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Anosognosia

When someone refuses to accept a diagnosis of mental illness, it might be tempting to say they’re “in denial.” However, for someone dealing with severe mental illness, it’s not just a choice to deny it. They may be going through something called “lack of insight” or “lack of awareness.” In medical terms, this is called anosognosia, which comes from a Greek word meaning “to not know a disease.”

Anosognosia in the context of mental illness means that a person doesn’t realize they have a mental health condition or can’t accurately understand it. It’s quite common in certain mental illnesses, and it can be hard to grasp, especially if you haven’t experienced it yourself.

Anosognosia isn’t a fixed thing; it can change. A person’s self-awareness can vary over time, allowing them to recognize their condition at times while being completely unaware of it at other times. When their insight fluctuates, it might seem like they’re denying their condition out of fear or stubbornness, but it’s just a characteristic of anosognosia.

What Causes Anosognosia?
Our perception of ourselves is always evolving. When we get a sunburn, we expect to look different, and learning a new skill can boost our self-image. But this process depends on the brain’s frontal lobe, responsible for organizing new information, updating our self-image, and retaining the new self-concept.
Studies show that conditions like schizophrenia, bipolar disorder, and dementia can damage this part of the brain. When the frontal lobe isn’t working properly, a person may struggle to update their self-image. They stick to their previous self-concept from before their illness, and because it feels right to them, they might think that others are lying or mistaken. This can lead to frustration, anger, or distancing from loved ones.

Research indicates that about 30% of people with schizophrenia and 20% of those with bipolar disorder experience a severe lack of awareness about their condition. Dealing with mental health conditions becomes much more challenging when a lack of insight is involved. People with anosognosia are at a higher risk of homelessness or getting into trouble with the law. Understanding anosognosia and its risks can improve the chances of helping those dealing with this difficult symptom.

Why is Insight Important?
For someone with anosognosia, their inaccurate perception of their condition is as real and convincing to them as your self-perception is to you. These misunderstandings lead to conflicts and increased anxiety. Lack of insight often results in the person avoiding treatment, making it the most common reason for not following prescribed medication plans. Additionally, as it often occurs with psychosis or mania, a lack of insight can lead to impulsive or undesirable behavior.