Schizophrenia symptoms come in two main types: positive and negative.

What are the two main types of symptoms in schizophrenia?

• A. Positive symptoms and negative symptoms
• B. Physical symptoms and cognitive symptoms
• C. Acute symptoms and chronic symptoms
• D. Mood symptoms and behavioral symptoms

Answer: (A)

The classification of symptoms in schizophrenia into positive and negative categories is well-established in the field of mental health. Positive symptoms refer to the presence of abnormal behaviors and thoughts that are not typically seen in healthy individuals. These include hallucinations, delusions, and disorganized thinking. Positive symptoms indicate an excess or distortion of normal functions. Negative symptoms, on the other hand, involve the absence or reduction of normal emotional responses or behaviors. Common negative symptoms include flat affect (lack of emotional expression), anhedonia (inability to experience pleasure), and social withdrawal. These symptoms can significantly affect a person's ability to function in daily life. This distinction is crucial for diagnosis and treatment, as it helps clinicians understand the individual’s experience and tailor interventions accordingly. Recognizing these two categories facilitates a comprehensive approach to the management of schizophrenia, addressing both the disruptive behaviors and the emotional deficits associated with the disorder. The other options represented different categorizations that do not align with the established symptomatology of schizophrenia, focusing instead on physical states or the duration of symptoms, which are not the primary classifications used in psychiatric practice for this disorder.

Schizophrenia often gets framed as a single bundle of symptoms, but clinicians actually think about it in two big families: positive symptoms and negative symptoms. Understanding this split isn't just academic—it's how doctors figure out what a person is experiencing and, crucially, how to help.

What are the two big symptom families?

Let me explain the two camps in plain terms.

Positive symptoms

These are the things that show up as extra experiences—things that aren’t part of typical thinking or perception. If you’ve ever heard someone describe hearing voices when no one else is around, that’s a classic example. Here’s a quick breakdown:

• Hallucinations: hearing, seeing, or feeling things that aren’t real. Auditory hallucinations (voices) are the most common in schizophrenia.

• Delusions: firmly held false beliefs that don’t change even when there’s clear evidence to the contrary. They can be paranoid, grandiose, or bizarre.

• Disorganized thinking or speech: thoughts that don’t connect logically, making conversation hard to follow. You might hear loose tangents, derailments, or garbled speech.

• Agitation or disorganized behavior: actions that seem out of place or unpredictable, sometimes including unusual pacing or ritualized behavior.

Think of positive symptoms as an excess or distortion of normal functions. They’re not pleasant, and they’re not simply “in the mind” in a casual sense—they reflect real differences in how a person experiences reality.

Negative symptoms

These are about what’s absent or reduced, not added. They often have a big impact on daily life because they touch motivation, emotion, and social connection. Common negative symptoms include:

• Flat or blunted affect: little or no facial expression, tone of voice that sounds flat.

• Anhedonia: reduced ability to experience pleasure or interest.

• Avolition: diminished drive to initiate or persist in goal-directed activities.

• Alogia: reduced speech output; speaking little or in a sparse way.

• Social withdrawal: pulling back from friends, family, and activities.

Negative symptoms aren’t about “being sad” or a mood issue alone. They can be mistaken for laziness or stubbornness, which is why a careful clinical assessment is so important. These symptoms can be subtler, but they’re often deeply impairing, impacting work, relationships, and self-care.

Why this distinction matters

This isn’t just a labeling exercise. The two families guide what clinicians do next:

• Diagnosis and prognosis: Positive symptoms tend to respond more quickly to certain antipsychotic medications, while negative symptoms often persist longer and may require additional supports.

• Treatment planning: If someone has prominent negative symptoms, clinicians might add cognitive remediation, social skills training, or supported employment strategies to help with functioning. Positive symptoms may be tackled with medication adjustments, psychoeducation, and strategies to reduce distress from psychotic experiences.

• Monitoring progress: It’s helpful to track changes in both areas. A decrease in hallucinations is good, but if motivation or social interest doesn’t improve, broader supports are still needed to improve day-to-day life.

A practical note for clinicians and students: it’s common for symptoms to overlap. A person might have both hallucinations and reduced motivation, and some negative symptoms can be influenced by mood, medications, or stress. Good care often means untangling these threads to see what’s driving which piece.

How this translates in real life (with sensitivity)

Consider a hypothetical-but-typical scenario: Jordan, a 22-year-old college student, starts seeing shadows in the corner of the eye and hearing a voice when alone. The voices comment on daily choices and sometimes tell Jordan not to trust friends. At first, Jordan’s energy tanks; mornings are rough, and hanging out with peers feels exhausting. The classroom attendance slips, not because the person doesn’t care, but because motivation has faded and social withdrawal has crept in.

In this kind of case, positive symptoms—hallucinations and disorganized thoughts—grab attention quickly. Yet the decline in daily functioning might be driven by a mix of negative symptoms, like avolition and reduced pleasure, alongside the stress of managing symptoms. A thoughtful clinician would address both: stabilizing the psychotic experiences while also supporting engagement, social connection, and routine.

Why it helps to name both sides

Separating symptoms into positive and negative categories helps families and care teams:

• It sets realistic expectations. Some improvements may come quickly (for example, reduced distress from voices), while others (like rebuilding a social life or finding motivation) take longer.

• It shapes support needs. Medication is often central for positive symptoms, but recovery often needs therapy, skills training, and environmental supports to address negative symptoms.

• It guides conversations. Talking about experiences in two buckets makes it easier to describe what’s changing and what still feels stuck.

Common myths and the real picture

• Myth: Negative symptoms are just mood problems. Reality: They’re a distinct part of schizophrenia that can stand apart from mood disorders, though mood and cognition can influence each other.

• Myth: Positive symptoms are the only thing that matters. Reality: Both types matter for daily life, safety, and long-term outcomes. Ignoring negative symptoms can leave someone with limited functioning even if psychosis is controlled.

• Myth: If you have negative symptoms, you’re unlikely to improve. Reality: With the right combination of medication, therapy, social supports, and meaningful activities, people can regain motivation and connection—though it often takes time and patience.

What to remember about these symptom families

• Positive symptoms = presence of unusual experiences (hallucinations, delusions, disorganized thinking).

• Negative symptoms = absence or reduction of normal functions (emotional expression, motivation, social engagement).

• Both shapes matter for care and recovery.

• The best outcomes come from a team approach that blends medical management with psychosocial supports.

A quick guide for learners and future clinicians

• Stay curious about the person’s experience. Ask about not just what is happening, but how it affects daily living, relationships, and self-care.

• Separate symptoms from possible medication effects. Some drugs can produce mood or cognitive changes that mimic or mask other symptoms, so a nuanced plan helps.

• Use simple language when explaining concepts to patients and families. Terms like “positive” and “negative” are clinical shorthand; real conversations happen in everyday terms—like “extra experiences” and “missing motivation.”

• Track function as much as symptoms. Improvements in work, school, or social life often signal meaningful change, even if some symptoms linger.

• Don’t overlook support systems. Friends, family, and peer groups can play a pivotal role in sustaining engagement and reducing isolation.

A practical takeaway

If you’re studying this topic, try this mental exercise: picture two bins in your head. In the first bin, you place the experiences that someone with schizophrenia might report as “extra” or “distorted.” In the second bin, you place the experiences that feel missing or diminished compared with typical life. That simple visualization helps when you’re communicating with clients or planning care. It keeps the focus on the person, not just the diagnosis.

Two words to keep close

Patterns matter, and people matter more. By understanding positive and negative symptoms, you’re better equipped to listen, empathize, and partner with someone on the path to better days. The distinction isn’t just a label—it’s a practical lens for improving care, guiding conversations, and supporting life beyond symptoms.

If you’re exploring the topic further, you’ll find that all the core ideas circle back to one practical aim: helping someone live a life that feels meaningful, not just free of distress. That’s the heart of mental health work, the thing that makes every clinician, student, or caregiver lean a little closer to understanding and, yes, hope.