The DSM-5 formulation presents an opportunity to refine the negative symptom assessments that are crucial for a schizophrenia diagnosis. This review traces the history of negative symptom constructs in neuropsychiatry from their earliest conceptualizations in the 19 th century. It presents the relevant literature for distinguishing between different types of negative symptoms. Although a National Institute of Mental Health consensus initiative proposed that there are five separate negative symptom domains, our review of the individual items demonstrates no more than three negative symptom domains. Indeed, numerous factor analyses of separate negative symptom scales routinely identify only two domains: 1) expressive deficits, which include affective, linguistic and paralinguistic expressions, and 2) avolition for daily-life and social activities. We propose that a focus on expressive deficits and avolition will be of optimum utility for diagnosis, treatment-considerations, and research purposes compared to other negative symptom constructs. We recommend that these two domains should be assessed as separate dimensions in the DSM-5 criteria.

Objective Aggression in schizophrenia is a major societal issue, leading to physical harm, stigmatization, patient distress, and higher healthcare costs. Impulsivity is associated with aggression in schizophrenia, but it is multidetermined. The subconstruct of urgency is likely to play an important role in this aggression, with positive urgency referring to rash action in context of positive emotion, and negative urgency to rash action in context of negative emotion. Method We examined urgency and its neural correlates in 33 patients with schizophrenia or schizoaffective disorder and 31 healthy controls. Urgency was measured using the Urgency, Premeditation, Perseverance and Sensation Seeking scale. Aggressive attitudes were measured using the Buss Perry Aggression Questionnaire. Results Positive urgency, negative urgency, and aggressive attitudes were significantly and selectively elevated in patients (1.21< Cohen’s ds < 1.50). Positive and negative urgency significantly correlated with Aggression Questionnaire total score (rs>.48) and each uniquely accounted for a significant portion of the variance in aggression over and above the effect of group. Urgency measures correlated with reduced cortical thickness in ventral prefrontal regions including right frontal pole, medial and lateral orbitofrontal gyrus and inferior frontal gyri, and rostral anterior cingulate cortex. In patients, reduced resting state functional connectivity in some of these regions was associated with higher urgency. Conclusions Findings highlight the key role of urgency in aggressive attitudes in people with schizophrenia and suggest neural substrates of these behaviors. They also suggest behavioral and neural targets for interventions to remediate urgency and aggression.

Research has demonstrated that the extent to which an individual integrates a traumatic event into their identity ("trauma centrality") positively correlates with posttraumatic stress disorder (PTSD) symptom severity. No research to date has examined trauma centrality in individuals exposed to combat stress. This study investigated trauma centrality using the abridged Centrality of Event Scale (Berntsen & Rubin, 2006) among Operation Enduring Freedom/Operation Iraqi Freedom combat veterans (n = 46). Multiple regression analyses demonstrated that trauma centrality predicted PTSD symptoms. Trauma centrality and PTSD symptoms remained significantly correlated when controlling for depression in subgroups of veterans with or without probable PTSD. This study replicates and extends findings that placing trauma at the center of one's identity is associated with PTSD symptomatology.