Anhedonia & How it’s Misunderstood
Anhedonia refers to the inability or lack of experienced pleasure throughout one’s daily life. It has had an important place in many aspects of psychopathology since it was first described in the 1900’s, and is still a feature of several types of psychiatric disorders. Anhedonia has been most extensively studied in major depression but, as it also constitutes one important negative symptom of schizophrenia, much literature has also been devoted to anhedonia in psychosis. Anhedonia has in fact been studied in a large range of neuropsychiatric disorders, including substance use disorder, Parkinson's disease, overeating, and various risky behaviors. It is a common occurrence in many diagnoses throughout the world of psychology, but it is little understood on its own outside of other coexisting conditions. Anhedonia is a core feature of major depressive disorder as it’s required that either depressed mood or anhedonia be present to properly diagnose depression. The lack of specificity is or can be viewed as a limiting factor when trying to define anhedonia as a pivotal feature of major depressive disorder. This stems from the lack of research on anhedonia on its own.
Patients with psychiatric disorders could differ from healthy individuals quantitatively more than qualitatively. These disorders (discussed in tandem with other major psychiatric illnesses) could be more extensively understood if the preconditions are studied within the patient. This involves getting down to the base level of a patient and factoring not only environmental factors, but genetics as well. The prevalence of genes in diagnosing mental illness is huge as the biological breakdown of a person depends largely on the chemical building blocks and foundation that exists within endophenotypes within the brain. These link together with other illnesses caused by both trauma and relational chemical imbalances in the brain to provide a greater degree of risk. Therefore, disorders existing in tandem with others (i.e. anhedonia with depression) should be looked at independently to understand its function in the brain as well as WITH genetic factors of the patient.
Involving the neurobiological and neuropsychological aspects of the disease more directly, could help to link the potential risk factors more directly to major depression. There are different required qualities to use a trait as an endophenotype, such as sensitivity and specificity, heritability, presence in unaffected relatives, state-independence, biological plausibility, sound psychometric properties, and feasibility. Even if there are practically no endophenotypes meeting all these criteria, the biological plausibility of anhedonia in major depressive disorder is the matter of this review, and the first required quality to constitute a valid endophenotype is the validity of its assessment.
From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181880/
Assessing Anhedonia
An emotion (as defined in the DSM) involves physiologic arousal, appraisal, subjective experience, expression, and goal-directed behavior. Anhedonia can thus be measured in various ways due to its relation to all of the above and how it impact executive function. Behavioral , electrophysiological, hemodynamic, interview-based measures, and self-reports are cited in research devoted to anhedonia in major depressive disorder (MDD). For example, depressed patients show a higher inkling to taste sweets or sugar with reduced reward responsiveness, partly because of difficulty in building a reinforcement history to the flavor/receptors over time. Ever been depressed and eaten a carton of ice cream? This may be why…
Rewards are our brains way of monitoring approaches to intake behaviors (such as eating and drinking), and are responsible for increasing the frequency and intensity of the behaviors, maintaining the behaviors, and inducing that “feel good” endorphin rush we’re all used to whenever we eat something good. Reward, and our brain’s initial response to it, is a key concept in assessing anhedonia.
Throughout studies, self-questionnaires have been more frequently used in clinical practice and research, due to their simplicity. These are not always the best assessments to use as the person taking the questionnaire is biased toward themselves or may misunderstand the question and cause the study to be inaccurate. However, they are useful for applications such as anhedonia, whereas the only other study available is to measure the brain’s stimulus response to pleasure in real time. Even in this instance, researchers need to evaluate if the patient is actually experiencing this pleasure or if the neurons firing aren’t being registered by the brain. These instruments almost all assess hedonic capacity, but their psychometric properties, and their analyzed dimensions, are different. Still, the nature of these instruments seems to be good; for example, individuals with higher scores on self-report measures of anhedonia report lower hedonic responses to emotion-eliciting pictures, positive emotional scripts, and sugar, and are less responsive on measures of heart rate and facial expressions in response to emotion-eliciting slides.
Items of the Snaith-Hamilton Pleasure Scale
This scale is used to measure a patient’s response to see if they have anhedonia in addition to other conditions. We all love a good quiz about ourselves, so I thought it apt to include it here. A score of 12-14 constitutes a “normal” score, while an “abnormal” score is defined as 11 or less. Keep tabs on how you score and I’ll let you know where I landed as well!
1. I would enjoy watching or listening to my favorite television or radio program
2. I would enjoy being with family or close friends
3. I would find pleasure in my hobbies and pastimes
4. I would be able to enjoy my favorite meal
5. I would enjoy a warm bath or refreshing shower
6. I would find pleasure in the scent of flowers, the smell of a fresh sea breeze, or freshly baked bread
7. I would enjoy seeing other people's smiling faces
8. I would enjoy looking well-dressed when I have made an effort with my appearance
9. I would enjoy reading a book, magazine, or newspaper
10. I would enjoy a cup of tea, coffee, or my favorite drink
11. I would find pleasure in small things (e.g a bright sunny day, a telephone call from a friend)
12. I would be able to enjoy a beautiful landscape or view
13. I would get pleasure from helping others
How did you score?! I’m at a solid 9 out of 14 which puts me in the abnormal range. I can definitely chalk it up to picking apart different parts of this questionnaire. I’ve felt very depressed over the past year but that has to do mainly with realizing that the people around me are learning and growing who they are, and that it’s okay to let them go if who they are becoming isn’t a person I want to be around. This is one area with which boundaries have to be maintained. I found anhedonia to be an interesting subject that should be talked about more, and hope you did as well! Let me know what you think.
Baking-ish is a podcast produced and edited by Fahrenheit Co., a U.S. based entity run and organized by Ren Newman.
**I am not a mental health professional. Please talk to a healthcare professional before doing or changing anything within your daily life. These experiences and opinions reflect only my personal experiences.
