When you have a physical injury, you are likely to have physical symptoms that you can observe with your senses. You feel the pain of trying to walk on a broken leg. You may have heard a loud crack as the bone broke. You might even be able to see the bone jutting out at an angle you know is wrong. All of these sensory sensations are able to relay messages to your brain about the injury you are experiencing. What tells your brain that something wrong with it? What if your brain cannot recognize its own sickness? When a person has a mental health disorder but is unable to recognize that the diagnosis is accurate, this is called anosognosia. At Highland Hospital Behavioral Health in Charleston, West Virginia, we help patients and their families to cope with mental health conditions that might be accompanied by this lack of awareness.
Anosognosia Versus Denial
Sometimes people use denial and anosognosia interchangeably. Given how much easier it is to say and describe denial, this is understandable; however, they aren’t quite the same. If a person is in denial and you offer additional education or show them evidence that contradicts their beliefs, they can often come to accept the information you provided. With anosognosia, however, brain imaging studies have shown that the frontal lobe of the brain, which organizes information about how we see ourselves, can be damaged, so even facts are not enough to allow the person to accept that they have a mental health disorder.
This might look like:
- A person believing that their friends, family, and medical team are mistaken, lying, or trying to hurt them by insisting on treatments they don’t need.
- Heightened resistance or avoidance, if their loved ones continue to insist that they get professional support.
- Stopping their medications without talking to anyone, if they don’t agree that the medications they previously agreed to take are actually necessary.
- Complaining about side effects from medications to get providers to discontinue them.
- Heightened risk for suicidality, as previously managed symptoms return in the absence of treatment.
Disorders Often Accompanied by Anosognosia
The mental illnesses that are most difficult for patients to consistently accept are:
- Schizophrenia. Anywhere from 30-75 percent of patients with this disorder may reject their diagnosis, even if it is clear to their loved ones that they are experiencing hallucinations, delusions, and/or paranoia. It’s so common for people with schizophrenia and schizoaffective disorders to have anosognosia that some researchers would like it to be listed as a symptom of the condition.
- Bipolar disorder. About a fifth of patients with this condition are unable to accept their diagnosis, even when presented with evidence of uncharacteristic behaviors they have displayed during mania or depression. Even if they can accept the diagnosis, they may reject statements about the severity and decide they can manage their condition on their own, without medications.
How to Respond to a Loved One with Anosognosia
You can’t force someone with anosognosia to accept their mental illness. Trying will just make you both feel frustrated and could even damage trust between you. Instead, Dr. Xavier Amador, a psychiatrist who specialized in treating schizophrenia due to his brother receiving the diagnosis, recommends the following:
- Listen more than you talk. If you hear them out, you may gain valuable insight into how they view their own situation.
- Reflect what the person has to say about their condition. This will help them to feel respected, heard, and understood.
- Try to see things from their perspective. They are not trying to be difficult or stubborn. They just don’t see the need for treatment.
- Find common ground. Even if the person does not agree that they have the mental health condition, they might be able to agree that they don’t want to be in the hospital or that they are having trouble sleeping. Help them see how the treatment you want for them can help them achieve that goal
- Stay in contact with your loved one’s treatment team. You may be better equipped than the patient to ensure that you and the treatment team have complete information, as patients with anosognosia may not be able to provide accurate details of their symptoms, behaviors, or recommended treatments.
Highland Hospital Behavioral Health is the leading provider of behavioral health services in the region. We strive to offer the right help at the right time for each of our patients. We serve children, adolescents, and adults who are struggling with mental illness and addiction.
