When most people think about schizophrenia, they think about hallucinations or delusions—voices that aren’t there or beliefs that don’t align with reality. These symptoms are often grouped under the term "positive symptoms" of schizophrenia and are typically what brings someone into treatment and leads to diagnosis.

But for many individuals, positive symptoms are not the beginning of the illness.

Long before hallucinations or delusions appear, more subtle and often misunderstood symptoms can emerge early on. These are known as negative symptoms, and they frequently shape long-term functioning far more than psychosis itself.

Negative symptoms are a reduction or loss of normal emotional and motivational functioning. They are not simply reactions to illness, personality traits, or side effects of medication—they are a core component of schizophrenia itself.

Negative symptoms that specifically affect motivation and emotional expression may include:

These symptoms are often misinterpreted as depression, apathy, or a lack of effort. In reality, they reflect changes in brain systems involved in motivation, reward, and emotional expression. These symptoms can often continue to present even when positive symptoms such as hallucinations and/or delusions are well controlled or absent with antipsychotics.

Negative symptoms are a core and common part of schizophrenia.

Research suggests that nearly 9 out of 10 people experience at least one negative symptom at the time of a first psychotic episode. Even after treatment, an estimated 35–70% continue to experience persistent negative symptoms, despite........

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