What Is Avolition and How Is It Treated?

Medically reviewed by Timothy J. Legg, PhD, CRNP on May 23, 2017Written by Susan York Morris

Understanding avolition

“Avolition” is a term used to describe the lack of motivation or ability to do tasks or activities that have an end goal, such as paying bills or attending a school function.

Avolition occurs most commonly in schizophrenia, depression, and bipolar disorder.

In schizophrenia, symptoms are categorized as being either positive or negative. Most people have a combination of the two. Avolition is considered a negative symptom.

Negative symptoms reflect the loss of ability to do or experience things. Examples of avolition in schizophrenia might be the inability to care for personal hygiene or participate in work or recreational activities.

Positive symptoms are behaviors or actions that aren’t generally seen in people who don’t have schizophrenia, although they may be present in other psychiatric disorders. Hallucinations, delusions, and speech that’s disorganized are common positive symptoms. However, negative symptoms are often the first sign of schizophrenia, appearing before hallucinations or delusions.

Keep reading to learn more on the characteristics of avolition and how it can be managed.

What avolition looks like

A person experiencing avolition may withdraw from social contact and normal activities. They often have no enthusiasm and get little enjoyment from life. Their emotions may become dulled and conversations may be disjointed.

Avolition is often mistaken as depression. It’s more clearly identified and understood when a person also displays positive symptoms of schizophrenia. It’s important to keep in mind that a person with avolition isn’t avoiding activities. They simply don’t have the ability to act.

Examples of avolition

Avolition affects every aspect of daily life — personal relationships, home, and school.

A person with avolition may experience the following:

  • doesn’t make eye contact when speaking or spoken to
  • limited or halted speech
  • stops participating in events or gatherings
  • avoids making or receiving phone calls
  • has trouble starting or completing projects
  • doesn’t participate or show enthusiasm for special occasions or events
  • fails to make appointments, such as for the doctor or tax preparer

Avolition isn’t the same thing as laziness

Some might assume these things are due to a person’s laziness or irresponsibility. But people with avolition don’t have the ability to act. In a sense, it’s like being paralyzed by apathy or the inability to anticipate or experience the rewards of performing a task. In contrast, laziness may be considered a willful act of a person who doesn’t have a mental health disorder.

What causes avolition in schizophrenia

Avolition is one of the more common negative symptoms of schizophrenia. It’s also seen in other mental and neurological disorders.

It isn’t clear what causes schizophrenia, though the following may be factors:

  • genetics
  • brain development
  • chemicals in the brain
  • complications of pregnancy and childbirth

It’s not known why some people develop negative symptoms like avolition.

When a person has two or more negative symptoms for more than 12 months and was clinically stable otherwise, they are said to have deficit schizophrenia syndrome. About 25 percent of people with schizophrenia have this syndrome.

People with deficit schizophrenia usually have more severe negative symptoms that are more difficult to treat. Although positive symptoms like delusions and hallucinations may seem more alarming, negative symptoms tend to have a greater impact on a person’s ability to function.

Other negative symptoms

Other negative symptoms of schizophrenia overlap with avolition. Mental health specialists often combine some of them as a single symptom.

It’s easy to see why when you consider how interrelated the following symptoms are:

Anhedonia: This is the inability to experience pleasure or anticipate rewards.

Affective blunting or flattening: When a person is unable to show or express emotions, it’s called blunting or flattening. Lack of emotional expression may be obvious when a person is speaking or by their body language.

Alogia: This refers to problems with speaking or carrying on your part of a conversation. It may include not asking or responding to questions. People with alogia often have trouble forming thoughts and following conversations, particularly when the speaker switches from one topic to another.

Attentional impairment: Many people with schizophrenia have trouble with concentration and focus. They may be unable to filter out unwanted noises and stimulation. It’s also not unusual to have problems with memory.

Anosognosia: This refers to a lack of insight or awareness that’s often used to describe a person’s inability to recognize that they have a mental illness. At least 50 percent of people with schizophrenia aren’t aware of their disease. Anosognosia is one of the main reasons many people with the disease don’t take their medications.

Treatment options

The negative symptoms of schizophrenia are generally more difficult to treat than positive symptoms. And there’s no gold standard for treating them.

Treatment is usually most effective when started early, so it’s important to begin it when the disorder is first identified. It can take several weeks for medications to take full effect.

Treatment usually includes a combination of medications and therapy.

Medications

Antipsychotic medications are most effective in treating positive symptoms of schizophrenia, including delusions and hallucinations. They are theorized to work by correcting the levels of neurotransmitters in the brain. Neurotransmitters are chemicals that help brain cells communicate with each other.

Antipsychotic medications are effective in helping four out of five people who take them. However, some antipsychotic medications can increase avolition and other negative symptoms.

Common antipsychotics taken by mouth include:

Side effects are common and may include:

  • shakiness
  • slowness or sluggishness
  • abnormal movement of the tongue and jaw
  • sexual problems

Many people have fewer side effects with newer antipsychotic medications, such as clozapine and risperidone. However, they may experience elevated levels of blood sugar, cholesterol, or triglycerides.

Some antipsychotic medications are given by injection, every two weeks, four weeks, or four times a year. This can be helpful for people who forget to take their medications.

Antidepressants are sometimes prescribed to be taken with antipsychotic medications.

Learn more: Depression medications and side effects »

Therapies

Cognitive behavioral therapy, or talk therapy, and cognitive enhancement therapy can be very useful in helping people gain skills they need to function in their daily activities.

Electroconvulsive therapy may be recommended if antipsychotic medications aren’t effective.

Outlook

Treatment can help control symptoms of schizophrenia for many people, enabling them to lead independent, productive lives. For those who aren’t helped by treatment, mental health agencies can provide information about services to support basic needs, such as housing, employment, and healthcare.

How to help someone who is experiencing avolition

Caring for someone can be challenging, both for you and for the person you’re caring for. It can be difficult to accept help, especially if it feels unneeded. It can also be difficult to offer help when it feels as though it’s unappreciated.

It’s important to be patient with yourself and with the person you’re caring for. Together, you can work through any obstacles you’re facing.

Here are a few other helpful approaches:

  • Create a schedule for them to follow, including grooming, taking medications, mealtimes, bedtime, and other regular activities. Post it in a list or calendar format in a location where it will be a ready reminder.
  • Make sure medications are being taken properly. Keep notes for the doctor on any side effects and how the person is responding to the medication.
  • All communication, especially instructions, should be simple and easy to understand.
  • Keep calm and be encouraging. Use gentle reminders rather than nagging.
  • Be prepared in case their condition reaches crisis proportions. Keep a list handy with contact information for doctors and the hospital. Make sure you’ll have transportation. Arrange for a friend or family member to act as a helper or driver if there’s a crisis.

Keep reading: 10 Tools to add to your caregiver toolkit »

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