BACKGROUND: Anhedonia is psychopathological dimension conceptualized as loss of pleasure in several activities. Although typically viewed as a characteristic feature of depressive episodes, anhedonic experience is also seen in other mental disorders. We aimed to investigate the relationship between anhedonia, separation anxiety, and attachment style in a large cohort of outpatients with mood and anxiety disorders, also considering its ties to suicidality. METHODS: 384 consecutively recruited outpatients with mood or anxiety disorders were recruited and assessed with the Structured Clinical Interview for Mood Spectrum-Self Report (MOODS-SR) for anhedonia and suicidality, the Adult Separation Anxiety-Checklist (ASA-27), the Assessment of Adult Attachment Style Questionnaire (ASQ), the Hamilton Rating Scale for Depression (HAMD) and for Anxiety (HAM-A). Anhedonia score was calculated using eight items of the MOODS-SR encompassing the definition of anhedonia. RESULTS: 84 patients were diagnosed with adult separation anxiety disorder only (A-SAD), 32 patients had separation anxiety disorder only during childhood (C-SAD), 77 had both A-SAD and C-SAD, and 191 had no A-SAD/C-SAD. No differences were found in HAM-A and HAM-D scores between the diagnostic groups. Anhedonia score was significantly worse in the two groups with A-SAD. Regression analyses showed that HAM-D (p <
.024), ASA-27 (p <
.002) total scores and the ASQ domains of Confidence (p <
.001) and Discomfort with Closeness (p <
.002) were significant predictors of anhedonia. Anhedonia score (p <
.001) and ASA-27 (p <
.041) total score were significant predictors of suicidal thoughts and behaviors. CONCLUSIONS: Adult separation anxiety is associated with anhedonia and suicide risk in outpatients with mood and anxiety disorders.