Anosognosia is a lack of ability to perceive the realities of one’s own condition. It’s a person’s inability to accept that they have a condition that matches up with their symptoms or a formal diagnosis.
It’s well known that many people with a serious mental illness, like bipolar disorder or schizophrenia, don’t take their prescribed medication. One major reason for this behavior is anosognosia, a word of Greek origin that roughly translates to “without knowledge of disease.” You may also hear it called “lack of insight.” What it boils down to is that the person is unaware of their condition and unable to accept it.
Someone with anosognosia isn’t simply in denial or being stubborn. Their brain can’t process the fact that their thoughts and moods don’t reflect reality.
Anosognosia is common in people with serious mental illness. Doctors think about 40% of people with bipolar disorder and 50% of those with schizophrenia have it.
Why It Matters?
When someone with a serious mental illness insists they aren’t sick (or aren’t as sick as others say they are), a dangerous situation could result. Someone with anosognosia is unlikely to take their medication. Why would you take a drug (especially one that might have unpleasant side effects) if you don’t think there’s anything wrong with you?
When this person stops taking medication, their symptoms will usually come back or get worse. Depending on their condition, they might start hearing voices, act recklessly, or become suicidal.
Anosognosia is mainly characterized by following sign and symptoms, which are mainly concerned with behavioral aspects of patients –
• A severe and persistent lack of insight.
• False believe that he/she is not sick, which doesn’t change even without the medical evidence of the disease.
• Strong and consistent denial that he/she needs medical help or treatment.
• Illogical explanation that try to counter the medical evidence.
We constantly update our mental image of ourselves. When we get a sunburn, we adjust our self-image and expect to look different in the mirror. When we learn a new skill, we add it to our self-image and feel more competent. But this updating process is complicated. It requires the brain’s frontal lobe to organize new information, develop a revised narrative and remember the new self-image.
Brain imaging studies have shown that this crucial area of the brain can be damaged by schizophrenia and bipolar disorder as well as by diseases like dementia. When the frontal lobe isn’t operating at 100%, a person may lose—or partially lose—the ability to update his or her self-image.
Without an update, we’re stuck with our old self-image from before the illness started. Since our perceptions feel accurate, we conclude that our loved ones are lying or making a mistake. If family and friends insist they’re right, the person with an illness may get frustrated or angry, or begin to avoid them.
Your doctor may recommend that you see a psychiatrist or other mental health specialist if you or a loved one have been diagnosed with a condition that may be associated with anosognosia.
A specialist may also recognize anosognosia early on. Even small behavior changes can be detected by a specialist.
One common evaluation technique is the “LEAP” method, which is done by:
• listening to the person
• empathizing with the person
• agreeing with the person
• partnering with the person
This method helps open a dialogue between a doctor and the person with anosognosia. This allows the person to develop an awareness of the objective facts of their situation as well as understand that people around them are supportive and understanding.
Another commonly used diagnostic tool is the Scale to Assess Unawareness of Mental Disorder (SUM-D). This test places the idea of “insight” on a spectrum that includes:
• Awareness. Does the person recognize that they have a condition? Do they notice the symptoms of their condition? Do they know that there may be social consequences of their condition?
• Understanding. Does the person realize that they need treatment?
• Attribution. Do they believe that their symptoms result from a mental health condition?
A person’s SUM-D test results may be able to indicate if a person has anosognosia.
Anosognosia isn’t easy to treat. Treatment for anosognosia may vary based on the cause. Common treatments include the following –
▪︎ Antipsychotic therapy
Your doctor may recommend medications known as antipsychotics to treat symptoms of conditions like schizophrenia or bipolar disorder. Some examples of antipsychotics that may be used include –
• chlorpromazine (Thorazine)
• loxapine (Loxitane)
• clozapine (Clozaril)
• aripiprazole (Abilify)
▪︎ Motivational enhancement therapy (MET)
MET uses techniques to motivate someone to either alter their self-image to accept that they have a condition or encourage them get treatment for their condition.
MET often consists of helping someone look at their symptoms, behaviors, and relationships objectively. This often leads to a realization that facts point to the existence of a condition.
▪︎ Support your loved one
Here are a few pieces of advice to help you and your loved ones cope with anosognosia:
• Don’t judge.
Remember that this is a medical condition, not stubbornness or self-destructive tendencies.
• Be supportive.
Some days may be better than others. Even if someone totally loses their perception of their condition, they’re not doing it on purpose. They need your support to make sure they get treatment and stay consistent with appointments and medications.
• Take notes.
Keeping a detailed diary of what the person says and does can help you compile evidence of the condition. This can not only help someone realize that they have anosognosia but also provide your doctor with a basis for a treatment plan.
Someone with anosognosia can be at risk of harming themselves or others. If this is the case, a family member or mental health professional may have to take legal action. Laws vary by state, but you might have to admit someone with a serious mental illness to the hospital against their will.
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