What is Anosognosia & How is it Treated? | Causes, Symptoms and Diagnosis of Anosognosia

Anosognosia is a term used for lack of awareness of mental health. It is a neurological condition in which there is a lack of ability to accept that a person himself has a diagnosis of a particular mental health condition. It can occur alongside various mental conditions and can also affect people who have sustained a brain injury.

Anosognosia affects how a person understands or perceives his mental condition, he also does not take treatment for it. It is observed in studies that anosognosia affects 60% of people with Schizophrenia and 40% of people with bipolar disorder.⁽¹⁾ It may also affect people with dementia and those with damage to certain areas of the brain. About 81% of people with Alzheimer’s disease have some degree of anosognosia.

It is the frontal lobe of the brain that is responsible for controlling a person’s self-image, a mental image a person forms of themselves and which keeps changing constantly. The frontal lobe also organizes any new information and creates an updated narrative. In certain mental health conditions such as Alzheimer’s, Schizophrenia, and dementia, there is damage to the frontal lobe. This leads to anosognosia. Injury to the brain or stroke can also lead to this condition.⁽¹⁾

A frontal lobe not functioning properly can prevent people from updating their self-image to include a mental illness. The perception of self and overall health is not renewed.

Lack of understanding, awareness, and acceptance is the main symptom of anosognosia, even if proof is present. Such people may deny the presence of any medical condition or may even downplay its importance.

Sometimes there may also be a fluctuation in the level of awareness, which means they may sometime acknowledge their condition and show great self-awareness as well and show little or no awareness at all at other times. Other people might mistake this symptom as denial, stubbornness, or fear around a mental health condition, but it is a common symptom of anosognosia.

People with anosognosia may express anger or frustration if people around them make them aware of their illness as it does not match their self-image.

People with anosognosia may refuse medication or treatment as they do not believe they are ill.

To diagnose anosognosia, the doctor questions the person to assess their awareness of their condition. There is an anosognosia rating scale that might be used to measure the level of awareness and how easily a person admits to his illness.⁽¹⁾

A mental status examination is carried out by the doctor that involves grading responses using a medical rating system that may assess certain criteria such as:

• A person completely denying the illness.
• Having slight awareness of the illness and wanting help but still denying it.
• Being aware of the illness but for others and external factors for it.
• Evidence of intellectual insight into the condition.
• A person’s true emotional insight into the condition.

The rating scale helps a doctor differentiate between anosognosia and denial which is a defense mechanism that people may use to respond to a difficult diagnosis.

Anosognosia is a result of physical damage to the brain, which means it is anatomical in origin and denial is psychological. If a brain injury is suspected, doctors may suggest brain scans to see which area of the brain is affected. This can also help in diagnosing anosognosia that may be confirmed if damage to a certain part of the brain is detected in scans.

As anosognosia is a mental health condition, seeking help from a counselor or a psychiatrist after the condition is diagnosed can be extremely helpful. The treatment of anosognosia can depend on the cause of it.

The common treatments are:

Antipsychotic medications are prescribed by the doctor to treat the symptoms of schizophrenia and bipolar disorder. These don’t work the same way for each person. As the cognitive ability changes, different types of antipsychotic remedies might be needed over time.

Motivational enhancement therapy motivates people to alter their self-image and accept that they have a condition. It also encourages them to get treated for the condition.

MET help someone look at their symptoms, behavior, and relationships objectively. It leads to the realization of the existence of a condition.

Anosognosia is a condition that exists with other mental conditions or brain injury. People with anosognosia lack awareness of their condition and also refuse their medication and treatment. It can be treated with the help of vestibular and cognitive therapies along with the assistance of a healthcare professional.