Negative Symptoms of Schizophrenia: The 5 As

Medical terms can be confusing. Case in point: Some symptoms of schizophrenia are described as negative. But don’t all symptoms of medical conditions mean something’s not working?

“In medical lingo, negative means something isn’t there,” explains psychiatrist Travis Krew, MD. “It isn’t describing something as bad — just like positive doesn’t mean something good in the medical world.”

Dr. Krew simplifies this concept and details what the five negative symptoms of schizophrenia look like.

What are the negative symptoms of schizophrenia?

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Negative symptoms of schizophrenia refer to a decrease or loss of typical behaviors and emotions. It’s like the things that make you feel like yourself are dialed down.

“You can think of negative symptoms like subtraction. They’re expressions and behaviors that are taken away,” illustrates Dr. Krew.

For example, most people naturally use facial expressions, body language and tone to show how they feel when speaking. Brain changes that lead to schizophrenia may limit that expression, making communication seem flat or emotionless.

Negative symptoms are one of several criteria healthcare providers consider when diagnosing schizophrenia. You don’t need them for a diagnosis, but they’re common.

“They’re often some of the earliest signs,” says Dr. Krew. “But people don’t tend to seek care until positive symptoms — like hallucinations and delusions — appear.”

Sticking with the math analogy, positive symptoms are additions. They’re “extra” experiences, like hearing voices that aren’t there.

Negative symptoms tend to persist in schizophrenia, while positive symptoms can come and go.

The 5 negative symptoms

There are five main negative symptoms of schizophrenia — known as the 5 As:

• Affective flattening
• Avolition
• Asociality
• Alogia
• Anhedonia

Here’s what those terms mean — and what they look like outside of a medical textbook.

1. Affective flattening

Affective flattening is reduced emotional expression. It’s one of the most common negative symptoms.

When you speak, you may have:

• Fewer facial expressions
• Limited eye contact
• A flat or monotone voice
• Fewer hand and head movements

“Affective flattening doesn’t mean you lack emotions entirely,” clarifies Dr. Krew. “You may still feel them, but it’s harder to show them to others.”

2. Avolition

Avolition is a lack of motivation. It’s another common negative symptom.

Avolition makes it hard to:

• Do basic hygiene tasks, like shower or change your clothes
• Keep up with household chores
• Participate in school, work or social activities
• Send or respond to texts, emails or phone calls

“Avolition isn’t laziness,” explains Dr. Krew. “It’s not that you avoid these activities. It’s more like your brain hits a pause button — you want to act, but your brain won’t allow you to get started.”

3. Asociality

Asociality is a lack of interest in social connection.

You may:

• Be less interested in spending time with others
• Avoid forming new relationships
• Stop making plans or initiating contact
• Prefer to be alone

“As a whole, these behaviors look like social withdrawal. It can make it harder to get the support you need,” says Dr. Krew.

4. Alogia

Alogia, also known as “poverty of speech,” means speaking less than usual.

You may:

• Talk less overall
• Use very few words
• Only speak in response to others
• Give brief or one-word answers
• Lose your train of thought
• Struggle to keep a conversation going

“This doesn’t mean you don’t want to communicate,” notes Dr. Krew. “It means your brain has trouble forming thoughts and finding the right words.”

5. Anhedonia

Anhedonia is a lack of interest in or pleasure from life’s experiences. You may not get as excited about things as you used to, like:

• Spending time with others
• Eating
• Music
• Sex

“People with schizophrenia may still enjoy things in the moment,” Dr. Krew says. “But it’s harder to anticipate that enjoyment, which makes it tough to feel motivated to do activities.”

Treatment for negative symptoms

Feeling like your personality has disappeared can be confusing and upsetting. It’s normal to want to feel like you again.

Unfortunately, negative symptoms can be difficult to treat, and right now, there aren’t any medications approved specifically for them.

Most schizophrenia medications target positive symptoms, like hallucinations. In some cases, they may even make negative symptoms worse because of how they affect your brain chemistry.

“Each case is different,” says Dr. Krew. “A psychiatrist can help you find a treatment plan that fits your symptoms.”

Treatment for negative symptoms often includes a combination of:

• Medication
• Therapy
• Support programs

Medications

Researchers are actively studying new drugs that treat negative symptoms. In the meantime, your provider may recommend options like antidepressants or certain atypical antipsychotics to help manage symptoms.

Therapies

Talk therapy and supportive programs that may help negative symptoms include:

• Cognitive behavioral therapy (CBT): You learn how your thinking patterns affect your behaviors. It may reduce apathy and improve motivation.
• Family therapy: You and your family learn to cope with the impacts of negative symptoms through education and communication strategies.
• Motivation and enhancement training (MOVE): This is a newer type of therapy specifically for negative symptoms. It combines support, CBT, skills training and other strategies.

The bottom line

Negative symptoms of schizophrenia can quietly affect how you feel and move through daily life. They’re not about a lack of effort. They reflect real changes in how your brain works.

While negative symptoms can be challenging to manage, support is available. With the right treatment plan and guidance, you can better understand these symptoms and find ways to improve your quality of life.