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Do you live with someone who isn’t aware of his or her mental condition: it might be anosognosia. You may be familiar with the symptoms of this condition without understanding that it is related to a brain injury and mental illness. I knew my son, Josh, suffered from from a lack of awareness: there was something wrong with his thinking. But, even as a physician, I was unaware that there was an official term for his condition.

I recently learned the term anosognosia through a friend of mine who spent her working life in the brain injury rehabilitation work field.

When we talk about anosognosia in mental illness, we mean that someone is unaware of their own mental health condition or that they can’t perceive their condition accurately. Anosognosia is a common symptom of certain mental illnesses, perhaps the most difficult to understand for those who have never experienced it.

National Alliance Of Mental Illness

What Causes Anosognosia?

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.

Early studies of anosognosia indicated that approximately 30% of people with schizophrenia and 20% of people with bipolar disorder experienced “severe” lack of awareness of their diagnosis. Treating mental health conditions is much more complicated if lack of insight is one of the symptoms. People with anosognosia are placed at increased risk of homelessness or arrest. Learning to understand anosognosia and its risks can improve the odds of helping people with this difficult symptom.

What does the condition of anosognosia look like

Someone with anosognosia has a lack of awareness. He/she may appear to be stubborn or just in denial, but that is too simple an excuse. It may be infuriating or baffling for loved ones to consider, or accept, that their loved ones’ brains simply cannot process the fact that their thoughts, moods, and insights do not reflect reality. It can be an intermittent issue as well; some days people with anosognosia understand and other days they don’t.

Substance use can cause it

It can be caused by a stroke or other physical brain trauma; both of which can occur during drug use, or as a result of overdose and resultant fall injuries, etc. Sometimes they may have limb ignorance. In mental damage (which also can be caused by a stroke or traumatic brain injury), we see our loved one deny they have this deficit. What are the 7 types of mental illness.

Sufferers of anosognosia don’t think they have a problem

They deny they can’t remember things, or deny that there is anything wrong with them at all. And if they also suffer from bipolar disorder, they can also have anger and impulse control problems. Basically, anosognosia can be manifested by this failure to be aware of a number of specific deficits; motor (hemiplegia), sensory (hemianopia, hemianesthesia), spatial (unilateral neglect), memory (dementia), and language (receptive aphasia). [these specifics taken from Wikipedia).

Insult to the various sections of the brain, and which side, can cause various manifestations of Anosognosia. Treatment is limited by the very lack of awareness the patient suffers from. Why get treated for something I don’t have?

Here are some negative consequences

When added to the many other problems we see in our addicts, the presence of anosognosia can really complicate their lives, our lives, and their ability to improve. If the person has the type of brain injury that leaves them fairly functional, meaning they can live independently, work a bit, and have relationships, then we can see how this issue can negatively affect them and all around them.

They will take jobs that they think they can do, and probably had the credential to do. However, the lack of ability to acknowledge their limitations, coupled with impulse control and potential for anger outbursts, their work life will become a revolving door. They’ll be fired frequently when the boss sees that they can’t do the job they are credentialed for, due to impulse control, and/or arguing and yelling at coworkers. It can be very frustrating for the addict and those trying to remember why they love this person.

There’s no cure or specific treatment for it

As far as I know (again from research for this topic) there is no real cure for this, though probably therapy can help; it’s certainly worth a try, especially if someone goes with them to help remember for them. Or, like my son, who at my suggestion years ago and constant reminders, takes notes on everything because his memory was compromised in other ways from the multiple strokes (one big and a few little). He has very poor short-term memory.

It is stated that there is no long-term treatment for neurological patients, though cognitive therapy(as I mention above) may be useful. The main obstacle to treatment of any kind comes back to the issue of lack of awareness of the problem. If the patient denies anything is wrong, how are you going to get them to treatment? Medications can often be helpful if they will take it, but convincing them to take a medication for something they don’t think they have can be an uphill battle. Therapists have a tool called motivational enhancement therapy (MET) which hopefully can help the patient understand the benefits of changing their behavior.

How can family members cope

What can those of us who are involved with someone in this situation do to cope? Patience, for sure is needed constantly. The desire and willingness to be there for them, and help them. Taking time to take care of ourselves is mandatory. Taking part in various support groups can give us the experience of others in our situation, a shoulder to lean on, others to bounce ideas off of, and potentially other resources for both us and our loved one. One hour at a time, one day at a time, and if you are so motivated: lots of prayer!

Check out What Are the symptoms of a mental illness

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Gail Dudley, D.O.
For more than twenty years Gail Dudley had a busy family practice with a hospital and nursing home component. Gail also obtained a MHA (Masters of Healthcare Administration) and completed a one-year health policy fellowship. Dr. Gail has worked in quality assurance and utilization review, hospice practice, and now works full time for a company that has contracts with Medicare and Medicaid to evaluate fraud, waste and abuse in the medical world. Gail describes herself as “a child from an abused childhood who ultimately decided to get ahead in life rather than remain a victim.” She became “a classic over achiever to make up for the losses and pain that accompany an abusive childhood as the daughter of an alcoholic.” The ex wife of an alcoholic and the mother of a son who has been struggling substance use since the age of 12, Gail is deeply familiar with the family disease of addiction. She is also the mother of a high achieving daughter. Gail is delighted to add her voice to Reach Out Recovery both as a medical professional and a mother who has experienced addiction from every aspect. "As someone surrounded on all sides (personal and professional) by addiction issues, I always try to help whenever and wherever I can."

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