Anosognosia: Everything You Need to Know
Different than denial
Medically reviewed by Nicholas R. Metrus, MD
Anosognosia is a symptom associated with mental health conditions, structural brain lesions, and dementia. Anosognosia is characterized by a person's lack of awareness of their disease or disorder and poor insight into their symptoms and their impact on everyday functioning.
When someone isn’t aware they’re experiencing symptoms, they don’t recognize the need for treatment, leading to worse health outcomes and overall prognosis.
This article will discuss anosognosia, including its causes, symptoms, and treatment in this overview.
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Anosognosia Definition
The word "anosognosia" has Greek roots and roughly means “to not know a disease.”
Someone living with anosognosia may not be aware they have an illness and need treatment. They might doubt their diagnosis, attribute signs and symptoms to other causes, or sincerely believe they don’t need help. They may not want to discuss their health or may become defensive when someone brings it up.
What Causes Anosognosia?
Awareness and insight have been linked to a person's ability to observe and organize new information about themselves, reflect on their own thoughts, and recognize the changes in themselves. If the frontal lobe doesn't recognize the symptoms of an illness, the person is left with the pre-illness self-image and a lack of insight into their current health status.
Brain injury and damage can also cause a person to lose awareness and insight. This can occur when brain lesions cause damage to one side of the brain or when a stroke is experienced and the person loses awareness on the recovering side of their body.
Associated Conditions
Several health conditions are linked to structural or functional brain differences or damage to the frontal lobe. Damage to the frontal lobe can cause many problems with thinking and cognition, including the lack of self-awareness that can cause anosognosia. These include:
Mood disorders like major depressive disorder (MDD) and bipolar disorder and psychotic disorders like schizophrenia
Cognitive and neurological conditions like Alzheimer’s disease and dementia (memory impairment and decline)
Psychosocial factors, including personality, beliefs, values
Anosognosia Symptoms
Anosognosia symptoms include:
Lack of awareness of one's disability or deficit
Denial of health conditions or problems
Inaccurate perception of mental health
Not recognizing the need for treatment
Not following through with treatment
Difficulties with social tasks
Symptoms present in a range of ways. A person may be partially aware of their illness and symptoms or not at all.
When anosognosia is due to traumatic brain injury, for example, the person may not be able to retrieve new information to update their insight about symptoms, but when associated with psychiatric illness, the person may connect current symptoms to other causes.
Anosognosia differs from denial in the following ways:
Lack of insight lasts longer (sometimes years)
Beliefs remain even when presented with strong evidence to the contrary
Illogical explanations are used to explain why their experience is understandable
Prevalence
The prevalence of anosognosia varies depending on the underlying cause. Based on early studies from the 1990s, the National Alliance on Mental Illness (NAMI) reports that approximately 30% of people with schizophrenia and 20% of people with bipolar disorder experienced a "severe" lack of awareness of their diagnosis. More recent research suggests an even higher prevalence of 57% to 98% in those with schizophrenia.
Related: An Overview of Traumatic Brain Injury
How Anosognosia Is Diagnosed?
The steps for diagnosing anosognosia include consulting with a healthcare provider who can provide a thorough evaluation. If structural brain damage or traumatic brain injury is suspected, neuroimaging (taking scans of the brain) may be used as part of the diagnostic process.
If anosognosia is due to mental illness, a mental healthcare provider may use the Scale to Assess Unawareness in Mental Disorder (SUM-D) to measure:
Symptom recognition and awareness
Willingness to follow a treatment plan
Awareness of symptoms being linked to condition
Evaluation is about assessing functional impairment. The challenge is providing the healthcare professional with an accurate picture of functionality when awareness is compromised.
Takeaway
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anosognosia is not a condition on its own, but a symptom of other diagnosable conditions.
Related: How to Check a Doctor's Background and Credentials
How Anosognosia Is Treated
There is no standardized treatment for anosognosia or cure. Treatment methods are usually based on the underlying cause. They may include medication, psychotherapy (talk therapy) and counseling, and supportive intervention and strategies, or a combination approach.
Takeaway
Poor insight is associated with an increased likelihood of involuntary hospitalizations and use of emergency services.
Antipsychotic Therapy
If symptoms are linked to psychiatric conditions causing psychotic symptoms like psychosis, some research suggests taking antipsychotic medication may help reduce anosognosia and improve insight.
Related: Medications to Treat Schizophrenia
Motivational Enhancement Therapy (MET)
Motivational enhancement therapy (MET) is typically used in treating alcohol use disorder. It’s a fast-paced form of therapy geared toward encouraging someone to make internally produced changes, meaning they change because they accept they need to and now want to.
Cognitive Behavioral Therapy (CBT) or Counseling
Psychotherapy can help those with anosognosia learn about their underlying illness and symptoms. Counselors and other mental health professionals may use one or more psychotherapy methods, including cognitive behavioral therapy and supportive intervention strategies.
Supportive Intervention Strategies
Supportive intervention strategies encompass a wide range of tools. For example, therapeutic benefits of activity-based therapies including animal therapy or arts therapy and other tools like peer mentoring have been explored for supporting children who’ve experienced traumatic stress.
Related: Therapy
How to Help Someone With Anosognosia
It is possible to help someone who doesn’t know they need help. While it can be tiring, frustrating, and even confusing, strategies include:
Learn about the signs and symptoms of their condition.
Express what you notice, your concerns, and support.
Connect them with local or virtual resources, reminding them help is available.
Engage with them by asking questions, actively listening, and being responsive when mental health topics come up.
Read Next: Types of Caregiver Burnout and How to Prevent It
Summary
Anosognosia is a symptom in which someone lacks insight or awareness about their medical condition. It can prevent someone from recognizing they need treatment, worsening recovery outcomes. The same factors contributing to a person's underlying condition may contribute to someone experiencing anosognosia.
Symptoms and treatment vary depending on the cause. Healthcare professionals may prescribe medication or encourage psychotherapy and other supportive interventions for symptom relief. Understanding anosognosia is important to increasing treatment follow-through and improving recovery outcomes.
Read the original article on Verywell Health.
