Anhedonia and Somatic Symptoms in Adolescents: Beyond Depression and Anxiety

INTRODUCTION: Anhedonia is increasingly recognized as a transdiagnostic construct associated with multiple dimensions of psychopathology. However, its relationship with somatic symptom burden in adolescents, independent of core internalizing symptoms such as depression and anxi-ety, remains unclear. This study aimed to examine the association between anhedonia and somatic symptoms in adolescents and to de-termine whether this relationship persists beyond depressive and anxiety symptom severity.
METHODS: A total of 242 adolescents aged 12–18 years referred to a child and adolescent psychiatry outpatient clinic were included. Psychiatric diagnoses were established using a semi-structured clinical interview. Depression severity was assessed with a clinician-rated instru-ment, while anhedonia, anxiety symptoms, and somatic symptoms were evaluated using validated self-report measures. Hierarchical regression analyses were conducted in three steps: Model I included age and sex; Model II added depression and anxiety; and Model III included anhedonia.
RESULTS: Clinically significant anhedonia was identified in 27.7% of participants. Adolescents with anhedonia exhibited higher somatic symp-tom severity (p<0.001). Somatic symptom scores were positively correlated with depression and anxiety severity and negatively corre-lated with hedonic capacity (p<0.001). In hierarchical regression analyses, female sex (β=0.295), depression (β=0.410), and anxiety (β=0.370) were significant predictors of somatic symptoms. In the final model, anhedonia remained an independent predictor (β=–0.184, p=0.003), explaining additional variance beyond core internalizing symptoms.
DISCUSSION AND CONCLUSION: Anhedonia is independently associated with somatic symptom burden in adolescents. These findings suggest that somatic symptoms should be conceptualized not only as manifestations of internalizing psychopathology but also in relation to dysfunctions in reward–motivation systems and interoceptive processing.

Keywords: Anhedonia, Somatic Symptoms, Adolescence, Depression, Anxiety