Anosognosia, or impaired awareness of one’s own illness, is a common symptom in patients with severe bipolar disorder and schizophrenia. In some cases, the afflicted individual may not have any awareness that they are ill. As a result of this symptom, patients may believe that their delusions and hallucinations are real. They may not see any impairments in their day to day functioning, even though those around them are having to cope with severe consequences of their lack of motivation, initiative, social skills, or ability to live independently. They may have difficulty with their elevated mood and manic behavior is creating a problem, even though they are spending money they don’t have, engaging in promiscuous sex, or making risky and dangerous life decisions, none of which is characteristic of their behavior when not manic.

How common is Anosognosia?

As many as 50% of patients with schizophrenia, and 40% of bipolar patients, suffer from this condition. Anosognosia is caused by damaged to the right side of the brain.  Anosognosia may fluctuate over time within the same individual, so that they may be more or less aware of their own illness at different points in time. It is important to distinguish anosognosia from denial, which is a psychological defense in which the individual does not want to face the seriousness of their problems because it is too painful to do so.

Anosognosia is the most common reason that patients with bipolar disorder and schizophrenia are not compliant with their medications. It makes sense from the patient’s point of view – if you don’t believe you’re sick, why take medications? Unfortunately, taking medications is one of the most effective ways to decrease these symptoms and increase awareness of illness. Patients with this condition are more likely to be hospitalized involuntarily and to end up in the emergency room as well.

How to Get Help for Anosognosia

If you have a loved one with anosognosia, seek help from a mental health professional at the earliest opportunity. Even if the person with the condition will not seek treatment, help is available for you and your family. A qualified mental health professional can explain the legal and clinical procedures that are available to get help for your loved one even if they do not realize that they need help.

References

Lerner, D.S., and Lorenz, J. Anosognosia in schizophrenia: Hidden in plain sight. Innovations in clinical neuroscience, 11 (5-6), 10-17.

Treatment Advocacy Center Briefing Paper (2005). Anosognosia (impaired awareness of illness): A major problem for individuals with schizophrenia and bipolar disorder.