Saxby Pridmore1 and William Pridmore2
1 Discipline of Psychiatry, School of Medicine, University of Tasmania, Hobart, Australia; 2Mental Health Services, Tasmanian Health Services, Hobart, Tasmania, Australia.
Correspondence: Prof Saxby Pridmore: email@example.com
[citation: Pridmore, Saxby & Pridmore, William (2022). ‘Having no feelings’: an interesting presentation. DHH, 9(1):http://www.journalofhealth.co.nz/?page_id=2749].
The Diagnostic and Statistical Manual of Mental Disorders the American Psychiatric Association – 5th Edition (DSM-5) is a world leading diagnostic system. For the diagnosis of Major Depressive Disorder (MDD) to be reached, at least 5 defined symptoms from a list of 9 must be present, and one of these must be ‘depressed mood’ or ‘loss of interest or pleasure’.
Additional symptoms of MDD listed in DSM-5 (but not among the 9 most common and accepted is ‘Having no feelings’.
In this letter we describe psychological test results of an adult with a successful private and professional life, admitted to hospital with acute, severe MDD. All identifying data has been removed and we have written permission to use the following details for educational purposes. The patient completed a visual analogue scale (VAS6) which examines items taken from the 6-item Hamilton Depression Rating Scale (May and Pridmore, 2020).
The first item of the VAS6 assesses depressed mood – the patient is asked to mark a position on a 10cm line separating the anchor points ‘Not depressed’ and ‘Most depressed possible’. The reported patient made no mark, but in a blank space on the side of the paper wrote, “Not feeling anything” (Fig. 1).
Figure 1. Visual analogue scale scored by person with MDD featuring the symptom, ‘having no feelings’.
The second item on the VAS6 deals with a DSM-5 criterion which pertains to the ability to experience pleasure. A 10 cm line separates the anchor points, ‘No activities give pleasure’ and ‘Activities give normal pleasure’. Consistent with the response to the first item, the patient placed a mark adjacent to, ‘No activities give pleasure’.
The patient was experiencing the inability to experience both pleasure (a common feature of MDD) and depression. The message, “Not feeling anything’, attached to the VAS6 depression question is a literal and graphic statement of the symptom of ‘Having no feelings’. In half a century of clinical work the authors have not seen this symptom present in this manner previously.
Declarations of conflicts of interest: none.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
May, T., Pridmore, S. 2020. A visual analogue scale companion for the six-item Hamilton Depression Rating Scale. Australian Psychologist. 55: 3-9. doi.org/10.1111/ap.12427