Lack of Motivation as a Symptom of Schizophrenia

Avolition and the Blunting of Emotional Action or Reaction

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While the lack of motivation is not an inherent sign of a mental disorder, there can be times when it is. Certainly, in people experiencing clinical depression, feelings of hopelessness and apathy can often manifest as a lack of motivation or interest. But there are times when the lack of motivation is a sign of something we call avolition commonly seen in people with schizophrenia.

Understanding Avolition

Avolition is a psychological term used to describe a severe lack of initiative or motivation to accomplish purposeful tasks.

In persons with schizophrenia, it can become so severe as to prevent a person from performing ordinary tasks related to work, home life, health, grooming, or the pursuit of personal interests.

Avolition should not be mistaken for procrastination wherein a person (often a perfectionist) looks for distractions to delay a task. Within the context of schizophrenia, the person experiencing avolition will want to complete the task but is unable to harness the mental and physical energy to do so.

Examples include:

  • The inability to start or complete paying bills even when urgent
  • Avoiding either making or answering important phone calls
  • Failing to make or follow up on an important appointment
  • Failing to show up for a scheduled event or meeting
  • Promising to get back to someone or something but never doing so
  • Sitting for hours doing nothing

Avolition as a Negative Symptoms of Schizophrenia

Avolition is considered a negative symptom of schizophrenia not because it is "bad." It is simply a term used to distinguish how a person experiences something, either positively or negatively.

As a symptom of schizophrenia, avolition will typically manifest with such negative experiences as:

  • The inability to express an emotion that the person fully feels
  • The inability to respond verbally to a situation or emotion

As such, the individual doesn’t necessarily exhibit apathy (although it may be perceived that way) but rather an emotional blunting to which event and response don’t match.

Moreover, persons experiencing avolition will typically speak in a halting or disjointed manner and have a tendency to avoid direct eye contact.

Avolition Versus Anhedonia

Avolition is not the same thing as anhedonia (another negative symptom of schizophrenia). With anhedonia, a person has the inability to feel pleasure. Some have theorized that it may be caused by a biological malfunction by which less dopamine is released to stimulate the brain’s pleasure center.

By contrast, a person experiencing with avolition can feel emotions, good and bad, but has the inability to act on them.

Treating Avolition in People With Schizophrenia

The negative symptoms of schizophrenia are considered difficult to treat, even more so that the positive symptoms such as hallucinations or delusions.

While people experiencing avolition may respond to a combination of medications and social skills training, the very nature of the disorder makes that person less likely to seek or adhere to treatment. Furthermore, treating avolition as a symptom cannot really be done without treating the primary disorder, schizophrenia. To accomplish this, a dedicated caregiver or social worker is usually needed.

Medications used to treat avolition include atypical antipsychotics such as Zyprexa (olanzapine) and Risperdal (risperidone).

On their own, the drugs are only moderately effective but may improve outcomes when used within the context of a comprehensive schizophrenia treatment plan.

Sources:

Lui, S.; Liu, A.; Chui, W.; et al. "The Nature of Anhedonia and Avolition in Patients With First-Episode Schizophrenia." Psychological Medicine. 2016; 46(2):437-47.

Remington, G.; Foussias, G.; Fervaha, G.; et al. "Treating Negative Symptoms in Schizophrenia: An Update." Current Treatment Options in Psychiatry. 2016; 3(2):133-150.

Sarkar, S.; Hillner, K.; and Velligan, D. "Conceptualization and Treatment of Negative Symptoms in Schizophrenia." World Journal of Psychiatry. 2015; 5(4):352-361.

Strauss, G.; Horan, W.; Kirkpatrick, B.; et al. "Deconstructing Negative Symptoms of Schizophrenia: Avolition-Apathy and Diminished Expression Clusters Predict Clinical Presentation and Functional Outcome." Journal of Psychiatric Research. 2013; 47(6):783-90.

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