Imagine for a moment that someone tells you that you have a health condition that you are certain you do not have. This person insists that you have this diagnosis despite the fact that you know they are wrong. On top of this, they want to give you a medication they claim will treat your problem. If this scenario sounds appalling, it may give you some empathy for people who are experiencing anosognosia. At Palms Behavioral Health in Harlingen, Texas, we treat adolescents, adults, and seniors with mental health conditions where anosognosia is often present.
What is Anosognosia?
Anosognosia is a complicated word that just means a person is unable to recognize that they have a condition. It’s more complicated than simply being in denial, which a person can typically move past. Anosognosia generally means that the person lacks insight into their own condition, and sometimes their disorder itself is a barrier to being able to understand that the diagnosis is real. Anosognosia may manifest as:
- A person believing that their friends and family are mistaken, lying, or trying to hurt them by giving them treatments they don’t need
- Increased resistance, anger, frustration, and avoidance if loved ones continue to insist on medications
- Quietly stopping medications they have previously agreed to take because they don’t think the treatment is necessary
- Increased psychiatric symptoms as a result of being off of medications, which could include suicidal ideation, impulsivity, and behaviors that endanger the person’s safety
- A person complaining about side effects of medication as a way to manipulate providers into letting them stop taking it
Self-awareness can fluctuate over time, with a person more able to accept their diagnosis at some points than they are at others. This can be terribly frustrating and confusing to loved ones, as the patient may be able to articulate that they have the condition or symptoms of the condition and be willing to cooperate with treatment at certain times and then utterly refuse treatment at other times.
Who is At Risk?
Anosognosia can impact people with medical conditions as well as mental illnesses. People with certain mental health disorders are more likely to experience this problem:
- Schizophrenia – 30 to 75 percent of patients with this diagnosis struggle to believe their diagnosis
- Bipolar disorder – Around 20 percent of patients with this condition have “severe” lack of awareness of their disorder
Brain imaging studies have found that people with these conditions may have damage within the frontal lobe of their brains, which helps with self-perception. Being unable to accurately perceive themselves may make individuals with these diagnoses particularly prone to anosognosia.
What Anosognosia Means for Medication Adherence
While it may be readily apparent to you that someone you know is struggling with a psychiatric condition, their inability to see themselves as mentally ill is very likely to lead to conflict with their loved ones and professionals treating them. People with anosognosia don’t see the need to complete treatment or take medications because they don’t believe they are sick, so they often don’t do these things consistently. If they are experiencing psychosis or mania, they might even think that the people offering them treatment are dangerous or that the medications being offered will cause them harm.
Treating Anosognosia
The “cure” for anosognosia is to treat the condition the person cannot accept, and this can be a challenge. Instead of trying to convince them directly that they have this condition and should take their medication, it may be more effective to focus on the person’s goals for themselves and how they can achieve those goals by following medical advice.
Dr. Xavier Amador, a professor of psychiatry and psychology, whose brother had schizophrenia, wrote a book to help loved ones support friends and family members with anosognosia. In his book, he recommended:
- Listening to the person more than you are talking to them about their condition, and reflecting back to them what you heard them say
- Focusing on building your relationship with your loved one and showing them empathy
- Finding common ground that you can agree upon, such as the fact that the person is having trouble sleeping or they want to stay out of the hospital
- Trying to see their perspective and why they don’t want to accept treatment instead of seeing their behavior as stubborn or difficult
- Family members talk with the patients’ medical and mental health providers to ensure that complete information is being provided, as patients may conceal the fact that they are engaging in behaviors that could lead to hospitalization
- Partnering with the person around things you agree upon, so that you can join forces to address that concern
At Palms Behavioral Health, we know that it is difficult for family and friends to watch as their loved one struggles. This is why we try to engage loved ones in the treatment process and give them the tools to be strong advocates for their friend or family member who has a psychiatric disorder. We know that relationships are important for our clients and that connection is a powerful recovery tool.
