Anhedonia Test

What is anhedonia?

Anhedonia is a psychological condition characterized by the inability to experience pleasure from rewarding or enjoyable activities. This can include hobbies, social interactions, physical activities, and other forms of recreation. It is often associated with mental health conditions such as depression, schizophrenia, and other mood disorders.

It's divided into two types: social anhedonia, characterized by a disinterest in social interactions and lack of enjoyment in relationships or social activities, and physical anhedonia, which is the inability to derive pleasure from bodily sensations, including eating, touch, or sexual activities.

This condition can impact a quality of life and overall well-being. Treatment for anhedonia typically involves addressing the underlying condition through therapy, medication, lifestyle changes, and support from mental health professionals.

Anhedonia symptoms

Anhedonia is a symptom of several mental health conditions. Accurately identifying it is crucial for effective diagnosis and treatment planning.

Key indicators that a patient is experiencing anhedonia: 

• Significant decline in engagement with formerly pleasurable experiences.
• Isolates and has a decreased desire for social connection or neglects interpersonal relationships.
• Struggling to feel a wide range of emotions, often feeling emotionally numb.
• Diminished ability to experience physical pleasure (e.g., loss of libido, lack of enjoyment from food) while still deriving some satisfaction from social interactions.

The degree of the condition can affect a patient's quality of life. Evaluate the extent to which it interferes with daily functioning and overall well-being.

What causes anhedonia?

The exact causes of anhedonia are still under investigation, but there is a complex interplay of factors:

• It is linked to brain reward system disruptions, particularly the ventral striatum.
• Dopamine is a key player in the reward system, and disruptions in its signaling may contribute to anhedonia. Serotonin and glutamate may also be involved.
• It's a common symptom of major depressive disorder (MDD), schizophrenia, bipolar disorder, and post-traumatic stress disorder (PTSD).
• Chronic illnesses like Parkinson's disease, chronic pain syndromes, and diabetes can lead to anhedonia due to their impact on reward processing.
• Drug abuse and dependence can disrupt brain chemistry and lead to symptoms. Withdrawal from substances can also cause temporary anhedonia.
• A potential genetic predisposition to anhedonia, the investigation of this is still ongoing.

Anhedonia diagnosis

This guide provides a framework for diagnosing and managing anhedonia in clinical practice and a patient-centered approach.

Clinical interview

Conduct a clinical interview to assess the patient's symptoms, duration, and impact on daily functioning. Inquire specifically about their emotional state and responses to activities and social interactions.

Standardized assessment tools

Utilize standardized tools to quantify anhedonia, including:

• Snaith-Hamilton pleasure scale (SHAPS): Measures pleasure response across various activities.
• Beck depression inventory (BDI): Contains items relevant to anhedonia assessment.
• Positive and negative syndrome scale (PANSS): Applicable primarily to schizophrenia but includes anhedonia metrics.
• Medical evaluation: Perform a thorough medical evaluation to exclude physical etiologies such as neurological disorders, hormonal imbalances, or chronic illnesses that could manifest as anhedonia.

Diagnostic criteria

Both DSM-5 and ICD-10 consider the condition a major symptom for diagnosing depression. You need at least five major depression symptoms, including either low mood or anhedonia, for at least two weeks.

Treatment approaches

The condition presents a challenge in treatment plans for various mental health conditions. We list the available treatment approaches to equip you with an approach to managing anhedonia in your patients.

• Psychotherapy: Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are practical approaches for addressing anhedonia. CBT focuses on identifying and changing maladaptive thought patterns and behaviors, while IPT aims to improve interpersonal relationships and social functioning. 
• Pharmacotherapy: Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants, are effective in alleviating anhedonia. Additionally, antipsychotics are prescribed for individuals with schizophrenia or bipolar disorder to help manage the condition.
• Lifestyle modifications: To promote mental well-being, it is essential to focus on regular physical activity, a balanced diet, and improved sleep habits. Social engagement, maintaining relationships, and an approach with a thorough assessment and tailored interventions are essential for accurate diagnosis and effective treatment.

What is an Anhedonia Test?

Accurately assessing anhedonia informs treatment plans for depressive disorders. Tools like standardized Anhedonia Tests are essential for gauging emotional and physical anhedonia, leading to informed decisions about the need for psychological interventions.

One of the most widely used and reliable instruments for assessing anhedonia is the Snaith-Hamilton Pleasure Scale (SHAPS). Developed in the 1990s, it is a self-report questionnaire with 14 prompts that evaluates a patient's ability to experience pleasure over a recent period, usually the past few days.

The SHAPS stands out as a well-established and reliable tool for assessing anhedonia. This self-report questionnaire offers a smooth and efficient way to evaluate patients across various clinical settings. Unlike broader mood assessments, it hones in directly on anhedonia, precisely measuring a patient's capacity to experience pleasure.

This tool is invaluable in evaluations, aiding in the diagnosis of emotional blunting, stress-induced anhedonia, and other psychological problems. Emotional responses, social interactions, and physical symptoms such as joint pain and new physical symptoms are assessed to understand anhedonic behavior.

How are the results interpreted?

Interpreted based on a total score ranging from 0 to 14, each disagreement or strong disagreement with a statement scores 1 point, while agreement or strong agreement scores 0 points. There's an inverse relationship between SHAPS scores and hedonic capacity.

In simpler terms, lower scores on the SHAPS scale mean a person has a higher capacity for pleasure or less anhedonia. On the other hand, higher SHAPS scores suggest reduced pleasure or greater anhedonia.

For instance, if a respondent disagrees with nine statements, their score would be 9, indicating a higher level of anhedonia. Conversely, agreeing with all statements would result in a score of 0, suggesting a greater ability to experience pleasure.

When is it usually conducted?

Anhedonia tests are conducted under the following circumstances:

• When seeking help for mental health concerns, an Anhedonia Test may be part of the evaluation to understand the symptoms and aid in diagnosis.
• In routine depression screenings, anhedonia is a crucial symptom of major depressive disorder, helping clinicians assess the severity of a patient's depression.
• In addiction treatment programs, to assess the presence of anhedonia related to substance use and its impact on the individual's motivation and pleasure in activities.
• For patients with chronic illnesses, to evaluate if they are experiencing anhedonia as a result of their condition or as a side effect of their treatment.
• During a psychiatric evaluation, especially when symptoms suggestive of mood disorders, such as major depressive disorder or bipolar disorder, are present.
• As part of follow-up evaluations, monitor changes in symptoms over time and assess the effectiveness of treatment interventions.

How to use our Anhedonia Test template

Accurate responses are essential for a reliable assessment, and the following steps will guide you through administering the test effectively:

1. Ensure the questionnaire is clearly printed or displayed for the respondent. Explain that their honest answers are crucial for an accurate assessment.
2. Ask the respondent to carefully read each statement and tick the box that best describes their level of agreement based on their experiences over the last few days. Each statement has four response options.
3. The scale is scored from 0 to 14, with each "disagree" response scoring 1 point and each "agree" response scoring 0 points.
4. Lower scores on the SHAPS scale indicate a higher capacity for pleasure or less anhedonia, while higher scores suggest reduced pleasure or greater anhedonia.
5. If the respondent shows signs of anhedonia, discuss the results with them, offer support, and suggest further assessment by a mental health professional if needed.
6. Record and summarize the responses, keeping the records confidential and secure, and share them only with relevant healthcare providers as necessary.

Benefits of conducting this test

Conducting the test offers several benefits:

• Enables prompt intervention and treatment, preventing further mental health deterioration.
• Assists in diagnosing depression, anxiety, and other mood disorders.
• Tailors treatment plans based on the severity and specific symptoms of anhedonia.
• Facilitates effective communication between patients and practitioners.
• Tracks change in symptoms over time for treatment adjustments.
• Streamlines the assessment process, saving time and ensuring consistent results.