Schizophrenia Negative Symptoms in Schizophrenia By Adrian Preda, MD Adrian Preda, MD LinkedIn Adrian Preda, MD, is a board-certified psychiatrist with specialties in adult and geriatric psychiatry and clinical neuropsychiatric research. Learn about our editorial process Updated on February 12, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Verywell / Cindy Chung Table of Contents View All Table of Contents Causes Types Diagnosis Treatment People with schizophrenia can experience both positive and negative symptoms. This doesn't mean that there are "good" versus "bad" symptoms. Positive symptoms are behaviors that appear in surplus in people with schizophrenia and are typically not found in otherwise healthy individuals. Positive symptoms, which include delusions, hallucinations, disorganized thoughts, and disorganized speech, can cause you or someone you love to lose touch with reality. Negative schizophrenia refers to behaviors or emotions that are deficient or lacking in people with schizophrenia. As negative symptoms indicate deficits in functioning they are also called deficit symptoms. Negative symptoms, including lack of emotion, decreased joy or motivation, delayed speech, and difficulty beginning and sustaining activities, can be scary and extremely debilitating. If you or someone you love is struggling with negative symptoms, you may need help in order to complete daily tasks. Causes of Negative Symptoms The cause of negative symptoms is not clear. While some studies say these deficits run in families, there is no known genetic association for negative symptoms or deficit schizophrenia. Interestingly, while winter birth increases the risk for schizophrenia, people with schizophrenia born in the summer appear to be at higher risk for negative symptoms. Causes and Risk Factors of Schizophrenia Types of Negative Symptoms The first step in managing the negative symptoms of schizophrenia is to understand the different types, which typically have one of four defining features: Affective deficits: lack of facial expression, eye contact, gestures, and variations in voice patternAvolition deficits: severe lack of motivation or initiative to accomplish purposeful tasks (also called conational)Communicative deficits: speech lacking in quantity or informationRelational deficits: lack of interest in social activities and relationships Because negative symptoms can include deficits in cognitive, emotional, and social abilities, there can be a large number of potential symptoms. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes negative symptoms as “restricted emotional expression and avolition,” and includes the following five types. Understanding Avolition Blunted Affect This limits a person's ability to convey his or her emotions, causing diminished facial and emotional expressions. A blunted affect is less severe than flat affect, in which a person has an extremely limited range of emotions; for instance, not even being able to crack a smile or laugh during a time of great joy. People can mistake blunted affect as someone being "cold" or "unfeeling." Alogia Defined in DSM-5 as a "decrease in verbal output or verbal expressiveness," alogia (also known as "poverty of speech") can make it nearly impossible to communicate your thoughts and carry on a conversation. People with alogia may answer a monosyllabic "yes" or "no" when responding to questions and/or experience delays in getting the words out. It should be noted that these speech delays are not the same as those caused by positive symptoms like auditory or visual hallucinations and disorganized thinking. Asociality Other terms used to describe asociality are nonsocial, unsocial, social disinterest or a lack of social drive. Asociality causes a lack of involvement in social relationships or increased desire to spend time alone. This is different than a person who isolates him or herself after hearing voices or experiencing feelings of paranoia. Avolition Avolition is a form of emotional or behavioral paralysis that can diminish your drive to participate in social activities and meet goals as well as your ability to complete daily tasks. Many people mistake this negative symptom for "laziness." But, in the case of schizophrenia, avolition causes a pervasive lack of enthusiasm coupled with a striking lack of concern for both minor and major matters such as what to eat, how the bills will get paid, and what will happen when the family will no longer be around for support). This can even carry over into basic activities like personal hygiene and grooming. Anhedonia In Greek, an means "without" and hedone means "pleasure," so in simple terms, anhedonia is a state where you are unable to feel pleasure. For people with schizophrenia, this can mean a lack of enthusiasm for activities, hobbies, passions, and pleasures once enjoyed. Diagnosing Negative Symptoms Negative symptoms are not always easy to recognize and can be mistaken for depression as well as other mental illnesses. What's more, they may come and go during the course of schizophrenia. Often times, people with schizophrenia might have one negative symptom in addition to the more commonly observed positive symptoms. At times, some of the medications prescribed for the treatment of schizophrenia, such as the first generation or typical antipsychotics, also known as neuroleptics, have adverse effects such as decreased interest or decreased emotional response. Since these symptoms are due to the medications, they are called secondary negative symptoms. What Is Deficit Schizophrenia? Deficit schizophrenia, which is not synonymous with deficit symptoms or negative symptoms, is diagnosed when patients have:At least two out of the six negative symptomsThe symptoms are persistent, or present for at least one year, and the patient experiences them even during times of clinical stabilityThe symptoms are primary, or not due to other causes like medication or other conditions People with deficit schizophrenia have a poorer response to treatment, social and occupational functioning, and overall quality of life than people with non-deficit schizophrenia. Treatment for Negative Symptoms Treating negative symptoms is tricky due to the very nature of the negative symptoms; someone experiencing a lack of motivation, enthusiasm, or desire to be social, for instance, may be hesitant to seek and stick with treatment. In addition, the drugs used to treat positive symptoms of schizophrenia can increase secondary negative symptoms and do not work on primary and persistent negative symptoms. This is why effective treatment ideally includes a combination of drugs, therapy, and support. How Schizophrenia Is Treated Atypical Antipsychotics Second-generation medications known as atypical antipsychotics are the first-line treatment for schizophrenia. There are many different atypical antipsychotics used to treat schizophrenia, including: Abilify (aripiprazole) Clozaril (clozapine) Geodon (ziprasidone) Invega (paliperidone) Risperdal (resperidone) Seroquel (quetiapine) Symbyax (olanzapine/fluoxetine) Zyprexa (olanzapine) Typical Antipsychotics Typical antipsychotic medications (Haldol (haloperidol) and Thorazine (chlorpromazine), which can be used for the treatment of positive symptoms of schizophrenia such as hallucinations and delusions, are not effective in treating negative symptoms, such as lack of emotion, motivation, or interest in social activities. While effective against positive symptoms, these older, first-generation antipsychotics have a number of neurological adverse effects, such as parkinsonism (when medications cause symptoms similar to Parkinson's disease), that can increase secondary negative symptoms. These drugs, also known as neuroleptics or major tranquilizers, can help treat negative symptoms that are secondary to positive symptoms. For example, people can be socially isolated due to paranoid beliefs or voices commanding them not to leave their home. In such cases, antipsychotics that decrease paranoia and auditory hallucinations (hearing voices or sounds) will improve social affiliation. Antidepressants While it is by no means a cure, combining antipsychotics with antidepressants has been shown more effective than taking antipsychotics alone. Antidepressants work by increasing the availability of one or several of the following neurotransmitters: Dopamine (decision-making, motivation, signaling of pleasure and reward)Norepinephrine (alertness and motor function)Serotonin (mood, appetite, sleep, memory, social behavior, sexual desire) The 5 Types of Antidepressants Psychosocial Interventions Psychosocial interventions, including behavioral therapy, support therapy, and family psychoeducation, aim to change a person's behaviors toward a more healthy interaction with society. These therapies can provide people with persistent negative systems as well as their families with tools to identify and cope with deficits in cognitive and emotional functioning and social skills. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. Supportive Therapy Supportive therapy provides an opportunity for companionship, non-judgmental validation, common-sense advice, and reassurance from a trained therapist. Often, your therapist will step in on your behalf to facilitate communication with family members as well as authorities like schools and social agencies. Behavioral Therapy Behavioral therapy, including social skills training and cognitive-behavioral therapy (CBT), can teach you to recognize and engage in behaviors and activities that will improve the quality of life and day-to-day living. For example, during social skills training you will be taught how to express feelings and needs, ask questions, and control voice, body, and facial expressions. CBT can teach you or someone you love to identify and change the deficits that have a negative influence on behavior and emotions. What Is Behavioral Therapy? Family Psychoeducation Family support plays a key role in the treatment of negative symptoms. Psychoeducation for patients and families is helpful in decreasing stigma and improving opportunities for ongoing social engagement. It can also offer families effective strategies for communicating and coping with a loved one with schizophrenia. A Word From Verywell The negative symptoms of schizophrenia can cause severe disruptions in daily functioning, relationships, work, school, hobbies, and leisure activities. With an appropriate diagnosis, treatment, and support, you or someone you love can find relief from these symptoms and discover ways to cope effectively. 16 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Institute of Mental Health. Health Topics. Schizophrenia. Kirkpatrick B, Galderisi S. Deficit schizophrenia: an update. World Psychiatry. 2008;7(3):143–147. doi:10.1002/j.2051-5545.2008.tb00181.x Marder SR, Galderisi S. The current conceptualization of negative symptoms in schizophrenia. World Psychiatry. 2017;16(1):14–24. doi:10.1002/wps.20385 Kilian S, Asmal L, Goosen A, Chiliza B, Phahladira L, Emsley R. Instruments measuring blunted affect in schizophrenia: a systematic review. PLoS One. 2015;10(6):e0127740. doi:10.1371/journal.pone.0127740 Mitra S, Mahintamani T, Kavoor AR, Nizamie SH. Negative symptoms in schizophrenia. Ind Psychiatry J. 2016;25(2):135–144. doi:10.4103/ipj.ipj_30_15 Foussias G, Remington G. Negative symptoms in schizophrenia: avolition and Occam's razor. Schizophr Bull. 2010;36(2):359–369. doi:10.1093/schbul/sbn094 Strauss GP. The emotion paradox of anhedonia in schizophrenia: or is it?. Schizophr Bull. 2013;39(2):247–250. doi:10.1093/schbul/sbs192 Rector NA, Beck AT, Stolar N. The negative symptoms of schizophrenia: a cognitive perspective. Can J Psychiatry. 2005;50(5):247–257. doi:10.1177/070674370505000503 Kirschner M, Aleman A, Kaiser S. Secondary negative symptoms - A review of mechanisms, assessment and treatment. Schizophr Res. 2017;186:29–38. doi:10.1016/j.schres.2016.05.003 Harvey RC, James AC, Shields GE. A systematic review and network meta-analysis to assess the relative efficacy of antipsychotics for the treatment of positive and negative symptoms in early-onset schizophrenia. CNS Drugs. 2016;30(1):27–39. doi:10.1007/s40263-015-0308-1 Hrdlicka M, Dudova I. Atypical antipsychotics in the treatment of early-onset schizophrenia. Neuropsychiatr Dis Treat. 2015;11:907–913. doi:10.2147/NDT.S82185 Li P, Snyder GL, Vanover KE. Dopamine targeting drugs for the treatment of schizophrenia: Past, present and future. Curr Top Med Chem. 2016;16(29):3385–3403. doi:10.2174/1568026616666160608084834 Andrade C, Rao NS. How antidepressant drugs act: A primer on neuroplasticity as the eventual mediator of antidepressant efficacy. Indian J Psychiatry. 2010;52(4):378–386. doi:10.4103/0019-5545.74318 Buckley LA, Maayan N, Soares‐Weiser K, Adams CE. Supportive therapy for schizophrenia. Cochrane Database Syst Rev. 2015;4(CD004716). doi:10.1002/14651858.CD004716.pub4 Cella M, Preti A, Edwards C, Dow T, Wykes T. Cognitive remediation for negative symptoms of schizophrenia: A network meta-analysis. Clin Psychol Rev. 2017;52:43–51. doi:10.1016/j.cpr.2016.11.009 Xia J, Merinder LB, Belgamwar MR. Psychoeducation for schizophrenia. Cochrane Database Syst Rev. 2011;2011(6):CD002831. doi:10.1002/14651858.CD002831.pub2 Additional Reading Kirkpatrick, B, Fenton, WS, Carpenter, WT., et al. The NIMH-MATRICS Consensus Statement on Negative Symptoms. Schizophrenia Bulletin. 2006;32(2):214–9. DOI: 10.1093/schbul/sbj053. Kring, A, Gur R, Blanchard J, et al. The Clinical Assessment Interview for Negative Symptoms (CAINS): Final Development and Validation. The American Journal of Psychiatry. 2013;170(2):165-72. DOI: 10.1176/appi.ajp.2012.12010109. By Adrian Preda, MD Adrian Preda, MD, is a board-certified psychiatrist with specialties in adult and geriatric psychiatry and clinical neuropsychiatric research. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.