How would you describe yourself? Are you caring? Are you a good friend? Are you athletic? Are you outgoing? For most of us, our self-image continually evolves based on feedback from others and the experiences we gain over time. This process happens because our brain’s frontal lobe organizes new information, develops a revised narrative, and remembers the self-image we’ve created. 

Unfortunately, the part of the frontal lobe that creates our self-image can be damaged by mental health disorders or diseases like dementia. When this happens, a person loses the ability to update their self-image to reflect current circumstances. This condition is known as anosognosia, which comes from a Greek expression meaning “to not know a disease.”

What Are the Symptoms of Anosognosia?

Anosognosia is characterized by a lack of awareness or insight into one’s own illness. People with anosognosia may exhibit the following symptoms: 

• Denial of illness-related symptoms. Someone with anosognosia will deny the existence or severity of their condition, even in the face of clear evidence to the contrary. For example, a person who isn’t sleeping due to bipolar disorder may say they’re simply more productive than others and don’t need a full night’s sleep.
• Resistance to treatment or assistance from others. Individuals may resist or refuse medication or other treatment recommendations due to their lack of awareness. They may also refuse help from friends and family because they underestimate how their condition has affected their daily functioning.
• Confabulation. Individuals with anosognosia may confabulate or invent explanations for their symptoms or behavior. These explanations may seem inconsistent or illogical but they serve to maintain the person’s sense of self and autonomy. For example, a person with schizophrenia might say, “The voices and visions I hear and see are real. They’re messages from a higher power guiding me. I’m not sick; I’m chosen for a divine purpose.”
• Lack of concern for safety. People with anosognosia are unaware of the limitations posed by their condition and may engage in risky behaviors or neglect basic safety precautions—putting themselves and others at risk of harm.
• Difficulty planning for the future. Anosognosia can impair a person’s ability to plan for the future or make decisions about their care since they do not fully comprehend the long-term implications of their condition.

Are Some People More Vulnerable to Developing Anosognosia?

Anosognosia is most often associated with the following mental health conditions and neurological disorders:

• Schizophrenia. Anosognosia can occur in individuals with schizophrenia, particularly in cases where the illness is severe or treatment resistant. 
• Bipolar disorder. In some cases of bipolar disorder, especially during manic episodes, individuals may experience anosognosia regarding the impact of their mood swings or the need for treatment. 
• Major depressive disorder. Anosognosia can also be present in people with major depressive disorder, particularly during severe depressive episodes. 
• Traumatic brain injury (TBI). Someone with TBI may not fully recognize the cognitive or physical impairments resulting from their injury, leading to challenges in rehabilitation and adjustment to life after the injury.
• Alzheimer’s disease and other forms of dementia. As these conditions progress, individuals may lose insight into their cognitive decline and memory loss.

What Can You Do When Your Loved One Won’t Acknowledge Their Illness?

If your friend or family member is denying their illness, it’s understandable if you’re feeling frustrated. Here are some tips to help you cope while you continue to encourage them to get the mental health treatment they need: 

• Get the facts. Learn as much as you can about anosognosia and the specific mental health disorder your loved one is struggling with. Understanding the challenges they face can help you approach the situation with empathy and patience. There is a free PDF e-book, “I Am Not Sick” on the NAMI website that you might find helpful. 
• Encourage open communication. Create a safe and supportive environment where your loved one feels comfortable discussing their feelings and experiences. Listen to them without interrupting or dismissing their concerns.
• Offer practical assistance. It’s a great idea to help your friend or family member research mental health treatment options. You can also offer to accompany them to appointments or support groups if they are willing. 
• Avoid stigma. Often, people are reluctant to seek help for mental health issues because they are worried about being unfairly judged by others. Assure your friend or family member that seeking help is a sign of strength and that they are not alone in their struggles.
• Make time for self-care. Supporting a loved one with anosognosia can be emotionally draining, so it’s important to make sure you take time to care for your own mental health needs. Get support from friends, family, or a therapist, and schedule time to engage in activities that bring you joy.

If you’d like to learn more about the treatment options at Raleigh Oaks Behavioral Health in Garner, North Carolina, contact our admissions representatives. We are available 24/7 to answer questions or to provide a confidential, no-cost assessment.