Anosognosia

Anosognosia is a condition that causes an individual to be unaware of or unable to accurately perceive their mental health condition and its effects. The term, coined by Joseph Francois Babinski in 1914, is roughly translated from the Greek for “to not know a disease.” Anosognosia is a common symptom of some mental health conditions, schizophrenia and bipolar among them.

What Is Anosognosia?

Anosognosia can be considered a lack of insight into one’s own state of mental health. It typically means an individual does not realize they have a mental health issue or is unaware of its extent. For example, a person may experience delusions and not realize they are delusions but instead believe them to be real.

This condition differs from denial. A person in denial is often consciously aware of a fact but refuses to accept it. Denial, a psychological defense mechanism most people use to some degree, is not necessarily a symptom of mental illness. Anosognosia, on the other hand, involves a form of brain impairment.

It is important to note people experiencing this concern are not being stubborn or refusing to acknowledge their mental health issue. Rather, the condition’s effects on their brain make it impossible for them to do so.

Anosognosia is not a fixed, stable condition. Those experiencing anosognosia can have insight into their mental health conditions at certain times and experience impaired insight at others. Some people may only be partially aware of their mental health issues, making anosognosia a condition of varying degrees.

What Causes Anosognosia?

Brain damage, specifically to the frontal and parietal lobes of the right hemisphere, is thought to be involved in anosognosia. An individual experiencing this condition may have difficulty understanding sensory information entering the body. While the systems responsible for seeing, hearing, and touching remain intact, someone with anosognosia is unable to accurately use that sensory information.

Brain changes that result in anosognosia can be caused by multiple factors, including a traumatic head injury, dementia, stroke, or other vascular issues. When caused by dementia, Anosognosia can be especially confusing to those close to the affected person, since any behavioral changes may contrast sharply with expected actions and behavior. Anosognosia is a common symptom of both schizophrenia and bipolar. In fact, it is estimated that 50% of individuals living with schizophrenia and 40% of those living with bipolar have some degree of anosognosia.

The Impact of Anosognosia

The most detrimental effect of anosognosia is that it can prevent people from getting treatment for their mental health condition. Someone who is not aware they are experiencing a mental health concern is not likely to seek treatment for it. Even if a person is seeing a mental health professional or other provider, they may not be compliant with treatment recommendations. Many, for example, may stop taking prescribed medications due to anosognosia. If the anosognosia comes from psychosis or mania, lack of treatment could lead to dangerous behavior.

People with anosognosia can also be more prone to conflict with loved ones or caregivers. For instance, loved ones may mistakenly believe an individual with anosognosia is in denial or being stubborn, leading to arguments and frustration.

How Can Anosognosia Be Addressed?

When anosognosia is a symptom of bipolar or schizophrenia, medication treating the underlying condition can alleviate its symptoms. For example, approximately a third of people with schizophrenia experience increased insight when taking antipsychotic medication.

If someone is not aware they have a mental health issue, they are unlikely to be motivated to take medication for it (in cases where medication is the recommended treatment). In such cases, trying to convince a person they are wrong does not typically work. Anosognosia can be thought of as a specific type of delusion, and talking someone out of a delusion is not always possible. Rather, a therapist or treatment provider may use Motivational Enhancement Therapy (MET) to help individuals see the potential benefits of treatment in a way that makes sense to them.

Laws Relating to Anosognosia

In most cases, people have the right to seek or decline medical and mental health treatment. However, in cases where an individual is impaired to the degree of becoming a danger to themselves or others, as may be the case in extreme cases of anosognosia, treatment can be mandated. Although specific laws vary by state, mandated treatment can include involuntary hospitalization, physical restraint, and the use of psychotropic medications.

References:

1. Anosognosia. (n.d.). National Alliance on Mental Illness. Retrieved from https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Anosognosia
2. Anosognosia. (n.d.). Treatment Advocacy Center. Retrieved from http://www.treatmentadvocacycenter.org/key-issues/anosognosia
3. Doty, L. (2007). Anosognosia (unawareness of decline or difficulties). Retrieved from http://alzonline.phhp.ufl.edu/en/reading/anosognosia.pdf
4. Fuller Torrey, E. (n.d.). Impaired awareness of illness: Anosognosia. Retrieved from https://mentalillnesspolicy.org/medical/anosognosia-studies.html
5. Thompson, K. (2008). Anosognosia: The most devastating symptom of mental illness. Retrieved from http://www.mentalmeds.org/articles/anosognosia.html
6. Tracy, N. (2012, October 12). Handling anosognosia—Neurological inability to recognize your mental illness. Retrieved from https://www.healthyplace.com/blogs/breakingbipolar/2012/10/handling-anosognosia-neurological-inability-recognize-mental-illness/

Last Updated: 10-16-2017