If you have ever met a person with a severe mental illness, you may have noticed a struggle to accept their diagnosis. No matter how much the illness affects their behavior, the person is unable to see these changes or consider them important. This inability to recognize and accept one’s diagnosis is called anosognosia.
Denial Versus Anosognosia
Anosognosia is sometimes described as being in denial, but it’s more than that. Anosognosia is a condition that prevents someone from accurately understanding their mental illness. While someone in denial can generally be persuaded by education and evidence, someone with anosognosia does not respond to these things. The condition may improve or get worse over time, which can be frustrating and confusing to people who love someone with anosognosia.
One study estimated that around 30 percent of people with schizophrenia and 20 percent of people with bipolar disorder have a severe lack of insight into their condition, but other estimates place the numbers as high as 57-98 percent. Anosognosia is also common among people with Alzheimer’s and stroke patients.
When Does Anosognosia Occur?
Anosognosia can accompany a number of different conditions, but it is particularly likely to occur with schizophrenia or bipolar disorder. Brain imaging studies have found that an area in the frontal lobe of the human brain, which helps with self-perception, can be damaged by schizophrenia and bipolar disorder; this damage may heighten the likelihood of anosognosia.
What Might Anosognosia Look Like?
Because it can occur alongside different diagnoses, the way anosognosia presents may vary.
- Schizophrenia – Someone with schizophrenia may find it easier to believe that their friends or family members are mistaken, lying, or trying to cause them active harm than to accept that they are suffering from a severe mental health condition. If their loved ones continue to push on the matter, the person may become angry or frustrated, or avoid loved ones altogether. Medication refusal is common.
- Bipolar Disorder – It is very common for people with this condition to stop taking their medications because they decide that they do not need them.
What are the Dangers of Anosognosia?
Lack of proper medication can trigger unsafe, impulsive behaviors and increase risk of suicidal ideation. The resulting behaviors can also increase a person’s risk of homelessness or being arrested. Doctors may also miss the fact that the person is struggling with anosognosia because the person may withhold information, fearing it could lead to hospitalization. For this reason, it can be helpful for medical professionals to work with a client’s close friends and family, who may be able to paint a more accurate picture of what the person has been saying and doing than what the individual will convey to their treatment team.
How is Anosognosia Treated?
The medications used to treat the person’s mental illness are also the most likely way to help them gain insight into their mental health condition. Unfortunately, getting the person to cooperate with taking their medication can be one of the hardest things to do when they are struggling to accept their diagnosis. Instead of trying to convince the person to accept their diagnosis, it may be more productive to ask them about their long-term goals and explain how following medical advice can help them achieve those goals.
Dr. Xavier Amador, a clinical psychologist whose brother suffered from schizophrenia, shares that for the first seven years after his brother’s diagnosis, he continuously tried to persuade his brother that he was mentally ill and needed to be medicated, only to be met with resistance. Once he stopped pushing so hard and started promoting his brother’s own wellness goals, his brother finally became medication compliant and started to get better. He made friends, entered an intimate relationship, got a job, and led a generally fulfilling life.
In the most extreme cases of anosognosia, when a person has become a danger to themselves or others, it may become necessary for loved ones to take legal steps to ensure that they receive treatment in order to avoid negative outcomes like homelessness, arrest, and suicide.
If you would like to learn more about anosognosia and how to help a loved one overcome lack of insight into their own mental health, Highland Hospital in West Virginia is happy to help.
