What would happen to a person if he or she could not care about his or her accomplishments or successes? Most of us find the very idea of such a state difficult to comprehend. That you will feel good if you get something you consider worthwhile done is very basic to our day to day living. Of course, the "something" differs with different people. One person will exult in conquering a difficult mountain peak, while another might be gladdened by the completion of a 10,000-piece jigsaw puzzle, and a third by something more mundane but nevertheless important, such as a promotion at work. We do things for many reasons, but it cannot be doubted that one of the most persistent motivators, the one that is always involved in task completion, is the satisfaction and pleasure this brings to the doer.

As one might suspect, this reaction is founded in specific parts of the chemistry of the brain. It is caused by a chemical named dopamine, which is released in the brain as part of the normal response to accomplishment. When it reaches another part of the brain called the dopamine receptors, it produces a sensation of pleasure, relaxation, and happiness. This is the body's natural mechanism for encouraging itself to further efforts, by making the completion of tasks pleasant.

Unfortunately, in a few people, this reaction does not proceed as it should. The dopamine receptors in the brain are classified into five groups, D1 to D5, with a variety of functions. In these people, the dopamine D2 receptor is compromised or entirely fails to function. As a result, the person concerned will feel less of a reward sensation when accomplishing tasks. In some cases, when the D2 receptors are very badly damaged, the person will feel no satisfaction at all.

The consequences to such a person vary with the extent of the damage to the D2 receptors. When these are merely dulled, not extinguished, this deficiency may cause the person to look for stronger and stronger stimuli so that he or she can feel the same sense of pleasure and accomplishment as a normal person would. This search can easily end up with drug addiction, or other compulsive behavior such as sugar binging or sexual mania. In some forms of drug addiction, a vicious circle is set up, since drugs such as cocaine will cause further damage to the brain, requiring a still more extreme stimulus.

On occasion, a person may have no activity at all in the D2 receptors. This at least protects him or her from drug addiction, and such a person has the uncanny ability to consume large quantities of powerful drugs with no effect on his or her mood whatsoever. But it also means that that person will feel no internal impulse to accomplish tasks. When not compelled by obligation to others or some separate drive like intellectual curiosity, the sufferer from full-blown reward deficiency syndrome will be extremely reluctant to do anything for himself or herself other than the absolutely essential. This obviously has a crippling effect on personal ambition and leaves the sufferer indifferent to any form of "getting ahead." Promotions, careers, rites of passage, congratulatory rituals -- all are incomprehensible to such a person. He or she will drift through life, not understanding what moves other persons, lacking a sense of the future or any compulsion to improve himself or herself.

Reward deficiency syndrome, or something very close to it, can be caused by excessive use of recreational drugs, but the more extreme forms are primarily inherited. The precise genetic link is unknown, but like autism, it appears to affect males more strongly than females. Indeed, damage to this part of the brain is suspected of playing a role in some forms of autism, as well as in such diverse and crippling traits as pathological gambling, sex addiction, ADHD, Tourette's Syndrome, chronic violence, post-traumatic stress disorder, schizoid/avoidant cluster, conduct disorder and antisocial behavior.

There is no cure for reward deficiency syndrome, since it is not a disease but a malfunction and repairs to that part of the brain are impractical at this stage of medical knowledge. The symptoms may be eased by some of the drugs typically prescribed for ADHD, such as Wellbutrin (buproprion). The most important result of diagnosis is that the sufferer is provided with an explanation for the difference between himself/herself and others, and can thus take it into account and consciously avoid its more damaging consequences.

School counselors and mental health workers dealing with adolescents would be well advised to learn more about reward deficiency syndrome. It can, for instance, be the reason for the intensely frustrating experience of having obviously intelligent and potentially high-performing students who are not interested in accomplishment or have a habit of abandoning tasks half-done or being indifferent to others taking credit for their work. The milder forms also predispose the sufferer towards addictive behaviors, which will be easier to treat when their underlying cause is known.

Bibliography

Blum K, Braverman ER, Holder JM, Lubar JF, Monastra VJ, Miller D, Lubar JO, Chen TJ, & Comings DE. (2000). "Reward deficiency syndrome: a biogenetic model for the diagnosis and treatment of impulsive, addictive, and compulsive behaviors." Journal of Psychoactive Drugs 32 (November), 1-112. Abstract indexed in PubMed database. PMID: 11280926.