E2 ModerateModerate confidencePEM not requiredCross-SectionalPeer-reviewedReviewed
Standard · 3 min
Exploring anhedonia in adolescents with Chronic Fatigue Syndrome (CFS): A mixed-methods study.
Smith, Lucie, Crawley, Esther, Riley, Madeleine et al. · Clinical child psychology and psychiatry · 2021 · DOI
Quick Summary
This study looked at whether teenagers with ME/CFS lose the ability to enjoy activities they once loved. Researchers surveyed 164 young people and found that 42% experienced some loss of enjoyment, with 15% experiencing significant loss. Many of these teenagers said their condition either stopped them from doing activities or made it hard to enjoy them, even when they did participate.
Why It Matters
This is the first study specifically examining anhedonia in adolescents with ME/CFS, filling an important knowledge gap about how the condition affects motivation and pleasure. Understanding anhedonia is crucial because it may interfere with behavioural treatments like graded activity programmes, which rely on patients' ability to engage in and find satisfaction in activities. Identifying anhedonia helps clinicians tailor more effective, individualised treatment approaches.
Observed Findings
42% of adolescents with ME/CFS reported subclinical or clinical anhedonia
15% of the sample experienced clinically significant anhedonia
72% of those with clinically significant anhedonia met diagnostic criteria for depression
Two main themes emerged: stopping previously enjoyed activities and disease-related obstruction of enjoyment
Adolescents with comorbid depression used more negative language describing activities than non-depressed participants, though underlying themes were similar
Inferred Conclusions
Anhedonia is prevalent in adolescents with ME/CFS and may represent a clinically important symptom warranting assessment and intervention
Anhedonia in this population is strongly associated with depression but may also occur as an independent feature of CFS/ME
Anhedonia could reduce treatment effectiveness if patients lack motivation for activity-based interventions
Clinicians should assess for and address anhedonia when treating adolescents with ME/CFS
Remaining Questions
Is anhedonia a primary symptom of ME/CFS or primarily a feature of comorbid depression in this population?
What This Study Does Not Prove
This study does not establish whether anhedonia is caused by ME/CFS itself, by depression that develops alongside it, or by both conditions. It cannot determine causality or directionality—it only documents that anhedonia occurs in this population. The cross-sectional design means we cannot track whether anhedonia develops before, after, or simultaneously with other CFS/ME symptoms.
Tags
Symptom:Fatigue
Phenotype:Pediatric
Method Flag:PEM Not DefinedNo ControlsExploratory OnlyWeak Case DefinitionSmall Sample
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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