Childhood Maltreatment and Anhedonic Symptoms: Test of a Dual-risk Model in Emerging Adults

Abstract

Anhedonia, defined as deficits in positive affect and approach related behaviors, remains an understudied trauma response. As anhedonic responses to interpersonal violence are associated with a more severe course of psychopathology that is more difficult to treat, an increased focus on risk factors for anhedonia is necessary. The present study sought to address this gap in the literature by testing a theoretical model that highlights two transdiagnostic pathways leading to anhedonic responses in emerging adults attending college. Specifically, our study examined how childhood maltreatment subtypes (a) uniquely associate with depressive and post-traumatic stress (PTS) manifestations of anhedonia and (b) how temperament (i.e., anticipatory positive affect) and distress (i.e., negative mood) explain these relations. At baseline, a racially diverse sample of 462 emerging adults (Age_Mean = 19.45; 75.5% female; 45.5% White) completed self-report forms on childhood abuse and neglect, anticipatory positive affect, negative mood, and anhedonia. Individuals completed measures of temperament and psychological distress again 6-weeks, and 12-weeks later. Latent growth curve models were utilized to test our model. Consistent with hypotheses, deficits in anticipatory positive affect uniquely explained the relation between neglect and depressive/PTS anhedonic symptoms. Meanwhile, negative mood mediated the relation between abuse and both forms of anhedonia. These findings support the theory that two separate risk pathways lead to anhedonia. Support for our model suggests that distinguishing between pathways for anhedonic responses may be the key to a more targeted, transdiagnostic, trauma-informed approach for treating and preventing these deleterious, treatment-resistant, internalizing symptoms.

Keywords

maltreatment anhedonia depression post-traumatic stress emerging adulthood

Investigations of trauma-related distress tend to examine negative affect, hyperarousal, and/or avoidant tendencies. However, deficits associated with positive affect and approach-related behaviors (i.e., anhedonia) represent clinically significant, yet understudied, trauma responses (Litz et al., 2000). Past research demonstrates that anhedonia is linked with elevated aggressive/violent behavior and emotional distress (Salem et al., 2018), as well as a more chronic, severe, and treatment-resistant course of psychopathology (Pizzagalli, 2014). Thus, clarifying the underpinnings of anhedonia secondary to traumatic experiences is necessary. In response, the present study examined a theoretical explanatory model of anhedonia in a sample of emerging adults, an at-risk developmental period for this outcome (Conway et al., 2017). Specifically, we tested (a) the unique contributions of neglect and abuse to the level and growth of anhedonia subtypes, and (b) two distinct risk pathways related to temperament and depressive symptoms that explain anhedonic responses to childhood maltreatment exposure. Findings from the present study can lay an evidence-based foundation for how to better target anhedonia in emerging adults with a history of maltreatment.

Anhedonia in Depression and Post-traumatic Stress

Depression and post-traumatic stress (PTS) represent the most common symptom manifestations in response to maltreatment (Infurna et al., 2016). For depression, anhedonia is characterized as a lack of positive affect and low pleasurable engagement with the environment (Watson & Clark, 1984). As for PTS, anhedonia (i.e., emotional numbing; Shankman et al., 2014) consists of restricted range of both positive and negative emotions and detachment from others (Litz et al., 2000). Despite the conceptual overlap between these outcomes, depressive anhedonia only has a small–medium correlation with emotional numbing, and both symptoms uniquely predict diagnostic status following trauma exposure (Kashdan et al., 2006). Thus, depressive anhedonia and emotional numbing are related, but distinct outcomes.

Across conceptualizations of anhedonia, maltreatment exposure is viewed as a robust risk factor. Historical conceptualizations of attachment (e.g., Bowlby, 1973) suggest that instead of becoming anxious or aggressive, some individuals exposed to maltreatment will become “more or less detached, apparently neither trusting nor caring for others” (p. 225). These themes are consistent with betrayal trauma theory (Freyd, 1996), which posits that emotional detachment arises in the aftermath of familial trauma. Empirically, these theories have been substantiated. Within a sample of clinically depressed adolescents, Lumley and Harkness (2007) found those with a history of emotional maltreatment exposure reported heightened anhedonia. Meanwhile, emotional numbing has been conceptualized as a mediating mechanism between maltreatment and trauma responses (e.g., callousness; Kerig et al., 2012).

Building off these findings, others have examined how forms of deprivation (i.e., neglect) and threat (i.e., abuse) differentially predict anhedonia. According to current developmental trauma models (e.g., McLaughlin & Sheridan, 2016), abuse and neglect differentially impact neural development related to reward and fear processing, potentially leading to different symptom manifestations. For instance, within the context of depression, findings suggest that neglect may uniquely relate to cross-sectional (Van Veen et al., 2013) and prospective (Cohen et al., 2019) anhedonic symptoms. Contrary to these findings, however, Wechsler-Zimring and Kearney (2011) found heightened emotional numbing in response to abuse, but not neglect. These findings suggest that anhedonia within the context of PTS may be sensitive to threatening events (i.e., abuse), while anhedonic depression may be more closely tied to deprivation experiences (i.e., neglect). Yet, past findings concerning emotional numbing may be limited, as PTS-assessments of anhedonia included avoidant tendencies. As abuse exposure uniquely relates to avoidance (McLaughlin & Sheridan, 2016), it is important to differentiate anhedonic and avoidant responses when testing the impact of traumatic events.

Mediating Mechanisms

Cohen and colleagues (2019) suggest that unique findings concerning neglect and anhedonia stem from deficits in learning. Specifically, that neglect corresponds to reduced reward learning due to impaired learning approaches that are unique to deprivation exposure (McLaughlin, Sheridan, & Nelson, 2017). Behavioral and neural indices of reward learning are associated with anhedonic symptoms (Pizzagalli, 2014), via anticipatory positive affect (APA). APA (also known as anticipatory anhedonia, and “wanting”; Shankman et al., 2014) represents a temperamental predisposition concerning one’s motivational tendencies in approaching positive stimuli. APA represents a key risk pathway in both depression (Pizzagalli, 2014) and PTS (Nawijn et al., 2015) due to its impact on anhedonia. However, to our knowledge, no study has explicitly tested whether that is the pathway that explains the relation between neglect exposure and anhedonia.

In addition to individual differences, there are other pathways that may explain the link between maltreatment exposure and anhedonia. DePierro and colleagues (2014) outline how both hedonic deficits, characterized by blunted APA, as well as depressed mood, can lead to anhedonia. Specifically, DePierro and colleagues (2014) theorize that for some individuals, it is not that one is unable to experience pleasure, but rather that valuable cognitive and emotional resources are devoted to maintaining a negative mood state. The authors coined this phenomenon negative affect interference (NAI). Within these contexts, negative emotional responses displace normative positive reactions. NAI may help explain why acute stressors directly (Pizzagalli, 2014) and disproportionately (Fried et al., 2015) predict anhedonia in emerging adulthood, as it may not be developmentally appropriate to suggest discrete events impact temperamental factors at this age (Roberts & DelVecchio, 2000). Thus, simultaneously testing APA and NAI as two theoretical mechanisms of risk may elucidate the multiple pathways that explain why maltreatment-exposed individuals are at increased risk for anhedonia.

Present Study and Hypotheses

The present study tested our hypotheses within the context of emerging adulthood, an at-risk developmental period for anhedonia. Specifically, although depressed mood and anxious arousal decrease at this age, anhedonia slightly increases. Conway and colleagues (2017) speculate that there are several reasons why anhedonia may maintain, or even increase, during this developmental stage. Biologically, maturation in the reward systems during mid-late adolescence (Steinberg, 2008) may create more variance in anhedonic symptoms during emerging adulthood, compared to responses characterized by negative mood or anxiety. Socially, emerging adults have increased responsibilities. For college-attending emerging adults these responsibilities may include increased coursework, challenges that come with independent living, and integrating oneself into a new social network, all of which may interfere with their ability to engage in pleasurable activities. Collectively, these findings suggest that the perception of increases in well-being in emerging adulthood (Schwartz, 2016), may be overstated due to an emphasis on negative mood and anxiety. More attention on anhedonia within this developmental context may help elucidate who is most at-risk for this deleterious pattern of mental health during this formative life stage.

Figure 1 displays the study’s overarching theoretical model. Overall, we sought to extend earlier work (e.g., Cohen et al., 2019; Lumley & Harkness, 2007) by testing (a) whether neglect uniquely related to depressive anhedonia and emotional numbing and (b) if deficits in APA mediated the relation between neglect and anhedonia. Overall, we hypothesized that APA would mediate the effects between neglect exposure and both forms of anhedonia. Further, we tested if NAI represented an alternative pathway to anhedonic symptoms. As both neglect and abuse relate to depressed mood (Cohen et al., 2019), we predicted negative mood would represent a robust pathway for anhedonia across maltreatment subtypes.

Figure 1.

Our proposed theoretical model hypothesizes that deficits in temperament uniquely mediate the relation between neglect and anhedonia. Meanwhile, we posit that negative affect/mood represents an explanatory pathway for both maltreatment dimensions. Finally, we expect that these pathways are robust for both depression and post-traumatic stress (PTS) manifestations of anhedonia.

Methods

Participants

Participants in the present study were recruited as part of a larger study examining different trauma profiles and their relation to mental health. A total of 462 emerging adults (Age_Mean = 19.45; Age_SD = 2.47 at baseline) were recruited via a university psychology subject pool. Of this sample, 75.5% of the participants were female. With respect to race and ethnicity, 45.5% of the sample identified as White, 42% as Asian, 10.4% as Hispanic or Latino, 3.2% as Black, 1.9% as Middle Eastern, and 0.2% as Native Hawaiian or other Pacific Islander.

Procedure

All data for the present study was collected via Qualtrics survey software (Snow & Mann, 2013). Assessments took place at baseline, as well as at 6-week and 12-week follow-ups. Students received course credit for participating in the study and were entered into a raffle to win a free iPad if they completed all three waves of data collection. All procedures for this study were approved by the authorship team’s affiliated institutional review board.

Measures

Childhood neglect. Neglect was assessed at baseline using the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), a 25-item measure that retrospectively assesses perceptions of primary caregivers’ caretaking behaviors. Participants rated how often their caregiver(s) performed a given supportive behavior on a 4-point scale from 0 (never) to 3 (a lot). The MNBS allows for a comprehensive examination of neglect, by assessing physical needs (7 items), emotional support (7 items), monitoring/supervision (7 items), and educational support (4 items). Past research demonstrates that the MNBS is a reliable and valid measure of self-reported neglect exposure (Kobulsky et al., 2018). The MNBS exhibited adequate reliability across our subscales: physical needs (α = 0.88), emotional support (α = 0.93), monitoring/supervision (α = 0.69), and educational support (α = 0.76).

Childhood abuse. Childhood abuse was measured at baseline using the physical abuse, sexual abuse, and emotional abuse subscales of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003). These 5-item subscales ask participants to rate their childhood experiences on a scale of 1 (never true) to 5 (very often true). The CTQ-SF is the most widely used measure for assessing childhood maltreatment (Baker & Festinger, 2011) and is a reliable retrospective measure in emerging adults (Faulkner et al., 2014). The CTQ-SF exhibited adequate reliability across our subscales: emotional abuse (α = 0.84), physical abuse (α = 0.71), and sexual abuse (α = 0.95).¹

Of note, subscales for both the MNBS and CTQ-SF were not treated as independent fixed-effects within our analytic plan. Instead, these variables were used within the context of latent variables reflecting patterns of abuse and neglect exposure.

Anhedonia (depression). Anhedonia was measured at each wave by using the 4-item anhedonia subscale of the Center for Epidemiologic Studies Depression Scale (CESD)-20 (Radloff, 1977; Shafer, 2006). Answers were rated on a 4-point Likert scale, ranging from 0 (rarely or none of the time; 0–1 days) to 3 (most or all of the time; 5–7 days). The anhedonia subscale has exhibited good convergent, factorial validity and reliability in prior work (Leventhal et al., 2008). This subscale demonstrated adequate reliability in the present study: wave 1 (α = 0.75), wave 2 (α = 0.74), and wave 3 (α = 0.76).

Emotional numbing (PTS). Emotional numbing was measured at each wave using the 3-item anhedonia subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5, Blevins et al., 2015), a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD on a scale from 0 (not at all) to 4 (extremely). The PCL-5 has previously displayed good internal reliability in adult populations (Lowe et al., 2015). The anhedonia subscale demonstrated excellent reliability across each wave in the present sample: wave 1 (α = 0.91), wave 2 (α = 0.91), and wave 3 (α = 0.93).

Anticipatory positive affect (APA). APA was measured using the 9-item anticipatory subscale of the Temporary Experience of Pleasure Scale (TEPS; Gard et al., 2006), an 18-item self-report scale that assesses the ability of experiencing pleasure on two subscales, anticipatory and consummatory, with lower scores reflecting higher levels of anhedonia. Participants respond using a 6-point Likert scale from 1 (very false for me) to 6 (very true for me). The TEPS has previously demonstrated adequate reliability (Gard et al., 2006). This subscale demonstrated good reliability across each wave: wave 1 (α = 0.80), wave 2 (α = 0.81), and wave 3 (α = 0.83).

Negative affect. To provide a more comprehensive assessment of the NAI pathway, both the 7-item negative mood subscale of the CESD-20 (7 items; Shafer, 2006) and a 4-item subscale of the PCL-5 (Blevins et al., 2015) were assessed. The CESD-20 subscale consists of behavioral and cognitive items related to sad mood. The PCL-5 subscale, meanwhile, focuses on negative alterations in cognitions and mood beyond just sadness (e.g., fear, horror, anger). The internal reliability on both the CESD-20 (α = 0.83, α = 0.84, α = 0.86) and PCL-5 (α = 0.85, α = 0.83, α = 0.87) was excellent across all three waves.

Preliminary Data Analysis and Data Analytic Approach

Descriptive statistics for all study variables are presented in Table 1 and bivariate correlations between all variables are presented in Table 2. Of note, consistent with past research (Kashdan et al., 2006), a small–moderate correlation emerged between anhedonia and emotional numbing, suggesting these constructs are correlated, but distinct outcomes. All maltreatment subtypes had a small–moderate effect on our mediating mechanisms and anhedonic outcomes in the expected directions. The stability of temperament and symptoms, as indicated by correlation coefficients within constructs, is similar to other short-term, longitudinal research with emerging adults (e.g., Anusic et al., 2012).

Table 1.

Descriptive Statistics of Study Variables.

	Mean	SD	N
Educational neglect	5.94	2.27	459
Emotional neglect	9.47	3.83	459
Physical neglect	7.57	1.78	459
Supervisory neglect	11.31	2.38	459
Emotional abuse	7.46	3.28	458
Physical abuse	6.07	2.16	459
Sexual abuse	5.69	2.69	459
Anhedonia time 1	8.48	3.10	457
Anhedonia time 2	8.78	2.97	380
Anhedonia time 3	8.80	3.07	327
Emotional numbing time 1	5.42	3.17	456
Emotional numbing time 2	5.81	3.29	378
Emotional numbing time 3	5.57	3.34	325
Anticipatory positive affect time 1	42.25	7.73	457
Anticipatory positive affect time 2	40.91	7.74	381
Anticipatory positive affect time 3	40.72	8.08	330
Negative affect (PCL-5) time 1	7.47	3.88	456
Negative affect (PCL-5) time 2	8.15	4.00	378
Negative affect (PCL-5) time 3	7.86	4.18	324
Negative affect (CESD-20) time 1	12.38	4.59	457
Negative affect (CESD-20) time 2	13.29	5.02	380
Negative affect (CESD-20) time 3	12.67	4.94	327

Note. Educational neglect = educational support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), Emotional neglect = emotional support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), physical neglect = physical needs subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), supervisory neglect = monitoring/supervision subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), emotional abuse = emotional abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), physical abuse = physical abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), sexual abuse = sexual abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), anhedonia = anhedonia subscale of the Center for Epidemiologic Studies Depression Scale (CESD)-20 (Radloff, 1977), emotional numbing = anhedonia subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5; Blevins et al, 2015), anticipatory positive affect = anticipatory subscale of the Temporary Experience of Pleasure Scale (TEPS; Gard et al., 2006), negative affect = negative affect subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5; Blevins et al, 2015).

Table 2.

Correlations of Observed Variables.

NM1

NM2

NM3

EdN

EmN

AP1

AP2

AP3

APA1

APA2

APA3

NP1

NP2

NP3

Age

0.59*

0.48*

0.50*

NM1

0.44*

0.49*

0.36*

NM2

0.37*

0.53*

0.30*

0.61*

NM3

0.45*

0.49*

0.45*

0.57*

0.63*

EdN

0.22*

0.20*

0.12 ł

0.16*

0.18*

0.10

EmN

0.31*

0.30*

0.19*

0.24*

0.21*

0.67*

0.15*

0.13 ł

0.02

0.09

0.13 ł

0.11 ł

0.41*

0.50*

0.07

–0.01

–0.04

–0.01

–0.02

0.26*

0.30*

0.35*

0.25*

0.33*

0.18*

0.36*

0.38*

0.28*

0.39*

0.56*

0.28*

0.13*

0.16*

0.18*

0.16*

0.24*

0.15*

0.26*

0.34*

0.39*

0.33*

0.12 ł

0.58*

0.17*

0.14*

0.06

0.17*

0.14*

0.12 ł

0.11 ł

0.13*

0.12*

0.05

0.41*

0.33*

AP1

0.37*

0.40*

0.35*

0.56*

0.48*

0.49*

0.21*

0.25*

0.19*

0.07

0.31*

0.27*

0.17*

AP2

0.36*

0.45*

0.31*

0.46*

0.64*

0.53*

0.19*

0.29*

0.17*

–0.01

0.34*

0.22*

0.21*

0.60*

AP3

0.31*

0.44*

0.36*

0.44*

0.51*

0.66*

0.11 ł

0.19*

0.13 ł

–0.12ł

0.28*

0.21*

0.17*

0.49*

0.59*

APA1

–0.37*

–0.31*

–0.24*

–0.16*

–0.13ł

–0.21*

–0.24*

–0.32*

–0.22*

–0.17*

–0.15*

–0.14*

–0.07

–0.30*

–0.24*

–0.18*

APA2

–0.35*

–0.34*

–0.31*

–0.17*

–0.15*

–0.25*

–0.17*

–0.25*

–0.16*

–0.08

–0.12 ł

–0.09

–0.02

–0.28*

–0.20*

0.78*

APA3

–0.39*

–0.33*

–0.40*

–0.18*

–0.16*

–0.23*

–0.15*

–0.26*

–0.15*

–0.04

–0.12 ł

–0.08

–0.04

–0.30*

–0.27*

–0.17*

0.70*

0.77*

NP1

0.36*

0.37*

0.29*

0.56*

0.45*

0.50*

0.17*

0.22*

0.18*

0.05

0.36*

0.25*

0.24*

0.77*

0.49*

0.50*

–0.24*

–0.22*

–0.23*

NP2

0.34*

0.44*

0.23*

0.50*

0.59*

0.48*

0.15*

0.27*

0.20*

0.01

0.40*

0.23*

0.17*

0.53*

0.75*

0.55*

–0.21*

–0.25*

–0.24*

0.56*

NP3

0.31*

0.41*

0.31*

0.44*

0.49*

0.63*

0.06

0.11ł

0.10

–0.07

0.25

0.14ł

0.15ł

0.48*

0.53*

0.83*

–0.18*

–0.23*

–0.18*

0.54*

0.58*

Age

0.02

–0.04

0.00

–0.01

–0.05

–0.03

–0.01

0.00

0.01

0.04

0.07

0.23*

0.08

0.07

–0.06

–0.08

0.00

0.05

0.06

Gender

–0.09

–0.12ł

0.07

0.06

–0.17*

–0.11 ł

–0.05

–0.06

0.04

–0.12*

0.06

–0.06

–0.03

0.04

0.30*

0.28*

0.25*

0.00

0.03

0.08

–0.06

Note. A = anhedonia subscale of the Center for Epidemiologic Studies Depression Scale (CESD)-20 (Radloff, 1977), NM = negative mood subscale of the CESD-20, EdN = educational support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), EmN = emotional support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), PN = physical needs subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), SN = monitoring/supervision subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), EA = emotional abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), PA = physical abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), SA = sexual abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), AP = anhedonia (emotional numbing) subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015), APA = anticipatory subscale of the Temporary Experience of Pleasure Scale (TEPS; Gard et al., 2006), NP = negative affect subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015), gender (0 = male; 1 = female). * = p ≤ .01; ł = p ≤ .05; pairwise deletion was used for missing data.

As is common in multiwave, longitudinal designs, attrition occurred at the 6-week (17.74%) and 12-week follow-up (29.22%). We investigated the nature of this missing data by using Little’s Missing Completely at Random (MCAR) test. Overall, findings suggested that missing data did not reflect a systematic pattern (χ²(211) = 205.76, p = .59). For the models described later, full-information maximum likelihood estimation with robust standard errors (Satorra & Bentler, 1994) was used, which is robust for datasets that include missing and/or nonnormal distributions of data. Initial models first included the CESD-20 subscale for negative mood, with subsequent analyses being conducted with the PCL-5 subscale.

All analyses were conducted on Mplus Version 7.0 (Muthén & Muthén, 1998–2012). To test our hypotheses, an unconditional parallel process latent growth model was first examined with anhedonia, emotional numbing, depressive symptoms, and APA. Next, relevant demographic covariates for anhedonia (i.e., age, gender; Conway et al., 2017) and our maltreatment subtypes were entered as predictors of intercepts (baseline values) and slopes (rates of change). Maltreatment was represented by two latent variables comprised of neglect and abuse subscales respectively. Given the high correlation between incidents of deprivation and threat (Infurna et al., 2016), confirmatory factor analyses (CFA) were conducted to determine our ability to parse between deprivation and threat experiences prior to entering them as predictors. To test potential mediation, the intercepts and slopes of depressive symptoms and APA were examined as predictors of anhedonia/emotional numbing intercepts and slope. Mediation was tested by examining the individual paths in each hypothesized mediational relation. To determine whether indirect effects were significant, the product of individual mediation paths were tested using the Delta Method (Preacher et al., 2007). Model fit was assessed with the following recommended (Hu & Bentler, 1998) cutoffs: CFI ≥ 0.95, RMSEA ≤ 0.06, SRMR ≤ 0.08, and χ²/df < 3.00.

Results

In the unconditional parallel process model, the slope for anhedonia was significant and positive (p < .01), suggesting depressive anhedonia increased over time in our emerging adults consistent with past research (Conway et al., 2017). However, the variance was nonsignificant (p = .48), suggesting that growth was similar across individuals. For emotional numbing, the slope was nonsignificant (p = .28), but the variance was significant (p = .003), conferring individual differences exist in the growth trajectory. Meanwhile, APA’s slope was negative and significant (p < .001) and the variance was significant (p = .05), suggesting that individual differences in change over time exist within the context of decreasing levels of APA. Finally, similar to emotional numbing, the average level of symptoms remained stable for negative mood (p = .12), but individual differences still existed in growth rates (variance: p < .01).

For the CFA for abuse and neglect, our initial model did not reach the a priori thresholds for model fit, CFI = 0.95, RMSEA = 0.07, SRMR = 0.05, χ²/df = 3.12. However, constraining the residual variance between emotional abuse and emotional neglect, a theoretically informed decision due to frameworks which conceptualize emotional maltreatment as a unitary construct (Glaser, 2002), led to acceptable model fit, CFI = 0.98, RMSEA = 0.05, SRMR = 0.04, χ²/df = 2.10. We next entered these latent variables, along with age and sex, as predictors in our model. As the variance associated with anhedonia slope was nonsignificant in the unconditional model, we constrained it to 0, which led to a permissible solution in our final model, which exhibited acceptable model fit, CFI = 0.97, RMSEA = 0.04, SRMR = 0.05, χ²/df = 1.68.

A complete summary of individual paths from our final model can be found in Table 3. All coefficients are standardized to facilitate comparison. Overall, emotional abuse and neglect were not related to the slopes of any of our indicators (p > .05). As for intercepts, levels of APA were associated with neglect (β = –0.35, p < .001), but not abuse (β = –0.01, p = .90). Meanwhile, levels of negative mood were related to abuse (β = 0.46, p < .001) but not neglect (β = 0.05, p = .60). As for our dependent variables, neither abuse nor neglect were directly related to anhedonia or emotional numbing (p > .05). Meanwhile, the intercept (β = –0.36, p < .001) and slope (β = –0.71, p < .001) of APA were related to the intercept and slope of anhedonia, respectively, and only the intercept of APA was associated with the intercept of emotional numbing (β = –0.24, p < .001). As for depressive symptoms, we found that the intercept was associated with the intercept of anhedonia (β = 0.66, p < .001) and emotional numbing (β = 0.68, p < .001), but was not related to the slope (p > .05).

Table 3.

Summary of Model Parameter Estimates.

	β	SE	p Value
Anhedonia intercept
Negative mood intercept	0.66	0.08	<.001
APA intercept	–0.36	0.07	<.001
Abuse total	–0.10	0.09	.25
Neglect total	0.17	0.09	.07
Anhedonia slope
Negative mood intercept	–0.37	0.23	.10
APA intercept	0.36	0.22	.10
Negative mood slope	0.37	0.25	.14
APA slope	–0.71	0.18	<.001
Abuse total	0.30	0.28	.27
Neglect total	–0.26	0.31	.40
Emotional numbing intercept
Negative mood intercept	0.68	0.07	<.001
APA intercept	–0.24	0.06	<.001
Abuse total	0.01	0.08	.89
Neglect total	0.05	0.08	.55
Emotional numbing slope
Negative mood intercept	–0.10	0.14	.50
APA intercept	0.27	0.10	.01
Negative mood slope	0.76	0.25	<.01
APA slope	–0.18	0.14	.21
Abuse total	0.15	0.21	.48
Neglect total	–0.04	0.20	.86
APA intercept
Abuse total	–0.01	0.07	.90
Neglect total	–0.35	0.07	<.001
APA slope
Abuse total	–0.07	0.16	.67
Neglect total	0.12	0.19	.52
Negative mood intercept
Abuse total	0.46	0.08	<.001
Neglect total	0.05	0.09	.60
Negative mood slope
Abuse total	–0.15	0.22	.49
Neglect total	0.18	0.21	.41

Note. Neglect total = Educational support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), emotional support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), physical needs subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), and Monitoring/supervision subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011); abuse total = emotional abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), physical abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), and sexual abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003); anhedonia = anhedonia subscale of the Center for Epidemiologic Studies Depression Scale (CESD)-20 (Radloff, 1977); emotional numbing = anhedonia subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015); APA = anticipatory positive affect = anticipatory subscale of the Temporary Experience of Pleasure Scale (TEPS; Gard et al., 2006), negative mood = negative affect subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015). Models included sex and age as covariates, although these parameter estimates are not included. Please contact the first author for parameter estimates for these variables.

Our findings for mediation are displayed in Figure 2. In sum, levels of APA mediated the effect between neglect and anhedonia (β = 0.13, p = .001) and emotional numbing (β = 0.09, p = .003) levels. NAI, meanwhile, mediated the relation between abuse and levels of anhedonia (β = 0.31, p < .001) and emotional numbing (β = 0.32, p < .001). The pattern of results was identical when using the PCL-5’s negative mood subscale.²

Details concerning the model including the PCL negative mood subscale can be obtained by contacting the first author.

Figure 2.

Note. Educational neglect = educational support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), emotional neglect = emotional support subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), physical neglect = physical needs subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), supervisory neglect = monitoring/supervision subscale of the Multidimensional Neglect Behavior Scale (MNBS; Dubowitz et al., 2011), emotional abuse = emotional abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), physical abuse = physical abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), sexual abuse = sexual abuse subscale of the Childhood Trauma Questionnaire-Short Form (CTQ-SF; Bernstein et al., 2003), Anhedonia = anhedonia subscale of the Center for Epidemiologic Studies Depression Scale (CESD)-20 (Radloff, 1977), emo numb = anhedonia subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015), anticipatory positive affect = anticipatory subscale of the Temporary Experience of Pleasure Scale (TEPS; Gard et al., 2006), neg mood = negative affect subscale from the Post-traumatic Stress Disorder Checklist for DSM 5 (PCL-5 Blevins et al, 2015); NS = not significant, ** = p < .01. *** = p < .001.

Discussion

Anhedonia represents a transdiagnostic symptom that contributes toward a more severe course of psychopathology (Pizzagalli, 2014; Salem et al., 2018). Although maltreatment exposure represents a robust risk factor for anhedonia (Cohen et al., 2019; Lumley & Harkness, 2007), little is known about the dynamic mechanisms of risk that may lead to this outcome. Overall, the present study found partial support for the proposed theoretical model (Figure 1). Congruent with hypotheses, levels of APA uniquely explained neglect’s relation with anhedonia. However, contrary to hypotheses, the NAI pathway was only significant for abuse and anhedonia. Findings were consistent across depression and PTS manifestations of negative mood and anhedonia. Subsequently, we contextualize these findings within the extant trauma literature and discuss clinical implications and future directions for individuals with a history of family violence exposure.

Overall, our findings reflect the translational importance of differentiating between subtypes of childhood adversities. Current theoretical models (e.g., McLaughlin & Sheridan, 2016) posit individual differences emerge from experiences of interpersonal deprivation and threat. Experiences of deprivation, for instance, are most closely linked to deficits in learning broadly, and reward learning specifically (McLaughlin et al., 2017). As past research shows that reward learning and APA are intertwined (Salamone & Correa, 2012), we propose that the APA pathway being unique for neglect exposure may in part be explained by deficits in learning. Alternatively, we found that the relation between abuse and anhedonia was uniquely explained via elevated depressive symptoms. Past research has found that people who are unable to experience pleasure may be prone to guilt or self-blame because they are unable to enjoy themselves (Frewen et al., 2012). Maltreated individuals are at-risk for psychopathology, in part, because they internalize feelings of shame and guilt based on the deleterious behavior perpetrated by a caregiver (Rose & Abramson, 1992). As acts of abuse are more direct compared to the indirect nature of neglect (Proctor & Dubowitz, 2014), these negative cognitions may be more likely to present in response to abuse exposure. In support of this proposition, recent findings suggest that only acts of abuse (i.e., emotional abuse) predicted feelings of shame, while both emotional and physical neglect did not (Ross et al., 2019). Thus, abuse-exposed individuals may be more prone to thoughts of guilt and shame, which inhibit their ability to experience pleasure. Collectively, these findings may suggest distinct pathways leading to anhedonia stemming from abuse and neglect experiences.

Multiple pathways stemming from adversity subtypes have implications for treating anhedonia. Traditional treatments for emotional distress have been shown to have attenuated effects for reducing anhedonia (Pizzagalli, 2014), possibly due to an overreliance on addressing deficits related to negative affect (Craske et al., 2016). In response, several alternative treatment options have been recommended. The most prominent example of this is behavioral activation, a third-wave treatment designed to heighten an individual’s daily exposure to positive reinforcement, and subsequently, increase reward processing (Nagy et al., 2018). However, even this more targeted approach has produced underwhelming results for reducing anhedonia (Moore et al., 2013). Although, in response, some suggest a greater focus on individual differences within reward processing is now necessary (e.g., Craske et al., 2016), differentiating between the two risk pathways during the assessment phase of treatment may also be warranted. To date, several experimental tasks exist to identify neural and behavioral phenotypes of anhedonia (Rizvi et al., 2016). Implementation of these measures into an assessment battery could clarify whether anhedonic symptoms are resulting specifically from impairments in APA. Alternatively, if an individual does not show any clear deficits in reward processing, and presents with heightened negative mood, more traditional, trauma-informed approaches may be effective in reducing anhedonia. Thus, consistent with past research (Frewen et al., 2012; Gutner et al., 2016), we suggest differentiating the reason for anhedonia symptoms during an initial assessment could be the key to reversing troubling trends concerning the treatment-resistant nature of anhedonia.

The present study had several strengths including its longitudinal design, theoretically informed (i.e., McLaughlin & Sheridan, 2016) conceptualization of maltreatment via a latent modeling approach, and its measure of anhedonia across depression and PTS. At the same time, there were notable limitations. First, our theoretical model was tested in a sample of undergraduate students. Although emerging adulthood is an at-risk period for anhedonia (Conway et al., 2017), important individual differences exist between college-attending and non-college-attending individuals (Schwartz, 2016). Of note, research has specifically shown that non-college-attending emerging adults may experience elevated levels of depression compared to those transitioning into a university setting (Liem et al., 2010). Relatedly, while our study was racially diverse, certain race/ethnicities, African Americans in particular, were underrepresented in our sample. Although past research suggests the relation between neglect, abuse, depressed mood, and anhedonia is similar across race/ethnicity (e.g., Cohen et al., 2019), it is critical to replicate our findings in a representative, diverse sample of emerging adults. Second, our mediation model was supported via differences in mean levels. Thus, our findings are largely based on cross-sectional links between our mediating mechanism and outcome, as opposed to prospective changes in trajectories. This may be due to our short-term follow-ups producing limited variance in the slope terms. As changes in slope terms need to be demonstrated before translating the findings into clinical protocols (Kazdin, 2007), future investigations with longer follow-ups should test if changes in our mechanisms of risk explain anhedonic increases. Third, our study only examined APA. Past research suggests that individual differences between anticipatory and consummatory phases of anhedonia exist (Shankman et al., 2014), and that disentangling these processes could have important clinical implications (Craske et al., 2016). Fourth, our study focused on emerging adulthood because prior research found that anhedonia may be uniquely problematic during this developmental period (Conway et al., 2017). However, as our study did not include multiple developmental epochs, we were unable to speak to why this is the case. It will be important for future research to replicate our findings in other developmental periods to examine whether emerging adults are more likely to respond to preexisting risk (e.g., maltreatment) with anhedonic responses due to developmental maturation or if independent risk factors for anhedonia not examined in the present study become more salient at this age (e.g., academic outcomes), contributing to the rise in this symptom outcome.

Finally, the present study relied on self-report measures. More intensive methods, which are advantageous for assessing maltreatment (e.g., structured interviews; Infurna et al., 2016), reward processing (e.g., behavioral tasks; Rizvi et al., 2016), and psychological distress (e.g., clinical interviews; Shankman et al., 2018), are necessary to replicate the study’s findings. These multimethod investigations are particularly important given the state-of-the-science concerning anhedonia. To date, Pizzagalli’s (2014) theoretical model represents the most comprehensive explanatory model for anhedonia. Highlighted within this model are critical biological predictors of anhedonia that we were unable to measure. The current study, however, still has implications for Pizzagalli’s (2014) model by suggesting two independent pathways may contribute to anhedonia within the context of trauma exposure. Given the transdiagnostic nature of anhedonia on emotional distress and aggressive behavior (Salem et al., 2018), continued efforts in identifying the biopsychosocial risk associated with APA and NAI may be the key to developing better clinical services for maltreatment-exposed individuals.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: JRC’s time on this manuscript was supported by the National Institute of Justice (2018-R2-CX-0022).

ORCID iD

Joseph R. Cohen

Author Biographies

Joseph R. Cohen, PhD, is an assistant professor of clinical/community psychology at the University of Illinois Urbana-Champaign. His research focuses on the processes that lead individuals to experience psychopathology across the developmental lifespan. In particular, his studies focus on clinical responses to traumatic events and how to leverage basic developmental psychopathology research and methods to improve mental health services for underserved populations.

Shiesha McNeil, BA, is a doctoral student in the clinical/community psychology program at the University of Illinois Urbana-Champaign. Her research interests focus on the mechanisms that explain the relation between interpersonal violence and psychological outcomes in youth and the cultural factors that influence this relationship.

Suvarna V. Menon, PhD, is a postdoctoral fellow at the Center for the Study of Family Violence and Sexual Assault at Northern Illinois University. Her program of research focuses on the community response to family violence and the mental health consequences of trauma in youth. She is also interested in the translational implications of trauma-informed research into improved prevention and intervention programs for survivors of violence.

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