Avolition or Lack of Motivation in Schizophrenia

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Avolition, a lack of motivation or a lack of motivation or reduced drive to complete goal directed activities, is a concerning and common characteristic in people with schizophrenia. It is one of the negative symptoms of schizophrenia. Negative symptoms involve those that cause a decrease or loss in mental functioning and can interfere with daily functioning, including maintaining a job, relationship, or social life.

While a lack of motivation is not an inherent sign of a mental disorder, it is often symptomatic of clinical depression. Avolition can be the primary symptom of certain mood disorders, such as bipolar depression, or a secondary feature of an anxiety disorder, such as post-trauma stress syndrome (PTSD).

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, 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.

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 of Avolition

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

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 to 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 of schizophrenia. A negative symptom is simply the absence of an emotion, a thought, or a 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, disorganization, and delusions are three such examples.

Differentiating Avolition

Avolition is often confused with other negative symptoms that may have similar characteristics but different root causes, including:

  • 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.

  • Avolition: severe lack of initiative to accomplish purposeful tasks

  • Aboulia: lack of will rather than motivation

  • Anhedonia: inability to feel pleasure

  • Asociality: lack of motivation in 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, a primary goal of treatment is to either eliminate or reduce the positive symptoms. This is because, unlike negative symptoms, positive symptoms are inherently more dramatic and easy to define.

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, cognitive therapy, and behavioral therapy (including social skills training), the very nature of the disorder makes them less likely to seek or adhere to treatment.

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, which may include psychotherapy (individual or group therapy), complementary and alternative therapies (animal assisted therapy, dietary supplements), and invasive procedures (deep brain stimulation).

Coping

Avolition can diminish your drive to participate in social activities and meet goals as well as your ability to complete daily tasks, causing a strain on your family, social, and work life. What's more, since many people can mistake this characteristic for being lazy or irresponsible, it can have an adverse impact on your relationships.

With the right treatment and support, however, you can take steps to help you cope with this negative symptom of schizophrenia. Here are a few to consider:

  • Find the right medication and never stop taking the medication unless directed by your mental health provider.
  • Work with your therapist to develop a better understanding of avolition along with strategies to harness the mental and physical energies to complete tasks and meet obligations.
  • Communicate with loved ones. Don't be afraid to let family and friends know that you are experiencing avolition and that it is not procrastination nor laziness. Consider enlisting their help by asking them to help you create a schedule for medications, therapy, bill paying, appointments, or any other regular activities.
  • Invest in a calendar or use your smartphone to help remember appointments and keep track of daily living tasks.
  • Find support. Whether online or in person, a support group will allow you to share your experiences and gain insight from others living with schizophrenia.
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