Voices from the minority: Understanding the acculturative experiences of British Shia Muslims.

Negative symptoms, a core feature of psychotic disorders, are associated with decreased functioning and increased disability (Strauss & Cohen, ). Negative symptoms represent impaired function in areas such as motivation, pleasure, and expressivity (Correll & Schooler, ). While earlier studies employed differing definitions of negative symptoms, in 2006 a consensus statement developed by the NIMH agreed that negative symptoms comprise anhedonia (a decreased ability to derive enjoyment from activities), asociality (having little interest in a social life), avolition (a lack of the wilful initiation of activity), blunted affect (a decrease in the outward expression of emotion), and alogia (poverty of speech) (Kirkpatrick et al., ). Mild and transient negative symptoms, described as negative schizotypy, have been reported to occur in non‐clinical populations (Kwapil & Barrantes‐Vidal, ), differing from those experienced by people with psychosis in only their intensity, frequency, and the level of distress they cause (Johns & van Os, ). Establishing the prevalence and correlates of negative symptoms across the psychosis continuum is complex. Assessment measures vary in their definition of negative symptoms, their recommended frequency of use, and their method of administration (Lincoln et al., ; Lyne et al., ). Measures developed prior to the NIMH consensus statement are affected by conceptual confusion and contain items unrelated to the construct, such as cognitive symptoms (Chang et al., ; Lincoln et al., ). In addition, they frequently utilize total scores when 1‐ and 2‐factor models of negative symptoms offer suboptimal fit, compared with 5‐factor models (Chang et al., ). A further confounding factor is that negative symptoms can be a primary manifestation of the underlying pathophysiology of psychosis, or a secondary cluster of symptoms that occur in response to factors such as anti‐psychotic‐related sedation, extrapyramidal side effects, comorbidities, or environmental effects (Mosolov & Yaltonskaya, ). For example, qualitative studies suggest that withdrawal from social interactions can arise from shame about mental health stigma or weight gain from medication (Moernaut & Vanheule, ). Regardless of the cause, negative symptoms are associated with poor global functioning (Austin et al., ). People with lived experience of negative symptoms have described their relentless nature and the disabling impact that these symptoms have on their lives (Butcher et al., ). Despite their prognostic importance, currently available psychosocial and pharmacological treatments provide, at best, a modest improvement in symptoms (Lutgens et al., ). Seeking to refine psychosocial treatments, researchers are increasingly considering the role of attachment theory in the development and maintenance of negative symptoms (Griffiths & McLeod, ).