Anosognosia is a neurological condition that affects how people view themselves and impairs their awareness of having a mental health condition, such as schizophrenia or bipolar disorder. This can make it hard for people to seek or follow treatment.

People with anosognosia may have no awareness of their condition or an inaccurate perception of it.

In this article, we look at how anosognosia affects the brain, how people with anosognosia may behave, and how doctors approach the treatment and management of the condition.

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Anosognosia is a neurological condition in which people do not accept a mental health diagnosis. People may also describe a person with the condition as having a “lack of insight.” The term anosognosia comes from the Greek for “to not know a disease.”

A person with anosognosia will be unable to identify their own mental illness accurately. They may be unaware of their illness or the true extent of it. As this can affect how they understand and perceive their mental health, it may prevent them from seeking treatment or taking their medication.

Health experts commonly link anosognosia to specific mental health conditions, although it may occur in all of them. Research estimates that anosognosia may affect 50–90% of people with schizophrenia and 40% of people with bipolar disorder.

Anosognosia can also affect people with dementia and those with damage to certain areas of the brain, which could be due to stroke. About 81% of people with Alzheimer’s disease may have anosognosia to some degree.

The frontal lobe of the brain is responsible for controlling a person’s self-image. Self-image is a mental image that each person forms of themselves, and it is constantly changing. For example, if a person gets a new haircut or learns a new skill, their self-image may adjust accordingly.

The frontal lobe of the brain organizes any new information, such as looking or acting differently, and then creates an updated narrative that becomes the new self-image.

Certain mental health conditions, such as bipolar disorder, schizophrenia, or dementia, can damage the frontal lobe and result in anosognosia. Similarly, injury to the brain, such as from a stroke or traumatic brain injury, can also cause anosognosia.

If the frontal lobe is not able to function properly, it can prevent people from being able to update their self-image to include a mental illness. This means that they may be following the narrative of their old self-image, which was in place before their mental health condition began.

People with anosognosia will have an impaired awareness, or a lack of understanding, of their mental health condition. People may deny that they have an illness, or they may downplay its importance.

Their levels of awareness may also fluctuate, so they may sometimes acknowledge their condition and show greater self-awareness. However, at other times, they may have little to no awareness of their condition. Other people may mistake this as denial, stubbornness, or fear around a mental health condition, but it is a common feature of anosognosia.

People with anosognosia may also express anger or frustration to those around them who are aware of their illness, as this does not match their self-image.

Anosognosia may lead people to refuse medication or treatment. If people do not believe themselves to be ill, treatment will seem unnecessary, and refusing any medication will seem rational.

To diagnose anosognosia, a doctor may question the person about their condition to assess their levels of awareness. They may use an anosognosia rating scale to measure the person’s level of awareness and how easily they admit to their symptoms.

The doctor may also carry out a mental status examination to assess insight. This exam involves grading responses using medical rating systems, which may assess certain criteria, such as:

  • The person completely denies the illness.
  • The individual has a slight awareness of the illness and of requiring help but continues to deny it.
  • Although the person has an awareness of the illness, they blame it on others or external factors.
  • There is evidence of intellectual insight into the condition.
  • The person has true emotional insight into their condition.

Rating scales may also help doctors tell the difference between anosognosia and denial, which is a defense mechanism that people may use to respond to an emotionally difficult diagnosis. Typically, anosognosia results from physical damage to the brain, meaning that it is anatomical in origin, whereas denial is psychological.

If a brain injury is present, a doctor may take brain scans to see which area of the brain the damage affects. This may help them diagnose anosognosia, as the condition is commonly associated with damage in particular regions of the brain.

Anosognosia is often associated with mental health conditions. Without treatment, this combination of symptoms can lead to serious consequences, such as reckless or dangerous behavior. Although anosognosia has no specific treatment method, vestibular stimulation may temporarily improve the condition.

The vestibular system is a sensory system in the body that provides the brain with information to create a sense of balance, as well as helping with cognitive function.

Vestibular stimulation may involve attaching electrodes to the skull behind the ears or using a vestibular implant to stimulate the vestibular system. Vestibular stimulation may help improve awareness in the affected areas of the brain.

Cognitive therapy may also be a long-term treatment option to help people with anosognosia gain a better understanding or awareness of their condition and learn to manage the symptoms of their illness.

Anosognosia increases the risk of severe consequences from a mental health condition. If a person who needs treatment refuses it due to anosognosia, this could lead to serious consequences, such as:

  • homelessness
  • arrest or incarceration
  • violence or danger to others
  • suicide

Understanding and learning about anosognosia and the potential risks can help people better support those with the condition. Everyday tasks, such as physical activity, handling money, or driving, may become more difficult for those with anosognosia.

People may need to take measures to ensure safety in the home and simplify everyday tasks to support those with anosognosia. Other beneficial approaches include:

  • maintaining a patient and positive attitude
  • showing empathy
  • listening to the other person and expressing concern and understanding where appropriate
  • providing a structured environment

Working alongside a team of healthcare professionals can help ensure that people receive the correct treatment and support. People may need to work with a range of experts, such as neurologists, psychotherapists, and psychiatrists.

In severe cases, people with anosognosia may require involuntary treatment when it is legally acceptable.

Anosognosia is a condition of the brain that may affect some people with mental health conditions or a brain injury. People with anosognosia have an impaired awareness of their condition and may not have an accurate perception of it.

This lack of insight can lead people to refuse treatment or medication, which could have serious consequences.

Anosognosia commonly occurs alongside certain conditions, such as schizophrenia, bipolar disorder, Alzheimer’s disease, and stroke.

Vestibular stimulation or cognitive therapies may help in the treatment of anosognosia. People can work alongside a team of healthcare professionals to manage both anosognosia and any mental health conditions.