SUMMARY: Anosognosia is a common symptom of schizophrenia and bipolar disorder with psychotic features. Also called "lack of awareness" or "lack of insight," it has an anatomical basis that has been confirmed in multiple scientific studies. The word itself comes from the Greek word for disease (nosos) and knowledge (gnosis) and literally means “to not know a disease.” It affects approximately 50 percent of individuals with schizophrenia and 40 percent of individuals with bipolar disorder and is the most common reason that individuals with schizophrenia and bipolar do not take their medications. When taking medications, awareness of illness improves in some patients.
* * *
What is impaired awareness of illness?
Anosognosia results from anatomical damage in the brain that impairs the ability to perceive one's own illness. As of August 2012, 18 studies had looked at the relationship between the condition and the brain's anatomical structure . Of them, 15 reported statistically significant correlations between anatomical conditions and anosognosia; three studies did not. The condition is often called "unawareness of illness" or "lack of insight."
For dramatic footage of an accused killer with symptoms of the condition being interviewed, watch our four-minute video, "Anosognosia." Our 2010 NAMI workshop on the condition may also be viewed online at "Confronting Anosognosia: How to Get Help to Those Who Don't Know They're Sick."
How big a problem is anosognosia?
Studies indicate that 50% of individuals with schizophrenia and 40% of those with bipolar disorder report experience moderate to severe impairment in their awareness of illness. Anosognosia in bipolar is most common among individuals whose disorder includes psychotic features.
Is this a new problem?
Impaired awareness of illness in individuals with psychiatric disorders has been known for hundreds of years. Playwright Thomas Dekker in his 1604 play “The Honest Whore” has a character say, “That proves you mad because you know it not.” The term "anosognosia" was first used by a French neurologist in 1914. Among neurologists, unawareness of illness has long been recognized in some individuals with strokes, brain tumors, Alzheimer’s disease and Huntington’s disease. In psychiatry, impaired awareness of illness has only become widely discussed since the late 1980s.
Is impaired awareness of illness the same thing as denial of illness?
No. Denial is a psychological mechanism we all use at times to deflect or reject unpleasant information. Impaired awareness of illness has a biological basis and is caused by damage to the brain. See "Pictures of Anosognosia" for illustrations and a summary of one study into the anatomical basis of the condition. Read Dr. E. Fuller Torrey's essay, "Anosognosia, denail and the new antipsychiatry" for additional information.
Can a person be partially aware of their illness?
Yes. Impaired awareness of illness is a relative, not an absolute, problem. Insight in some individuals may also fluctuate over time, with awareness being heightened during periods of remission but lost during periods of relapse.
Are there ways to improve a person’s awareness of their illness?
Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take antipsychotic medication. Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.
Why is impaired awareness of illness important in schizophrenia and bipolar disorder?
Impaired awareness of illness is the most common reason why individuals with schizophrenia and bipolar disorder do not take medication. They do not believe they are sick, so why should they? Without medication, the person’s symptoms become worse. This often makes them more vulnerable to the consequences of non-treatment, which include arrest, incarceration, homelessness, victimization, suicide and violence.
Additional information about anosognosia is available from the following sources:
- "The anatomical basis of anosognosia" - the first published summary of recent research investigating changes to the brain in individuals with lack of insight into mental illness (August 2012)
- "Anosognosia, denial and the new antipsychiatry" - Dr. E. Fuller Torrey takes on the argument that anosognosia doesn't exist (October 2012)
- "Why we talk about anosognosia" - We talk about ansosgnosia because our mission is eliminating barriers to treatment, and not recognizing ones' own need for treatment is a huge one (August 2012)
- "Anosognosia is blindness - personally speaking" - Dr. David Hager, a practicing psychiatrist, talks about anosognosia in the clinical setting (May 2012)
- "Why individuals with severe psychiatric disorders often do not take their medications" - backgrounder (updated April 2011)
- "How unawareness of illness (anosognosia) increases violent behavior in individuals with serious mental illnesses" - backgrounder (updated March 2011)
- "Confronting anosognosia: How to get help to those who don't know they're sick" - a Treatment Advocacy Center video featuring Xavier Amador PhD, Jonathan Stanley, JD, and Delaney Ruston, MD (2010)