Avolition and expressive deficits capture negative symptom phenomenology: Implications for DSM-5 and schizophrenia research
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The DSM-5 formulation presents an opportunity to refine the negative symptom assessments that are crucial for a schizophrenia diagnosis. This review traces the history of negative symptom constructs in neuropsychiatry from their earliest conceptualizations in the 19th century. It presents the relevant literature for distinguishing between different types of negative symptoms. Although a National Institute of Mental Health consensus initiative proposed that there are five separate negative symptom domains, our review of the individual items demonstrates no more than three negative symptom domains. Indeed, numerous factor analyses of separate negative symptom scales routinely identify only two domains: 1) expressive deficits, which include affective, linguistic and paralinguistic expressions, and 2) avolition for daily life and social activities. We propose that a focus on expressive deficits and avolition will be of optimum utility for diagnosis, treatment-considerations, and research purposes compared to other negative symptom constructs. We recommend that these two domains should be assessed as separate dimensions in the DSM-5 criteria.
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Anhedonia (diminished 'liking') is a less prominent feature of schizophrenia than avolition (diminished 'wanting').
“Several authoritative reviews thus concluded that anhedonia (diminished ‘liking’) is a less prominent feature of schizophrenia than avolition (diminished ‘wanting’) [49,51-53].”
From Social “wanting” dysfunction in autism: neurobiological underpinnings and treatment implications (2012) · cites this paper as [52]
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“Negative symptoms in schizophrenia and other psychotic disorders include avolition, anhedonia, and asociality (Messinger et al., 2011).”
BackgroundTrémeau, F., Goldman, J., Antonius, D., & Javitt, D. C. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.05.031 · Cited by 28 · see citing works
Self-citationLyngstad, S. H., Gardsjord, E. S., Engen, M. J., Haatveit, B., Ihler, H. M., Wedervang-Resell, K., Simonsen, C., Melle, I., & Færden, A. (2020) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-020-01112-3 · Cited by 16 · see citing works
Health states for schizophrenia and bipolar disorder within the Global Burden of Disease 2010 Study
Ferrari, A. J., Saha, S., McGrath, J. J., Norman, R., Baxter, A. J., Vos, T., & Whiteford, H. A. (2012) · Population Health Metrics · doi:10.1186/1478-7954-10-16 · Cited by 1 · see citing works
- Authors
- Messinger, J. W., Trémeau, F., Antonius, D., Mendelsohn, E., Prudent, V., Stanford, A. D., & Malaspina, D.
- Affiliations
- Nathan Kline Institute for Psychiatric Research (US)
- New York University (US)
- Emory University (US)
- New York State Psychiatric Institute (US)
- ORCID
- Malaspina, Dolores
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2011-02
- Volume
- 31
- Issue
- 1
- Pages
- 161-168
- ISSN
- 0272-7358 (ISSN-L)
- PMC
- PMC2997909
- OpenAlex
- W2089011671
- Cited by
- 271
- References
- 100
- Citations by year
- 2026: 3 · 2025: 16 · 2024: 11 · 2023: 16 · 2022: 16 · 2021: 17 · 2020: 17 · 2019: 19 · 2018: 32 · 2017: 24 · 2016: 22 · 2015: 18 · 2014: 17 · 2013: 26 · 2012: 12
- FWCI
- 1.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5rc1mh088843-02)
- National Institute of Mental Health (K23MH076976, R01MH066428, K24-MH01699, RC1-MH088843, K24MH001699)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Applied Psychology › Psychological Testing and Assessment
- Keywords
- negative symptoms, schizophrenia, avolition, DSM-5, emotional expression, language expression, social functioning
- MeSH terms
- Emotions, Humans, Schizophrenia, Schizophrenic Psychology, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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