |volume=38 |issue=2 |pages=143–162 |doi=10.1016/0165-1781(91)90040-V |pmid=1754629 |issn=0165-1781|url-access=subscription }}</ref><ref>{{cite web|url=http://www.dementia-assessment.com.au/symptoms/AES_self.pdf |title=Apathy Evaluation Scale (Self rated) |publisher=Dementia-assessment.com.au |access-date=25 February 2014 |archive-url=https://web.archive.org/web/20140126074628/http://dementia-assessment.com.au/symptoms/AES_self.pdf |archive-date=26 January 2014 }}</ref>

===Apathy Motivation Index===
The Apathy Motivation Index (AMI) was developed to measure different dimensions of apathy in healthy people. [[Factor analysis]] identified three distinct axes of apathy: behavioural, social and emotional.<ref name="Ang et al PLoS One">{{cite journal | vauthors = Ang YS, Lockwood P, Apps MA, Muhammed K, Husain M | title = Distinct Subtypes of Apathy Revealed by the Apathy Motivation Index | journal = PLOS ONE | volume = 12 | issue = 1 | article-number = e0169938 | date = 2017 | pmid = 28076387 | pmc = 5226790 | doi = 10.1371/journal.pone.0169938 | bibcode = 2017PLoSO..1269938A | doi-access = free }}</ref> The AMI has since been used to examine apathy in patients with [[Parkinson's disease]] who, overall, showed evidence of behavioural and social apathy, but not emotional apathy.<ref>{{cite journal | vauthors = Ang YS, Lockwood PL, Kienast A, Plant O, Drew D, Slavkova E, Tamm M, Husain M | display-authors = 6 | title = Differential impact of behavioral, social, and emotional apathy on Parkinson's disease | journal = Annals of Clinical and Translational Neurology | volume = 5 | issue = 10 | pages = 1286–1291 | date = October 2018 | pmid = 30349863 | pmc = 6186939 | doi = 10.1002/acn3.626 }}</ref> Patients with [[Alzheimer's disease]], [[Parkinson's disease]], subjective cognitive impairment and [[limbic encephalitis]] have also been assessed using the AMI, and their self-reports of apathy were compared with those of caregivers using the AMI caregiver scale.<ref>{{Cite journal |last1=Klar |first1=Verena S. |last2=Ang |first2=Yuen-Siang |last3=Lockwood |first3=Patricia |last4=Attaallah |first4=Bahaaeddin |last5=Dickson |first5=Shannon |last6=Drew |first6=Daniel |last7=Kienast |first7=Annika |last8=Maio |first8=Maria R. |last9=Plant |first9=Olivia |last10=Slavkova |first10=Elitsa |last11=Toniolo |first11=Sofia |last12=Zambellas |first12=Rhea |last13=Irani |first13=Sarosh R. |last14=Husain |first14=Masud |date = March 2022 |title=Assessment of apathy in neurological patients using the Apathy Motivation Index caregiver version |journal=Journal of Neuropsychology |volume=16 |issue=1 |pages=236–258 |doi=10.1111/jnp.12262 |issn=1748-6653 |pmc=9290131 |pmid=34532963}}</ref>

===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]], 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<ref name="Radakovic & Abrahams Psychiatry Res">{{cite journal | vauthors = Radakovic R, Abrahams S | title = Developing a new apathy measurement scale: Dimensional Apathy Scale | journal = Psychiatry Research | volume = 219 | issue = 3 | pages = 658–63 | date = November 2014 | pmid = 24972546 | doi = 10.1016/j.psychres.2014.06.010 | hdl = 20.500.11820/2c1a046b-3836-4890-8e38-f85436c76474 | s2cid = 16313833 | url = https://www.pure.ed.ac.uk/ws/files/25353052/abrahams_accepted_man_2_.pdf }}</ref> and an informant/carer-rated version of the DAS.<ref name="Radakovic et al JNNP">{{cite journal | vauthors = Radakovic R, Stephenson L, Colville S, Swingler R, Chandran S, Abrahams S | title = Multidimensional apathy in ALS: validation of the Dimensional Apathy Scale | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 87 | issue = 6 | pages = 663–9 | date = June 2016 | pmid = 26203157 | doi = 10.1136/jnnp-2015-310772 | s2cid = 15540782 | url = https://ueaeprints.uea.ac.uk/id/eprint/65877/1/Accepted_manuscript.pdf }}</ref> Further a clinical brief DAS has also been developed.<ref name="Radakovic et al TCN">{{cite journal | vauthors = Radakovic R, Stephenson L, Colville S, Swingler R, Chandran S, Abrahams S | title = Multidimensional apathy in ALS: validation of the Dimensional Apathy Scale | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 87 | issue = 6 | pages = 663–9 | date = June 2016 | pmid = 26203157 | doi = 10.1080/13854046.2019.1621382 | s2cid = 173994534 | url = https://ueaeprints.uea.ac.uk/id/eprint/71489/1/TCNPURE.pdf }}</ref> It has been validated for use in [[stroke]], [[Huntington's disease]], [[motor neurone disease]], [[Multiple Sclerosis]], [[dementia]], [[Parkinson's disease]] and [[schizophrenia]], showing to differentiate profiles of apathy subtypes between these conditions.<ref name="Radakovic & Abrahams Curr Opin Behav Sci">{{cite journal | vauthors = Radakovic R, Abrahams S |title=Multidimensional apathy: evidence from neurodegenerative disease |journal=Current Opinion in Behavioral Sciences |date=2018 |volume=22 |pages=42–49 |doi=10.1016/j.cobeha.2017.12.022 |s2cid=53173573 |url= https://ueaeprints.uea.ac.uk/66281/1/Accepted_manuscript.pdf }}</ref><ref>{{cite journal | vauthors = Atkins KJ, Andrews SC, Chong TT, Stout JC | title = Multidimensional Apathy: The Utility of the Dimensional Apathy Scale in Huntington's Disease | journal = Movement Disorders Clinical Practice | volume = 8 | issue = 3 | pages = 361–370 | date = April 2021 | pmid = 33816664 | pmc = 8015897 | doi = 10.1002/mdc3.13147 }}</ref><ref>{{cite journal | vauthors = Raimo S, Trojano L, Gaita M, Spitaleri D, Santangelo G | title = Assessing apathy in multiple sclerosis: Validation of the dimensional apathy scale and comparison with apathy evaluation scale | journal = Multiple Sclerosis and Related Disorders | volume = 38 | article-number = 101870 | date = February 2020 | pmid = 31830701 | doi = 10.1016/j.msard.2019.101870 | s2cid = 209343166 }}</ref><ref>{{cite journal | vauthors = Barek LM, Mercy G, Gautier C, Noquet M, Legros-Lafarge E, Fiegl L, Fiard D, Allain P | display-authors = 6 | title = The use of the French Dimensional Apathy Scale (f-DAS) to assess apathy in schizophrenia: Properties and profiles | journal = Journal of Affective Disorders | volume = 294 | pages = 181–188 | date = November 2021 | pmid = 34298224 | doi = 10.1016/j.jad.2021.06.081 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Myhre P, Radakovic R, Ford C | title = Validation of the self-rated Dimensional Apathy Scale in community stroke survivors | journal = Journal of the Neurological Sciences | volume = 434 | article-number = 120103 | date = March 2022 | pmid = 34999366 | doi = 10.1016/j.jns.2021.120103 | s2cid = 245423518 | url = https://ueaeprints.uea.ac.uk/id/eprint/82849/1/Accepted_Manuscript.pdf }}</ref>

== Medical aspects ==

===Depression===
{{Main|Major depressive disorder}}
Mental health journalist and author John McManamy argues that although [[psychiatrist]]s do not explicitly deal with the condition of apathy, it is a psychological problem for some [[clinical depression|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".<ref name="McManamy">{{cite web | vauthors = McManamy J | url = http://www.mcmanweb.com/apathy.html | title = Apathy Matters - Apathy and Depression: Psychiatry may not care about apathy, but that doesn't mean you shouldn't | archive-url = https://web.archive.org/web/20140820171536/http://www.mcmanweb.com/apathy.html | archive-date=20 August 2014 }}".</ref>{{self-published inline|date=March 2020}} He describes depressed people who "...cannot seem to make [themselves] do anything", who "can't complete anything", and who do not "feel any excitement about seeing loved ones".<ref name="McManamy" /> He acknowledges that the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' does not discuss apathy.

In a ''[[Journal of Neuropsychiatry and Clinical Neurosciences]]'' 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.<ref name="McManamy" /> This has now been shown to be the case across a range of neurological and psychiatric conditions.<ref name="HusainRoiser2018" />

A review article by Robert van Reekum, MD, et al. from the [[University of Toronto]] in the ''Journal of Neuropsychiatry'' (2005) claimed that an obvious relationship between depression and apathy exists in some populations.<ref>{{cite journal | vauthors = van Reekum R, Stuss DT, Ostrander L | title = Apathy: why care? | journal = The Journal of Neuropsychiatry and Clinical Neurosciences | volume = 17 | issue = 1 | pages = 7–19 | date = February 2005 | pmid = 15746478 | doi = 10.1176/jnp.17.1.7 }}</ref> However, although many patients with depression also have apathy, several studies have shown that apathy can occur independently of depression, and vice versa.<ref name=HusainRoiser2018 />

Apathy can be associated with depression, a manifestation of negative disorders in schizophrenia, or a symptom of various somatic and neurological disorders.<ref>{{cite journal | vauthors = Andersson S, Krogstad JM, Finset A | title = Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity | journal = Psychological Medicine | volume = 29 | issue = 2 | pages = 447–456 | date = March 1999 | pmid = 10218936 | doi = 10.1017/s0033291798008046 | s2cid = 34996374 }}</ref><ref name="HusainRoiser2018" /> Sometimes apathy and depression are viewed as the same thing, but actually take different forms depending on someone's mental condition.<ref>{{cite journal | vauthors = Levy ML, Cummings JL, Fairbanks LA, Masterman D, Miller BL, Craig AH, Paulsen JS, Litvan I | display-authors = 6 | title = Apathy is not depression | journal = The Journal of Neuropsychiatry and Clinical Neurosciences | volume = 10 | issue = 3 | pages = 314–319 | date = 1998-08-01 | pmid = 9706539 | doi = 10.1176/jnp.10.3.314 }}</ref>

===Alzheimer's disease===
Depending upon how it has been measured, apathy affects 19–88% percent of individuals with [[Alzheimer's disease]] (mean prevalence of 49% across different studies).<ref name="NobisHusainAD" /> It is a neuropsychiatric symptom associated with functional impairment. Brain imaging studies have demonstrated changes in the [[anterior cingulate cortex]], [[orbitofrontal cortex]], [[dorsolateral prefrontal cortex]] and ventral striatum in Alzheimer's patients with apathy.<ref name="LeHeronAppsHusainAnatomy2018">{{cite journal | vauthors = Le Heron C, Apps MA, Husain M | title = The anatomy of apathy: A neurocognitive framework for amotivated behaviour | journal = Neuropsychologia | volume = 118 | issue = Pt B | pages = 54–67 | date = September 2018 | pmid = 28689673 | pmc = 6200857 | doi = 10.1016/j.neuropsychologia.2017.07.003 }}</ref> [[Cholinesterase inhibitors]], 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.<ref>{{cite news | vauthors = Malloy PF |title=Apathy and Its Treatment in Alzheimer's Disease and Other Dementias |url=https://www.psychiatrictimes.com/articles/apathy-and-its-treatment-alzheimers-disease-and-other-dementias |work=Psychiatric Times |date=2 November 2005 }}</ref> The effects of [[donepezil]], [[galantamine]] and [[rivastigmine]] 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.<ref name="NobisHusainAD" /> [[Methylphenidate]], 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.<ref>{{cite journal | vauthors = Herrmann N, Rothenburg LS, Black SE, Ryan M, Liu BA, Busto UE, Lanctôt KL | title = Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine challenge | journal = Journal of Clinical Psychopharmacology | volume = 28 | issue = 3 | pages = 296–301 | date = June 2008 | pmid = 18480686 | doi = 10.1097/JCP.0b013e318172b479 | s2cid = 30971352 }}</ref><ref>{{cite journal | vauthors = Rosenberg PB, Lanctôt KL, Drye LT, Herrmann N, Scherer RW, Bachman DL, Mintzer JE | title = Safety and efficacy of methylphenidate for apathy in Alzheimer's disease: a randomized, placebo-controlled trial | journal = The Journal of Clinical Psychiatry | volume = 74 | issue = 8 | pages = 810–6 | date = August 2013 | pmid = 24021498 | pmc = 3902018 | doi = 10.4088/JCP.12m08099 }}</ref><ref>{{cite journal | vauthors = Lanctôt KL, Chau SA, Herrmann N, Drye LT, Rosenberg PB, Scherer RW, Black SE, Vaidya V, Bachman DL, Mintzer JE | display-authors = 6 | title = Effect of methylphenidate on attention in apathetic AD patients in a randomized, placebo-controlled trial | journal = International Psychogeriatrics | volume = 26 | issue = 2 | pages = 239–46 | date = February 2014 | pmid = 24169147 | pmc = 3927455 | doi = 10.1017/S1041610213001762 }}</ref> A phase III multi-centered randomized placebo-controlled trial of methylphenidate for the treatment of apathy has reported positive effects.<ref>{{Cite journal |last1=Mintzer |first1=Jacobo |last2=Lanctôt |first2=Krista L. |last3=Scherer |first3=Roberta W. |last4=Rosenberg |first4=Paul B. |last5=Herrmann |first5=Nathan |last6=van Dyck |first6=Christopher H. |last7=Padala |first7=Prasad R. |last8=Brawman-Mintzer |first8=Olga |last9=Porsteinsson |first9=Anton P. |last10=Lerner |first10=Alan J. |last11=Craft |first11=Suzanne |last12=Levey |first12=Allan I. |last13=Burke |first13=William |last14=Perin |first14=Jamie |last15=Shade |first15=David |date = November 2021 |title=Effect of Methylphenidate on Apathy in Patients With Alzheimer Disease: The ADMET 2 Randomized Clinical Trial |journal=JAMA Neurology |volume=78 |issue=11 |pages=1324–1332 |doi=10.1001/jamaneurol.2021.3356 |issn=2168-6157 |pmc=8477302 |pmid=34570180}}</ref>

=== Parkinson's disease ===
Overall, ~40% of [[Parkinson's disease]] patients suffer from apathy, with prevalence rates varying from 16 to 62%, depending on the study.<ref name="den Brok 759–769"/> Apathy is increasingly recognized to be an important non-motor symptom in Parkinson's disease.<ref>{{Cite journal |last1=Pagonabarraga |first1=Javier |last2=Kulisevsky |first2=Jaime |last3=Strafella |first3=Antonio P. |last4=Krack |first4=Paul |date = May 2015 |title=Apathy in Parkinson's disease: clinical features, neural substrates, diagnosis, and treatment |journal=The Lancet. Neurology |volume=14 |issue=5 |pages=518–531 |doi=10.1016/S1474-4422(15)00019-8 |issn=1474-4465 |pmid=25895932|hdl=10609/92806 |s2cid=43614772 |hdl-access=free }}</ref> It has a significant negative impact on quality of life.<ref>{{Cite journal |last1=Benito-León |first1=Julián |last2=Cubo |first2=Esther |last3=Coronell |first3=Carlos |last4=ANIMO Study Group |date = February 2012 |title=Impact of apathy on health-related quality of life in recently diagnosed Parkinson's disease: the ANIMO study |journal=Movement Disorders|volume=27 |issue=2 |pages=211–218 |doi=10.1002/mds.23872 |issn=1531-8257 |pmid=21780179|hdl=10553/48392 |s2cid=35925068 |hdl-access=free }}</ref> In some patients, apathy can be improved by [[dopaminergic]] medication.<ref>{{Cite journal |last1=Thobois |first1=Stéphane |last2=Lhommée |first2=Eugénie |last3=Klinger |first3=Hélène |last4=Ardouin |first4=Claire |last5=Schmitt |first5=Emmanuelle |last6=Bichon |first6=Amélie |last7=Kistner |first7=Andrea |last8=Castrioto |first8=Anna |last9=Xie |first9=Jing |last10=Fraix |first10=Valerie |last11=Pelissier |first11=Pierre |last12=Chabardes |first12=Stephan |last13=Mertens |first13=Patrick |last14=Quesada |first14=Jean-Louis |last15=Bosson |first15=Jean-Luc |date = May 2013 |title=Parkinsonian apathy responds to dopaminergic stimulation of D2/D3 receptors with piribedil |journal=Brain: A Journal of Neurology |volume=136 |issue=Pt 5 |pages=1568–1577 |doi=10.1093/brain/awt067 |issn=1460-2156 |pmid=23543483|doi-access=free }}</ref> There is also some evidence for a positive effect of [[cholinesterase inhibitor]]s such as [[Rivastigmine]] on apathy.<ref>{{Cite journal |last1=Devos |first1=David |last2=Moreau |first2=Caroline |last3=Maltête |first3=David |last4=Lefaucheur |first4=Romain |last5=Kreisler |first5=Alexandre |last6=Eusebio |first6=Alexandre |last7=Defer |first7=Gilles |last8=Ouk |first8=Thavarak |last9=Azulay |first9=Jean-Philippe |last10=Krystkowiak |first10=Pierre |last11=Witjas |first11=Tatiana |last12=Delliaux |first12=Marie |last13=Destée |first13=Alain |last14=Duhamel |first14=Alain |last15=Bordet |first15=Régis |date = June 2014 |title=Rivastigmine in apathetic but dementia and depression-free patients with Parkinson's disease: a double-blind, placebo-controlled, randomised clinical trial |journal=Journal of Neurology, Neurosurgery, and Psychiatry |volume=85 |issue=6 |pages=668–674 |doi=10.1136/jnnp-2013-306439 |issn=1468-330X |pmid=24218528|s2cid=7052710 }}</ref> Diminished sensitivity to reward may be a key component of the syndrome in Parkinson's disease.<ref>{{Cite journal |last1=Muhammed |first1=Kinan |last2=Manohar |first2=Sanjay |last3=Ben Yehuda |first3=Michael |last4=Chong |first4=Trevor T.-J. |last5=Tofaris |first5=George |last6=Lennox |first6=Graham |last7=Bogdanovic |first7=Marko |last8=Hu |first8=Michele |last9=Husain |first9=Masud |date = October 2016 |title=Reward sensitivity deficits modulated by dopamine are associated with apathy in Parkinson's disease |journal=Brain: A Journal of Neurology |volume=139 |issue=Pt 10 |pages=2706–2721 |doi=10.1093/brain/aww188 |issn=1460-2156 |pmc=5035817 |pmid=27452600}}</ref><ref>{{Cite journal |last1=Le Heron |first1=Campbell |last2=Plant |first2=Olivia |last3=Manohar |first3=Sanjay |last4=Ang |first4=Yuen-Siang |last5=Jackson |first5=Matthew |last6=Lennox |first6=Graham |last7=Hu |first7=Michele T. |last8=Husain |first8=Masud |date = May 2018 |title=Distinct effects of apathy and dopamine on effort-based decision-making in Parkinson's disease |journal=Brain: A Journal of Neurology |volume=141 |issue=5 |pages=1455–1469 |doi=10.1093/brain/awy110 |issn=1460-2156 |pmc=5917786 |pmid=29672668}}</ref>

=== Frontotemporal dementia ===
Pathological apathy is considered to be one of the diagnostic features of behavioural variant [[frontotemporal dementia]],<ref>{{cite journal |last1=Rascovsky |first1=Katya |last2=Hodges |first2=John R. |last3=Knopman |first3=David |last4=Mendez |first4=Mario F. |last5=Kramer |first5=Joel H. |last6=Neuhaus |first6=John |last7=van Swieten |first7=John C. |last8=Seelaar |first8=Harro |last9=Dopper |first9=Elise G. P. |last10=Onyike |first10=Chiadi U. |last11=Hillis |first11=Argye E. |last12=Josephs |first12=Keith A. |last13=Boeve |first13=Bradley F. |last14=Kertesz |first14=Andrew |last15=Seeley |first15=William W. |last16=Rankin |first16=Katherine P. |last17=Johnson |first17=Julene K. |last18=Gorno-Tempini |first18=Maria-Luisa |last19=Rosen |first19=Howard |last20=Prioleau-Latham |first20=Caroline E. |last21=Lee |first21=Albert |last22=Kipps |first22=Christopher M. |last23=Lillo |first23=Patricia |last24=Piguet |first24=Olivier |last25=Rohrer |first25=Jonathan D. |last26=Rossor |first26=Martin N. |last27=Warren |first27=Jason D. |last28=Fox |first28=Nick C. |last29=Galasko |first29=Douglas |last30=Salmon |first30=David P. |last31=Black |first31=Sandra E. |last32=Mesulam |first32=Marsel |last33=Weintraub |first33=Sandra |last34=Dickerson |first34=Brad C. |last35=Diehl-Schmid |first35=Janine |last36=Pasquier |first36=Florence |last37=Deramecourt |first37=Vincent |last38=Lebert |first38=Florence |last39=Pijnenburg |first39=Yolande |last40=Chow |first40=Tiffany W. |last41=Manes |first41=Facundo |last42=Grafman |first42=Jordan |last43=Cappa |first43=Stefano F. |last44=Freedman |first44=Morris |last45=Grossman |first45=Murray |last46=Miller |first46=Bruce L. |title=Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia |journal=Brain |date=September 2011 |volume=134 |issue=9 |pages=2456–2477 |doi=10.1093/brain/awr179|doi-access=free |pmid=21810890 |pmc=3170532 }}</ref> occurring in the majority of people with this condition.<ref>{{cite journal |last1=Johnson |first1=Emma |last2=Kumfor |first2=Fiona |title=Overcoming apathy in frontotemporal dementia: challenges and future directions |journal=Current Opinion in Behavioral Sciences |date=August 2018 |volume=22 |pages=82–89 |doi=10.1016/j.cobeha.2018.01.022}}</ref> Both hypersensitivity to effort as well as blunting of sensitivity to reward may be components of behavioural apathy in [[frontotemporal dementia]].<ref>{{cite journal |last1=Husain |first1=Masud |title=Mechanisms underlying apathy in frontotemporal dementia |journal=Brain |date=13 February 2023 |volume=146 |issue=2 |pages=416–417 |doi=10.1093/brain/awac494|doi-access=free |pmid=36567496 }}</ref>

===Anxiety===
While apathy and [[anxiety]] 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]] 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.<ref>{{cite web | vauthors = Abraham M | date = 10 October 2020 |url= http://www.calmclinic.com/anxiety/apathy |title=Apathy: Anxiety's Unusual Symptom |publisher=Calm Clinic |access-date=25 February 2014}}</ref>

=== Other ===
Often, apathy is felt after witnessing horrific acts, such as the killing or maiming of people during a [[war]], e.g. [[posttraumatic stress disorder]]. It is also known to be a distinct psychiatric syndrome<ref>{{Cite web | vauthors = Sederer L |date=July 26, 2012 |title=The Enemy Is Apathy |url=https://www.psychiatrictimes.com/view/enemy-apathy |website=Psychiatric Times |language=en}}</ref> that is associated with many conditions, more prominently recognized in the elderly, some of which are: [[CADASIL syndrome]], [[Major depressive disorder|depression]], [[Alzheimer's disease]], [[Chagas disease]], [[Creutzfeldt–Jakob disease]], [[dementia]] (and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia), [[Korsakoff's syndrome]], [[Hypervitaminosis D|excessive vitamin D]], [[hypothyroidism]], [[hyperthyroidism]], general fatigue, [[Huntington's disease]], [[Pick's disease]], [[progressive supranuclear palsy]] (PSP), [[brain damage]], [[schizophrenia]], [[schizoid personality disorder]], [[bipolar disorder]],<ref>{{Cite journal |last1=Ishii |first1=Shinya |last2=Weintraub |first2=Nancy |last3=Mervis |first3=James R. |date=2009-07-01 |title=Apathy: A Common Psychiatric Syndrome in the Elderly |url=https://www.sciencedirect.com/science/article/pii/S1525861009000991 |journal=Journal of the American Medical Directors Association |volume=10 |issue=6 |pages=381–393 |doi=10.1016/j.jamda.2009.03.007 |pmid=19560715 |issn=1525-8610|url-access=subscription }}</ref> [[autism spectrum]] disorders, [[ADHD]], and others. Some medications and the heavy use of drugs such as [[opiate]]s may bring apathy as a side effect.<ref>{{cite journal | vauthors = Baldini A, Von Korff M, Lin EH | title = A Review of Potential Adverse Effects of Long-Term Opioid Therapy: A Practitioner's Guide | journal = The Primary Care Companion for CNS Disorders | volume = 14 | issue = 3 | date = 2012-06-14 | pmid = 23106029 | pmc = 3466038 | doi = 10.4088/PCC.11m01326 }}</ref>

== See also ==
*[[Acedia]]
*[[Callous and unemotional traits]]
*[[Compassion fatigue]]
*[[Detachment (philosophy)]]
*[[Political apathy]]
*[[Reduced affect display]]
*[[Anhedonia]]

==References==
{{Reflist}}

=== Sources ===
*{{1728|title=Apathy}}

== External links ==
{{Wikiquote}}
* [https://web.archive.org/web/20081201033826/http://www.rem1.org/local_voices/summer2000/education/apathy.htm/ ''The Roots of Apathy''] – Essay By David O. Solmitz
* [https://web.archive.org/web/20140820171536/http://www.mcmanweb.com/apathy.html ''Apathy''] – McMan's Depression and Bipolar Web, by John McManamy

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[[Category:Problem behavior]]
[[Category:Emotions]]
[[Category:Psychological attitude]]
[[Category:Disorders of diminished motivation]]
[[Category:Symptoms or signs involving mood or affect]]