Negative Symptoms of Schizophrenia

Negative symptoms are behaviors or emotions that are lacking or missing in people with schizophrenia. They can be just as debilitating as positive schizophrenia, which refers to behaviors that appear in excess in people with schizophrenia and are typically not found in otherwise healthy individuals. These symptoms, which include delusions, hallucinations, disorganized thoughts, and disorganized speech, can cause you or someone you love to lose touch with reality.

Since negative symptoms indicate deficits in functioning, they are often called deficit symptoms. They can be frightening and debilitating, making it difficult to complete everyday tasks.

Causes of Negative Symptoms

The cause of negative symptoms is not fully understood. While some studies suggest that these deficits may be related to genetics, there is no known genetic association for negative symptoms or deficit schizophrenia. However, it is interesting to note that while winter birth increases the risk for schizophrenia, people with schizophrenia born in the summer appear to be at higher risk for negative symptoms.

Types of Negative Symptoms

The first step to managing the negative signs of schizophrenia is to understand the various types, which typically have one of four defining features:

• Affective deficits: Lack of facial expression, eye contact, gestures, and variations in voice pattern

• Avolition deficits: Severe lack of motivation or initiative to accomplish purposeful tasks (also called conational)

• Communicative deficits: Speech lacking in quantity or information

• Relational deficits: Lack of interest in social activities and relationships

Negative symptoms can include deficits in cognitive, emotional, and social abilities, resulting in a wide range of potential symptoms. The latest 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:

• Blunted Affect: This limits a person's ability to convey emotions, leading to diminished facial and emotional expressions. Blunted affect is less severe than flat affect, in which a person displays an extremely limited range of emotions; for instance, not even being able to crack a smile or laugh during moments of great joy. People may mistake blunted affect for 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 in monosyllables like "yes" or "no" when responding to questions and/or experience delays in getting the words out. It is important to note 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 results in a lack of involvement in social relationships or an increased desire to spend time alone. This is different from someone isolating themselves 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." However, in the case of schizophrenia, avolition causes a pervasive lack of enthusiasm coupled with a striking lack of concern for minor and major matters, such as what to eat, how the bills will get paid, and what will happen when the family is no longer around for support. This can even carry over into basic activities like personal hygiene and grooming.

• Anhedonia: 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 or other mental illnesses. Additionally, they may come and go during the course of schizophrenia. Often, people with schizophrenia might have one negative symptom in addition to the more commonly observed positive symptoms. Sometimes, certain medications prescribed for the treatment of schizophrenia, such as 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 symptoms

• The symptoms are persistent, or present for at least one year, and the patient experiences them even during times of clinical stability

• The 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 can be challenging due to the nature of the symptoms themselves; someone experiencing a lack of motivation, enthusiasm, or desire to be social, for instance, may be hesitant to seek and stick with treatment. Additionally, the drugs used to treat positive symptoms of schizophrenia can increase secondary negative symptoms and do not work on primary and persistent negative symptoms. Therefore, effective treatment often involves a combination of psychotherapy, social skills training, and medication.