Reward Deficiency Syndrome

Dopamine and three other neurotransmitters— serotonin, the enkephalins, and gamma-Aminobutyric acid — are a major part of the reward pathway in the brain. In the majority of people, the reward system begins with one of these chemicals spreading out to “network” and involve the other neurotransmitters in what resembles a cascade. As a result, people feel secure, calm, comfortable and satisfied. In some people, this reward system is deficient, and they have a hard time feeling satisfied.

This deficiency can contribute to alcoholism, drug abuse, obesity, and various other problems because there is no “off button” of satiety.

I seldom feel these rewards. When I eat, I don’t feel a cessation of hunger, don’t feel any sustained pleasure from foods (though I do enjoy various tastes, of course). When I ran when I was younger, I never felt a runner’s high or any mindother sort of satisfaction except that of having completed the course. After a lifetime of wondering what the big deal is — what this natural “high” is that gives people such great satisfaction — I no longer particularly care if I am deficient or not. I’ve adjusted. I find my satisfactions in other things — a job done, a skill learned, a blog written.

This reward deficiency syndrome is often present in people with mental challenges such as bipolar disorder and narcissistic personality disorder. Rage is a characteristic of both of these mental disorders — perhaps because rage is a way of releasing adrenaline which leads to a small cascade of reward neurotransmitters. Alcoholism is also often present with both these disorders — those suffering from these problems often self-medicate with alcohol to relieve feelings of dullness and depression.

Although reward deficiency syndrome is related to neurotransmitters, I have a hunch it also relates to behavioral issues. For most of us, if we do something “bad” and are punished, we see the cause/effect of bad/punishment. If we do something positive, such as work hard and take home a nice paycheck, we see the cause/effect of good/reward. But those with behavioral reward deficiency don’t seem to be able to see cause and effect, hence they feel no accountability.

I’ve seen this in my dysfunctional homeless brother. I am trying to be as kind to him as possible, even though he is never grateful and takes all such kindness as his due. In fact, his sense of entitlement is so great, he doesn’t even seem to be able to see that I’ve been kind to him; instead, he harangues me for being selfish. (This projection of his own qualities onto me is part of the narcissist personality disorder.) Conversely, if I ignore his demands, he doesn’t seem to be able to figure out that being courteous would get him courtesy in exchange. Instead, he escalates his demands. I used to be afraid that if I paid attention to him after his demands became insanely insistent that it would teach him to continue his assault (that’s what his demands feel like — an assault), but it has no effect on him since he doesn’t seem to be able to see that I am “rewarding” his assault. To him, it’s all the same. In fact, often when he knocks on my window for attention and I ask what he wants, he gets angry because I am demanding and inconsiderate, as if it were I who wanted his attention. It doesn’t compute that he was the one who wanted to say something to me.

He got a jaywalking ticket a couple of months ago and was so angry about it that I said I’d pay it, not just to shut him up but because I didn’t want to drive him across town to the courthouse and hang around all day while he tried to fight it. He never said that he wanted me to pay it, but he kept reminding me I had offered to pay. A couple of days ago, my father offered to pay the ticket, too. When I asked my brother for the bill so my father could write a check, my brother got mad. “You lied to me,” he said. “You said you were going to pay the ticket.” We went round and round for a while, me trying to explain that I had intended to pay it and he calling me a liar. Today, after I paid the ticket, all he said was, “I never asked you to pay it.” (Incidentally, “lying” is a big thing for him. Any miscommunication is an opportunity for calling me a liar, among other things.)

Ah, the joys of living with a dysfunctional brother.


Pat Bertram is the author of the suspense novels Light Bringer, More Deaths Than One, A Spark of Heavenly Fire, and Daughter Am I. Bertram is also the author of Grief: The Great Yearning, “an exquisite book, wrenching to read, and at the same time full of profound truths.” Follow Pat on Google+. Like Pat on Facebook.

5 Responses to “Reward Deficiency Syndrome”

  1. rami ungar the writer Says:

    Why do you put up with him, Pat? If I had a sibling like that, I’d have shut that door a long time ago and never opened it again.

    • Pat Bertram Says:

      And that’s exactly why the streets are full of people like him. No one wants to deal with them. The system is not set up to treat all who want treatment. It certainly has no place for those who don’t want it. The warden of the LA jail brags that he runs the biggest mental institution in the country. Doesn’t seem as if it’s much to brag about.

      The only reason I’m writing about the situation at all is to see if I can find a way through a difficult time. And maybe, just maybe, learn something about me.

  2. Eleanor Anders Says:

    I’m sure many are on a journey like yours. Although many of those are different in reason, different in people, different in circumstances, but they all are on a journey for sure. I’m praying for all of your family and you.

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