Schizophrenia is a mental health condition defined by a breakdown in the relation of thoughts, feelings, and emotions. Without a cure, people tend to experience both positive and negative symptoms of schizophrenia throughout their lives. But what are these symptoms?

Negative Symptoms of Schizophrenia

Two sets of negative symptoms are categorized as: ¹

• Primary Negative Symptoms – Those related to the disorder itself.

• Secondary Negative Symptoms – Those related to other aspects of daily life, such as:
  • Depression
  • Hospitalization
  • Isolation
  • Medication (including withdrawal)
  • Personality disorders
  • Substance abuse

Negative symptoms are difficult to address as they don’t always appear outwardly. For example, someone who doesn’t show facial expressions may not necessarily lack emotions but rather struggle with a severe emotional state. ²

The consistency of negative symptoms varies. Some will experience them all the time whereas others will have severe bouts followed by remissions.

Schizophrenia’s most common negative symptoms include:

• Alogia (inability to speak due to disorganized thoughts)
• Anhedonia (inability to feel pleasure)
• Cannot act spontaneously
• Doesn’t gesture during communication
• Inexpressive face
• Lack of motivation
• Loss of interest in the world
• Monotone speech
• Physical inactivity
• Quietness
• Reduced sense of purpose
• Social withdrawal
• Unable to make eye contact

Positive Symptoms of Schizophrenia

While negative symptoms are difficult to distinguish, positive symptoms are what we often associate with schizophrenia. The most common include: ³

• Delusions – Holds beliefs that aren’t supported by facts. For example, your irrational fears from believing things you see on television may lead to paranoia. ⁴

• Hallucinations – Hearing and seeing things that aren’t actually there.

• Thought Disorder – Disorganized thoughts that carry over into the way you communicate.

Other positive symptoms include:

• Agitated body movements
• Inappropriate emotions for specific situations
• Psychosis
• Strange ideas and plans

Since positive symptoms are more apparent, this is what mental health professionals will look for in a schizophrenia diagnosis.

Positive vs. Negative Symptoms of Schizophrenia

For a schizophrenia diagnosis, you need to seek out positive symptoms. Beyond the fact that these are more apparent, they’re also unique. While healthy individuals may experience negative symptoms associated with schizophrenia, they’ll never experience positive symptoms.

Since negative symptoms are common in the general population, they’re also easier to overlook. Therefore, it can be difficult for doctors to see these symptoms and automatically assume it’s schizophrenia. Furthermore, some negative symptoms are common in other mental illnesses, such as bipolar disorder.

Cognitive Symptoms of Schizophrenia

Along with positive and negative, people with schizophrenia may also struggle with cognitive symptoms. These include:

• Difficulty focusing or paying attention
• Issues with information immediately after learning it
• Unable to process information to make decisions

While cognitive symptoms are usually subtle, they can appear in conversations or when someone with schizophrenia learns new information. However, these symptoms replicate other mental illnesses (such as attention-deficit/hyperactivity disorder) and, therefore, cannot alone diagnose schizophrenia.

Examples of Negative Symptoms of Schizophrenia

Since negative symptoms are difficult to recognize, it can help to understand common behaviors of these symptoms:

• Appearing Apathetic – While this doesn’t indicate true apathy, people with schizophrenia may appear emotionless in serious situations.

• Difficulty with Diet – You may eat too much or too little. While it depends on your diet, some foods can exasperate schizophrenia symptoms. ⁵

• Inability to Communicate – As mentioned, some people with schizophrenia struggle with conversations as their speech and thoughts are disorganized. ⁶

• Lack of Personal Hygiene – With disorganized thoughts, you may not take care of yourself.

• Lack of Productivity – Spend most of the day lying around, inability to find something to do or complete tasks (procrastination).

• Sleep Problems – Not getting enough sleep or getting too much sleep. Up to 80% of people diagnosed with schizophrenia will experience some degree of insomnia. ⁷

• Withdrawal from Social Situations – Since schizophrenia often leads to isolation, people with it are vulnerable to depression. ⁸

Furthermore, negative emotions may be present in other ways, such as a person’s inability to make eye contact or properly respond to questions.

How to Treat Negative Symptoms of Schizophrenia

Since negative symptoms are directly linked to positive ones, doctors will address them within schizophrenia treatment itself. It’s vital to understand that schizophrenia is a lifelong condition and, therefore, treatment will need to be consistent.

Currently, doctors treat schizophrenia with: ⁹

• Medication – While most doctors prescribe antipsychotics to treat positive symptoms, you may receive other medicines if you struggle with another mental illness.

• Psychotherapy – Meant to address symptoms of positive and negative symptoms. The type of therapy you’ll attend will be based on your needs. For example, some people benefit more from group rather than individual therapy.

Still, some negative emotions may not appear until after you start treatment. Recent research has found a link between certain antipsychotics and the development of negative emotions. ¹⁰

Due to this, your doctor may prescribe other antipsychotics, such as cariprazine (Vraylar) which has been found to improve negative symptoms.

Natural Remedies for Negative Symptoms of Schizophrenia

Many have found natural remedies to help with negative symptoms. While more research is necessary, the following supplements have been found to help ease schizophrenia symptoms:

• B Vitamins
• Vitamin D
• Omega-3 Fatty Acids

Furthermore, some holistic treatments have also been found useful:

• Change in diet
• Cognitive behavioral therapy (CBT)
• Crisis intervention
• Stress management techniques (i.e. exercise)
• Specific coping mechanisms (i.e. avoiding alcohol and drugs)

Since schizophrenia is a lifelong condition, your best bet to ease negative symptoms requires you to make positive lifestyle changes.

Final Word

Negative symptoms of schizophrenia can be just as damaging as positive ones. However, with the right techniques, you can overcome them.

While a doctor may not initially recognize your negative symptoms, you should keep track of them if you notice any. This may involve writing them down in a journal and presenting them when you see a psychiatrist.

If you currently treat schizophrenia, chances are you’ve already addressed negative symptoms to some degree. However, if you find some negative symptoms appear after treatment, it’s important to discuss these with a mental health professional.

References

¹ Correll CU, Schooler NR. Negative Symptoms in Schizophrenia: A Review and Clinical Guide for Recognition, Assessment, and Treatment. Neuropsychiatr Dis Treat. 2020 Feb 21;16:519-534. doi: 10.2147/NDT.S225643. PMID: 32110026; PMCID: PMC7041437.

² Mandal MK, Pandey R, Prasad AB. Facial expressions of emotions and schizophrenia: a review. Schizophr Bull. 1998;24(3):399-412. doi: 10.1093/oxfordjournals.schbul.a033335. PMID: 9718632.

³ Hany M, Rehman B, Rizvi A, Chapman J. Schizophrenia. 2024 Feb 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30969686.

⁴ Kiran C, Chaudhury S. Understanding delusions. Ind Psychiatry J. 2009 Jan;18(1):3-18. doi: 10.4103/0972-6748.57851. PMID: 21234155; PMCID: PMC3016695.

⁵ Tsuruga K, Sugawara N, Sato Y, Saito M, Furukori H, Nakagami T, Nakamura K, Takahashi I, Nakaji S, Yasui-Furukori N. Dietary patterns and schizophrenia: a comparison with healthy controls. Neuropsychiatr Dis Treat. 2015 Apr 22;11:1115-20. doi: 10.2147/NDT.S74760. PMID: 25960655; PMCID: PMC4411018.

⁶ Merrill AM, Karcher NR, Cicero DC, Becker TM, Docherty AR, Kerns JG. Evidence that communication impairment in schizophrenia is associated with generalized poor task performance. Psychiatry Res. 2017 Mar;249:172-179. doi: 10.1016/j.psychres.2016.12.051. Epub 2017 Jan 6. PMID: 28104564; PMCID: PMC5452682.

⁷ Stummer L, Markovic M, Maroney ME. Pharmacologic Treatment Options for Insomnia in Patients with Schizophrenia. Medicines (Basel). 2018 Aug 11;5(3):88. doi: 10.3390/medicines5030088. PMID: 30103483; PMCID: PMC6165340.

⁸ Samsom JN, Wong AH. Schizophrenia and Depression Co-Morbidity: What We have Learned from Animal Models. Front Psychiatry. 2015 Feb 18;6:13. doi: 10.3389/fpsyt.2015.00013. PMID: 25762938; PMCID: PMC4332163.

⁹ Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: overview and treatment options. P T. 2014 Sep;39(9):638-45. PMID: 25210417; PMCID: PMC4159061.

¹⁰ Cerveri G, Gesi C, Mencacci C. Pharmacological treatment of negative symptoms in schizophrenia: update and proposal of a clinical algorithm. Neuropsychiatr Dis Treat. 2019 Jun 5;15:1525-1535. doi: 10.2147/NDT.S201726. PMID: 31239687; PMCID: PMC6556563.