Avolition: The Lack of Motivation in Schizophrenia

How It Differs From Apathy or Procrastination

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While the lack of motivation is not an inherent sign of a mental disorder, there may be times when it is symptomatic of clinical depression. Known as avolition, the symptom is seen in many forms of mental illness and differs from apathy in that you may have the desire to complete a task but cannot find the emotional tools take action on those desires.

Avolition may be the primary symptom of certain mood disorders, such as bipolar depression, or a secondary features of an anxiety disorder, such as post-trauma stress syndrome (PTSD).

However, avolition is most concerning and characteristic in people with schizophrenia, the condition of which was classified as a negative symptom of schizophrenia in 2006.

Understanding Avolition

Avolition is a term used to describe the severe lack of initiative to accomplish purposeful tasks. With schizophrenia, it can become so severe as to prevent you from keeping a job, managing your home or family, or caring for your health or personal appearance.

Avolition should not be mistaken for procrastination wherein a person actively seeks distractions to delay a task, such as is common with obsessive-compulsive disorder (OCD).

Within the context of schizophrenia, avolition suggests that you are willing to complete a task but are unable to harness the mental and physical energies to do so.

Even if there are consequences to that inaction—consequences you may want desperately to avoid—you will still be unable to act.

Examples include:

  • The inability to start or complete paying bills even when urgent
  • Avoiding either making or answering important phone calls
  • Failing to make or follow up on an important appointment
  • Failing to show up for a scheduled event or meeting
  • Failing to deal with everyday family or children needs
  • Not tending to your personal hygiene or appearance
  • Ignoring incoming phone calls or letters

Avolition is often characterized by emotional blunting, meaning that you may not show any clear signs of emotion. For this reason, people will often label the behavior as "apathetic" or "lazy," even though it may be more accurately regarded as a form of emotional and behavioral paralysis.

Where avolition differs from apathy is that people with apathy will be more likely alter their behaviors if there is a real threat of consequences. People with avolition will more likely not.

Avolition as a Negative Symptom

Avolition is considered a negative symptom not because it is bad. A negative symptom is simply the absence of an emotion, thought, or behavior that might otherwise be expected. It is not something that comes and goes but rather something that is characteristic, occurring either chronically or in protracted episodes.

Avolition is, in fact, one of the four defining features of a negative symptom, which include:

  • Affective deficits, or the lack of facial expression, eye contact, gestures, and variations in voice pattern
  • Communicative deficits, or speech that is lacking in quantity or information (sometimes to point of complete silence)
  • Relational deficits, or the lack of interest in social activities and relationships
  • Conational deficits, another term for avolition

By contrast, a positive symptom is defined as the presence of an abnormal emotion, thought, or behaviors. Hallucinations, paranoia, and delusions are three such examples.

Differentiating Avolition

Avolition is often confused with other negative symptoms which may have similar characteristics but different root causes. Among them:

  • Aboulia is the lack of will rather than motivation, a subtle difference but one which may be defined as a more severe form of apathy.
  • Anhedonia is the inability to feel pleasure, the symptom of which can lead to lack of motivation (rather than the other way around).
  • Asociality (another term for a relational deficit) is the lack of motivation restricted to relationships and social interactions.

Treatment

The treatment of avolition is considered difficult since the symptom is defined by the absence of a behavior or emotion rather than the presence of one.

With illnesses like schizophrenia, the primary goal of treatment is to either eliminate or reduce the positive symptoms. Thie is because, unlike negative symptoms, positive symptoms are inherently more dramatic and easy to define.

But, even if the positive symptoms are ultimately controlled with antipsychotics and other drugs, negative symptoms will still tend to persist. At present, there are no drugs able to treat these deficits.

While people experiencing avolition may respond to a combination of medications and social skills training, the very nature of the disorder makes them less likely to seek or adhere to treatment. Furthermore, treating avolition as a symptom cannot really be done without treating the primary disorder, schizophrenia. To accomplish this, a dedicated caregiver or social worker will be needed.

Medications used to treat avolition may include atypical antipsychotics, such as Zyprexa (olanzapine) and Risperdal (risperidone). On their own, the drugs are only moderately effective but may improve outcomes when used within the context of a comprehensive schizophrenia treatment plan.

Sources:

Lui, S.; Liu, A.; Chui, W. et al. The Nature of Anhedonia and Avolition in Patients With First-Episode Schizophrenia.  Psychology Med. 2016; 46(2):437-47. DOI: 10.1017/S0033291715001968.

Remington, G.; Foussias, G.; Fervaha, G. et al. Treating Negative Symptoms in Schizophrenia: An Update.​ Curr Treat Opt Psychiatry. 2016; 3(2):133-150. DOI: 10.1007/s40501-016-0075-8.

Strauss, G.; Horan, W.; Kirkpatrick, B. et al. Deconstructing Negative Symptoms of Schizophrenia: Avolition-Apathy and Diminished Expression Clusters Predict Clinical Presentation and Functional Outcome.J Psychiatric Res. 2013; 47(6):783-90. DOI: 10.1016/j.jpsychires.2013.01.015.