Negative Symptoms in Schizophrenia

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People withschizophreniacan experience bothpositive 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:

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 theDiagnostic 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 thanflat 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.

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 afterhearing voicesor experiencing feelings ofparanoia.

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,anmeans “without” andhedonemeans “pleasure,” so in simple terms,anhedoniais 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 ortypical 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 calledsecondarynegative 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

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

Deficit schizophrenia, which is not synonymous with deficit symptoms or negative symptoms, is diagnosed when patients have:

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 asatypical antipsychoticsare the first-line treatment for schizophrenia.

There are many different atypical antipsychotics used to treat schizophrenia, including:

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 aresecondaryto 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

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 ProgramsWe’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, includingsocial skills trainingandcognitive-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.

How Behavioral Therapy Works

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 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.xMarder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14–24. doi:10.1002/wps.20385Kilian 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.0127740Mitra 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_15Foussias G, Remington G.Negative symptoms in schizophrenia: avolition and Occam’s razor.Schizophr Bull. 2010;36(2):359–369. doi:10.1093/schbul/sbn094Strauss GP.The emotion paradox of anhedonia in schizophrenia: or is it?.Schizophr Bull. 2013;39(2):247–250. doi:10.1093/schbul/sbs192Rector NA, Beck AT, Stolar N.The negative symptoms of schizophrenia: a cognitive perspective.Can J Psychiatry. 2005;50(5):247–257. doi:10.1177/070674370505000503Kirschner 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.2016.05.003Harvey 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/s40263-015-0308-1Hrdlicka M, Dudova I.Atypical antipsychotics in the treatment of early-onset schizophrenia.Neuropsychiatr Dis Treat. 2015;11:907–913. doi:10.2147/NDT.S82185Li 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:10.2174/1568026616666160608084834Andrade 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:10.4103/0019-5545.74318Buckley LA, Maayan N, Soares‐Weiser K, Adams CE.Supportive therapy for schizophrenia.Cochrane Database Syst Rev.2015;4(CD004716). doi:10.1002/14651858.CD004716.pub4Cella 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.2016.11.009Xia J, Merinder LB, Belgamwar MR.Psychoeducation for schizophrenia.Cochrane Database Syst Rev. 2011;2011(6):CD002831. doi:10.1002/14651858.CD002831.pub2Additional ReadingKirkpatrick, 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.

16 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.xMarder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14–24. doi:10.1002/wps.20385Kilian 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.0127740Mitra 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_15Foussias G, Remington G.Negative symptoms in schizophrenia: avolition and Occam’s razor.Schizophr Bull. 2010;36(2):359–369. doi:10.1093/schbul/sbn094Strauss GP.The emotion paradox of anhedonia in schizophrenia: or is it?.Schizophr Bull. 2013;39(2):247–250. doi:10.1093/schbul/sbs192Rector NA, Beck AT, Stolar N.The negative symptoms of schizophrenia: a cognitive perspective.Can J Psychiatry. 2005;50(5):247–257. doi:10.1177/070674370505000503Kirschner 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.2016.05.003Harvey 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/s40263-015-0308-1Hrdlicka M, Dudova I.Atypical antipsychotics in the treatment of early-onset schizophrenia.Neuropsychiatr Dis Treat. 2015;11:907–913. doi:10.2147/NDT.S82185Li 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:10.2174/1568026616666160608084834Andrade 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:10.4103/0019-5545.74318Buckley LA, Maayan N, Soares‐Weiser K, Adams CE.Supportive therapy for schizophrenia.Cochrane Database Syst Rev.2015;4(CD004716). doi:10.1002/14651858.CD004716.pub4Cella 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.2016.11.009Xia J, Merinder LB, Belgamwar MR.Psychoeducation for schizophrenia.Cochrane Database Syst Rev. 2011;2011(6):CD002831. doi:10.1002/14651858.CD002831.pub2Additional ReadingKirkpatrick, 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.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto 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.xMarder SR, Galderisi S.The current conceptualization of negative symptoms in schizophrenia.World Psychiatry. 2017;16(1):14–24. doi:10.1002/wps.20385Kilian 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.0127740Mitra 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_15Foussias G, Remington G.Negative symptoms in schizophrenia: avolition and Occam’s razor.Schizophr Bull. 2010;36(2):359–369. doi:10.1093/schbul/sbn094Strauss GP.The emotion paradox of anhedonia in schizophrenia: or is it?.Schizophr Bull. 2013;39(2):247–250. doi:10.1093/schbul/sbs192Rector NA, Beck AT, Stolar N.The negative symptoms of schizophrenia: a cognitive perspective.Can J Psychiatry. 2005;50(5):247–257. doi:10.1177/070674370505000503Kirschner 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.2016.05.003Harvey 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/s40263-015-0308-1Hrdlicka M, Dudova I.Atypical antipsychotics in the treatment of early-onset schizophrenia.Neuropsychiatr Dis Treat. 2015;11:907–913. doi:10.2147/NDT.S82185Li 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:10.2174/1568026616666160608084834Andrade 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:10.4103/0019-5545.74318Buckley LA, Maayan N, Soares‐Weiser K, Adams CE.Supportive therapy for schizophrenia.Cochrane Database Syst Rev.2015;4(CD004716). doi:10.1002/14651858.CD004716.pub4Cella 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.2016.11.009Xia J, Merinder LB, Belgamwar MR.Psychoeducation for schizophrenia.Cochrane Database Syst Rev. 2011;2011(6):CD002831. doi:10.1002/14651858.CD002831.pub2

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

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.

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.

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