Most people can recognize changes in their physical or mental health as they happen. When they don’t, this may indicate anosognosia.

With anosognosia, there’s a significant difference between how you see your own health and how the world sees it.

Anosognosia can be confusing, both for those who live with it and those who witness it. With a treatment plan in place, though, it’s possible to manage it.

The word anosognosia is Greek for “to not know a disease,” according to the National Alliance on Mental Illness (NAMI).

The term was first coined in 1914 when neurologist Joseph Babinski noticed that some of his patients seemed to be unaware of how their mental and physical faculties had changed after surviving a stroke.

In sum, anosognosia is a neurological symptom of some health conditions that refers to an impaired ability to understand and identify the symptoms you live with.

In other words, you’re not aware of your condition, despite the evidence.

Is anosognosia the same as lack of insight?

Almost, but it’s not that black and white. “Lack” implies that something is missing altogether.

In psychology, insight refers to your ability to objectively observe your own mental health status and make changes and decisions accordingly. This is something you can develop and work on.

Anosognosia actually exists on a spectrum. It can also come and go with time and depending on its causes.

Instead of “lack,” it may be useful to think of anosognosia as your insight being diminished, impaired, or reduced.

Is anosognosia a defense mechanism?

Defense mechanisms, like denial, are the mind’s clever way of protecting you against distress until you’re prepared to handle a difficult situation.

Denial may seem the same as anosognosia, but it isn’t.

When you’re in denial, you may take in information but minimize, dismiss, or avoid it in order to feel safe. You can work through it, and you’re likely to step out of it when confronted with evidence and facts.

Anosognosia, on the other hand, is a neurological symptom that may be caused by anatomical, functional, or structural changes in your brain.

If you or someone you know has anosognosia, there are several signs that may be present.

Perhaps first and foremost, when confronted about physical and mental symptoms, someone may say something like:

  • “That’s not happening to me.”
  • “I don’t need any help.”
  • “What do I need medication for?”

However, this could also happen with denial or even difficulty adapting to a life change.

Other signs may include:

  • confusion or irritation about a diagnosis
  • inability to notice symptoms even when pointed out
  • firm belief that there’s no need for treatment
  • refusing to talk about a condition or symptom
  • stopping medication out of feeling it’s not needed
  • suggesting that people are lying or making it up

Another symptom of anosognosia is varying levels of awareness of the symptoms. This awareness can come and go with time.

For example, one study found that roughly 25% of older adults living with schizophrenia had fluctuations in their awareness about the condition, particularly as they got older.

Researchers have long debated the neurological basis for many conditions, and it seems anosognosia is a thread between several of them.

Some conditions that may present anosognosia as a symptom include:

While researchers still haven’t nailed down the exact cause of anosognosia, some studies suggest that it may be related to deficits in certain regions of the brain, likely the frontal lobe.

Your frontal lobe is responsible for taking in new data, organizing it, then updating your internal “software” to the latest version to reflect that new information. You can think of this system update as your self-image (or self-reflection).

For those living with anosognosia, it’s as if the system update didn’t happen, so your self-image isn’t an accurate or up-to-date representation of what’s happening in real time.

Newer research shows that anosognosia may also have to do with differences in the right hemisphere of the brain, in the case of symptoms of psychosis, or dominance in the left side of the brain, in the case of schizophrenia.

Anosognosia, also referred to as “unawareness of illness,” isn’t considered a condition on its own. Rather, it’s a symptom of an underlying condition, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

Research shows that between 50% and 98% of those living with schizophrenia have anosognosia at some point.

To diagnose it, a mental health professional may use the Scale to Assess Unawareness of Mental Disorder (SUM-D).

The scale would measure three aspects:

  • symptom recognition and awareness
  • willingness to adhere to a treatment plan
  • awareness of the link between symptoms and condition

The “LEAP Method” can also help start a dialogue when trying to diagnose anosognosia. The method is centered around the premise that the therapeutic relationship is more important than winning the argument.

The four tenants to help someone work through signs of anosognosia include:

  • listen
  • empathize
  • agree
  • partner

Living with anosognosia, or having a loved one who lives with it, can be a challenge because it directly impacts the long-term outcome of a mental health condition.

Some studies show that those living with anosognosia may have a harder time following their treatment plan.

For those living with schizophrenia, specifically, older research shows that the more aware you are of your condition, the more likely you are to have a positive outcome in several key areas.

These include:

  • ability to gain employment
  • improved social functioning
  • increased remission of symptoms
  • lowered frequency of symptoms returning
  • reduced possibility of harm (toward self or other people)

That same study found that those with anosognosia are more likely to use emergency services and have involuntary hospitalizations compared to people who are aware of their condition.

Other research shows that anosognosia can also interfere with the therapeutic alliance, the unique bond you share with your therapist. This can impact your treatment progress.

Yes, but treatment choice and outcome are usually linked to the cause of anosognosia.

The front-line treatment for anosognosia is usually a combination of talk therapy and medication.

Psychotherapy

Talk therapy may be effective for regaining some insight into your health status. It may require several sessions with an experienced therapist and it depends on the condition causing the symptom.

Some therapy approaches may be more effective than others.

Research shows that cognitive behavioral therapy (CBT) can help manage anosognosia, particularly when used with motivational interviewing techniques and other modalities based around mindfulness.

Another study suggests that the metacognitive reflection and insight therapy (MERIT) approach can also help you with an eight-step process. This is effective for developing a solid sense of yourself and other people.

Medications

The use of medications will depend on the underlying cause of anosognosia and likely on what other symptoms you live with.

Some studies suggest that drugs like antipsychotic medications may help improve insight when used together with therapy sessions.

The effects of prescription medications vary significantly and depend on many factors. Your doctor or other health professional may have to try different drugs to find the one that works best for you.

If someone you love has anosognosia, you might feel confused, sad, or even frustrated. These are natural reactions to seeing someone you care about not taking care of themselves.

When thinking about ways to support your loved one, consider these tips.

Keep things in perspective

Try to remember that this isn’t something your loved one is choosing. They’re not denying their symptoms on purpose to hurt themselves or you. This is another symptom of their condition.

Be compassionate

Approaching anosognosia in a loved one may require a similar attitude than if they had diabetes, a broken bone, or cancer. It may scare or concern you, but you may also understand that it’s not up to your loved one to heal from one moment to the next.

Compassion and patience are key in supporting them while they work on regaining some insight into their current situation and how they can improve.

Avoid arguments

You may want to document incidents and symptoms for your own reference or to discuss them with a health professional. However, consider not confronting your loved one with these facts, particularly if they become upset when you do.

Remember that their impaired insight isn’t a personal choice.

Suggest family counseling

If you’re facing some friction with the person living with anosgnosia, you may find it helpful to seek professional support.

While a therapist won’t take “sides,” they can help you resolve conflict and make suggestions for treatment options, where appropriate.

Take care of you

For some, trying to navigate anosognosia can be a difficult experience. You may find it helpful to find a therapist so you have a safe place to vent and problem-solve.

Anosognosia is a symptom of some mental health conditions as well as brain injuries. It refers to impaired or diminished insight about your health condition and symptoms.

Anosognosia can impact many facets of treatment, like how likely you are to complete your treatment plan or take your medications.

For the best possible outcome, you may find it helpful to work with a compassionate mental health professional and come up with a plan of action together, which may include a combination of therapy and medications.

While anosognosia is an ongoing condition, there is always hope. The sooner you reach out for support, the sooner you’ll be able to gain clarity around your symptoms and manage your condition.