Anosognosia: Definition, Symptoms, & Causes

What Is Anosognosia?

The word anosognosia comes from the Greek language and its meaning is to not be aware of mental or physical health illness.¹ When anosognosia is present, people may adamantly claim the absence of illness or symptoms. Anosognosia keeps people from updating their self-image and so they do not realize changes in their functioning. They are not intentionally trying to mislead others; they truly cannot recognize that they are ill.

In cases of schizophrenia, anosognosia may be exhibited even when the person experiences delusions and hallucinations.¹ While anosognosia is frequently exhibited in cases of schizophrenia, it is also present in a variety of other mood, neurological, and psychotic disorders. These include delusional disorder, stroke, personality disorders, dementia, bipolar disorder, and intellectual disabilities. Having a lack of insight into mental health can result in multiple undesirable outcomes.¹

Impact of Anosognosia on Other Conditions

When a person is unable to acknowledge that they are ill, they are unlikely to follow treatment recommendations for an illness they do not believe they have.² This can lead to a variety of negative consequences including refusal to follow treatment protocol, increased frequency of relapse, poor psychosocial functioning, psychotic relapses, and increased risk of violence.³

Common Symptoms of Anosognosia

Although anosognosia can manifest in a variety of disorders, symptoms are similar across diagnoses. The lack of insight can appear in a variety of ways from avoiding conversations about symptomatic behaviors to blatantly denying the presence of symptoms. Whether the anosognosia is a product of mental disorders or injury, symptoms are similar in that they reflect the inability to see oneself clearly.

Symptoms of anosognosia may include:

• Blatantly denying illness: A person may be exhibiting unexpected illness-related behaviors, but wholeheartedly deny that they are ill.
• Forgetting to take medication: When a person does not believe that they are ill, they may unintentionally or intentionally miss medicine doses.
• Dismissive behaviors: A person may feel that others are bringing up concerns that are not based in reality and may dismiss the comments shared by others or make light of the concerns of others, including helping professionals.
• Selective attention to symptoms: People may focus on a particular symptom while downplaying or denying the presence of other potentially more concerning symptoms. The denial doesn’t come from wanting to mislead about the presence of a symptom, people with anosognosia truly do not recognize the presence of some symptoms.
• Avoidance: Individuals may try to change the topic if their health is being discussed or avoid situations where their mental health would be addressed. Individuals with anosognosia do not perceive their illness and may prefer to avoid settings where it might be a focus.
• Irritability: Due to the lack of awareness of a disorder, individuals may exhibit irritability and impatience with people who want to draw attention to their symptoms.

How Is Anosognosia Diagnosed?

Although friends and family members may be the first to recognize symptoms of anosognosia, it typically must be diagnosed by a healthcare provider. It can be challenging to diagnose anosognosia when patient insight is compromised and self-report of behavior may not be accurate. Professionals must be able to differentiate between a person’s decision to deny symptoms rather than their honest lack of awareness of symptoms.³

A doctor may diagnosis you as having anosognosia with one or a combination of these methods:

• “LEAP” Method: This is a method of communicating with a person and building trust in order to move towards treatment. LEAP is an acronym for Listen, Empathize, Agree, and Partner.⁴
• SUM-D – Scale to Assess Unawareness of Mental Disorder: This is a 74-item scale that assesses awareness of having an illness, comprehending treatment is needed, recognizing the social significance of mental disorders, being aware of one’s symptoms, and the attribution of symptoms to the disorder.⁵
• Physical exam: A physical exam may be needed to assess the presence of symptoms that a person denies exist. The physical exam provides objective information to the medical provider.
• Neurological exam: Neurological exams provide insight into how the brain and nervous system are functioning and this can provide information about which the patient has no knowledge.
• CT scan: This scan allows the professional to check for structural brain abnormalities and assess the gray matter of the brain which can help determine the cause of anosognosia.
• EEG: This test measures the activity going on in the brain. The test is conducted by placing electrodes on the scalp which measure brain activity.
• MRI: These tests are helpful in assessing the structure of the brain in more detail than a CT.

Causes of Anosognosia

Anosognosia can be caused by a variety of things including illness, brain injury, and other stressors on the brain. Mental illnesses, including schizophrenia, can lead to inaccurate thoughts and beliefs.⁶ Bipolar disorder and depression also can sometimes involve anosognosia. Physical illnesses, including strokes, and other diseases that affect the brain can also lead to anosognosia.

Anosognosia may be caused by:

• Schizophrenia: This disorder is caused by a disturbance of neurotransmitter activity that affects function of many regions in the brain.
• Bipolar Disorder: This mood disorder causes episodes of extreme depression and mania.
• Alzheimer’s Disease: Anosognosia is very frequently seen in Alzheimer’s disease and this is due to impaired memory and thinking skills. This is why someone with this disorder may deny the presence of any symptoms.
• Strokes: When a person suffers a stroke, damage that is done to the right hemisphere can impair a person’s ability to recognize parts of their own body. All of these factors can contribute to anosognosia.
• Dementia: Anosognosia is extremely common in people with dementia. Individuals may be unable to remember facts about themselves or acknowledge their symptoms.
• Depression: While there is no clear relationship between depression and anosognosia, it appears that depression can occur in those who have dementia, Alzheimer’s Disease, or post-stroke.
• Huntington’s Disease: This is a progressive disease that affects a person’s thoughts, feelings, and movement. Due to its effect on the brain, anosognosia can develop as a result of this disease.

The underlying causes of anosognosia include:

• Brain damage:  Anosognosia is a result of compromised brain functioning. This can result from strokes, seizures, epilepsy, tumors, lack of oxygen to the brain, traumatic brain injuries, and infections in the brain.
• Degenerative diseases: In diseases that affect the brain’s functioning, anosognosia can result. The area of concern is the frontal lobe where self-reflection and the ability to update self-image are located. When these areas are damaged by degenerative diseases, including dementia, schizophrenia, bipolar disorder, and Alzheimer’s disease, anosognosia is a frequent complication.

Treatments for Anosognosia

While there are no specific treatments that are designed to treat anosognosia, there are some treatments designed to treat the disorders and diseases that are the cause of the disorder. Thus, the methods used to address and minimize the disruption of the symptoms of anosognosia vary based on the condition that is responsible for it. In some cases, medication can be helpful and in other cases, psychotherapy is a useful adjunctive treatment.

Medications

Due to the variety of disorders and diseases that lead to anosognosia, there is no single medication that is effective for all cases of anosognosia. Individuals who have schizophrenia or other disorders that are marked by psychotic episodes are typically prescribed antipsychotics. While these may not directly address the presence of anosognosia, they can help manage the symptoms of the mental disorder.

If a person’s primary disorder is depression, they will be prescribed antidepressants. However, in cases where psychotic episodes occur alongside depression, treatment will include both antidepressants and antipsychotics, such as olanzapine or quetiapine. In bipolar disorder, medications may include mood-stabilizing drugs, antidepressants, and antipsychotic medications. Some people need to try multiple drugs or drug combinations before they find the one that is best for them.

Psychotherapy Options

There are several types of psychotherapy that offer support for anosognosia. Cognitive Behavioral Therapy (CBT) can be helpful in reframing and revising negative beliefs. Cognitive Enhancement Therapy (CET) helps support cognition/thinking and functioning in individuals with schizophrenia   Motivational Enhancement Therapy (MET) doesn’t cure anosognosia but it is used to help someone be more willing to follow treatment protocol.

Here are treatments that show some promise:

• CBT: Cognitive behavior therapy is helpful in encouraging individuals to replace their negative beliefs with more realistic beliefs. CBT also encourages the reframing of situations in a more positive light.
• CET: Cognitive enhancement therapy uses a variety of methods to help individuals with schizophrenia and other severe mental illnesses increase their cognitive skills including their memories, attention spans, and ability to learn.
• MET: Motivational enhancement therapy is focused on helping a patient be more objective in how they view their behaviors and symptoms. It also can support the reshaping of a person’s self-image so that they can realize the reality of their health situation.

Hospitalization

When symptoms are extreme, hospitalization or in-patient care for the person with anosognosia is an option. The lack of insight and potential for personality change connected to anosognosia can be especially concerning. If a person appears to be a risk to themselves or others, hospitalization may be the most logical treatment to pursue. This will allow them to receive more concentrated therapy, medical care including adjusting medicines, as needed; and round-the-clock care.⁷

How to Help Someone With Anosognosia

Individuals who suffer from anosognosia have little to no insight into their behavior, symptoms, or need for care. Offer them patience and show caring concern. It’s essential to invest the necessary time to understand the feelings and emotions of this person and to be kind in sharing information and concern. Being supportive and empathetic can help the person better understand how to handle communication in a healthy way.

Some ways to help a loved one cope with anosognosia include:

• Being supportive: Recognize that this person is not intentionally denying the presence of symptoms or a disorder; support them in ways that help them manage their symptoms and the negative effects on routine functioning these symptoms may have.
• Keep a diary of symptoms: It’s helpful to maintain a diary of symptoms that provides a perspective over time regarding symptoms worsening or new symptoms appearing or symptoms abating in frequency. This can be used to show their loved ones how they’re being affected by their anosognosia, as well as provide evidence for a doctor or psychiatrist.
• Be empathetic: Recognize that this person’s lack of insight may be anxiety-producing for the person with anosognosia as they learn about their condition or see the results from their behaviors. By empathizing with their feelings, you can be more supportive in ways that matter to them.
• Be nonjudgmental: Many people may be quick to label or condemn the behaviors of someone with anosognosia. It is important to recognize that brain damage or degenerative disease is the cause of their lack of insight and self-awareness; they honestly do not have malicious intentions.
• Focus conversations on achievable goals: Rather than discuss the person’s deficits or challenges, explore the ways that they are capable of changing their life for the better, such as independent living. By breaking down goals into achievable objectives, this may help them see where they need medical or psychotherapeutic support.
• Focus on safety: When someone is committed to the belief that they are not ill, maintain and share compassionately your objective perspective. If safety becomes a concern – the safety of the patient, yourself, or others – additional intervention and support may be needed.

Where to Find Professional Help for Anosognosia

Finding professional support for anosognosia may require care both from a medical professional and a mental health professional. To find a therapist or a physician, you may want to check in with friends and family or your own general practitioner for recommendations. You also might decide to review the therapists within an online therapist directory. Online directors provide valuable information about the types of services offered, modalities, and insurance/payment information.