Two subdomains of negative symptoms in psychotic disorders: Established and confirmed in two large cohorts

Edith Liemburg, Stynke Castelein, Roy Stewart, Mark van der Gaag, André Aleman, Henderikus Knegtering, René S. Kahn, Don H. Linszen, Jim van Os, Durk Wiersma, Richard Bruggeman, Wiepke Cahn, Lieuwe de Haan, Lydia Krabbendam, Inez Myin-Germeys

Research output: Contribution to journalArticlepeer-review

155 Scopus citations


Negative symptoms of schizophrenia are normally grouped into a single category. However, the diversity of such symptoms suggests that they are actually made up of more than one dimension. The DSM-V proposes two negative symptom domains, namely expressive deficits and avolition/asociality. We investigated whether the negative symptoms do indeed have two dimensions. An exploratory factor analysis was carried out based on interviews with the PANSS (664 patients). We restricted our analysis to items that had been described as negative symptoms in previous factor analyses. The symptom structure was then tested for stability by performing a confirmatory factor analysis on PANSS interviews from a separate cohort (2172 patients). Exploratory factor analysis yielded a two-factor structure of negative symptoms. The first factor consisted of PANSS items Flat affect, Poor rapport, Lack of spontaneity, Mannerisms and posturing, Motor retardation, and Avolition. The second factor consisted of Emotional withdrawal, Passive/apathetic social withdrawal, and Active social avoidance. The first factor could be related to expressive deficits, reflecting a loss of initiative, and the second factor to social amotivation, related to community interaction. This factor structure supports the DSM-V classification and may be relevant for pathophysiology and treatment of schizophrenia and other psychotic disorders.

Original languageEnglish
Pages (from-to)718-725
Number of pages8
JournalJournal of Psychiatric Research
Issue number6
StatePublished - Jun 2013
Externally publishedYes


  • Factor analysis
  • Negative symptoms
  • Psychotic disorder
  • Schizophrenia


Dive into the research topics of 'Two subdomains of negative symptoms in psychotic disorders: Established and confirmed in two large cohorts'. Together they form a unique fingerprint.

Cite this