Exploring anhedonia in adolescents with Chronic Fatigue Syndrome (CFS): A mixed-methods study

Lucie Smith, Esther Crawley, Madeleine Riley, Megan McManus, Maria Elizabeth Loades*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

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Chronic Fatigue Syndrome (CFS/ME) may get in the way of enjoying activities. A substantial minority of adolescents with CFS/ME are depressed. Anhedonia is a core symptom of depression. Anhedonia in adolescents with CFS/ME has not been previously investigated.

One hundred and sixty-four adolescents, age 12 to 18, with CFS/ME completed a diagnostic interview (K-SADS) and questionnaires (HADS, RCADS). We used a mixed-methods approach to explore the experience of anhedonia and examine how common it is, comparing those with clinically significant anhedonia to those without.

Forty-two percent of adolescents with CFS/ME reported subclinical or clinical levels of anhedonia. Fifteen percent had clinically significant anhedonia. Thematic analysis generated two themes: (1) stopping activities that they previously enjoyed and (2) CFS/ME obstructs enjoyment. Most (72%) of those who reported clinically significant anhedonia met the depression diagnostic criteria. Those who were depressed used more negative language to describe their experience of activities than in those who were not depressed, although the themes were broadly similar.

Experiencing pleasure from activities may be affected in CFS/ME, particularly in those who are depressed. Anhedonia may get in the way of behavioural strategies used within CFS/ME treatments.
Original languageEnglish
Pages (from-to)855-869
Number of pages15
JournalClinical Child Psychology and Psychiatry
Issue number3
Early online date16 Apr 2021
Publication statusPublished - Jul 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study did not receive any specific funding. Prof Crawley was part-funded by the National Institute for Health Research (NIHR) during data collection (Senior Research Fellowship, SRF-2013-06-013). Dr Loades is funded by the NIHR (Doctoral Research Fellowship, DRF-2016-09-021). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, The National Institute for Health Research or the Department of Health and Social Care.

Publisher Copyright:
© The Author(s) 2021.


  • Chronic Fatigue Syndrome
  • mood disorder
  • qualitative
  • survey


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