Anosognosia: Is Denial a Mental Disorder?

When someone rejects a diagnosis of a mental disorder, it’s tempting to say they’re in denial.

But someone with a severe mental illness may not be clear-headed enough to even choose to deny their condition, let alone understand what they’re going through. They may instead be experiencing a lack of insight into mental illness versus denial of mental illness. People like this are otherwise referred to as anosognosiacs. But what is anosognosia in the mental health world? Is denial a mental disorder?

What Is Anosognosia?

To be clear, denial is not a mental disorder; however, people often mistakenly believe that anosognosia is denial. Also referred to as anosognosia psychosis, anosognosia is a Greek word that roughly translates to “without knowledge of disease” or “lack of insight.” This word is often used to describe people who are not denying mental health problems but are rather unaware of their condition.

Many people with severe mental conditions like bipolar disorder and schizophrenia struggle with anosognosia, which is often why they don’t take their medications. One study on anosognosia in people with schizophrenia and bipolar disorder sampled 412 people and found that approximately 30% of the ones with schizophrenia and 20% of the ones with bipolar disorder experienced a “severe” lack of self-awareness of their diagnosis.¹ Mental illness denial is very different from a lack of understanding or insight into your condition.

As a mental therapy center in Florida, we understand how difficult it is to treat and care for patients with anosognosia. While a misdiagnosis of a mental illness can complicate matters, the situation becomes equally as difficult if the individual is simply unaware of their condition. Learning to understand this condition is crucial for ensuring affected individuals get the help they need.

What Causes Anosognosia?

Some experts believe that anosognosia is caused by brain damage in certain regions of the brain involved with self-reflection. The frontal lobe of the brain is responsible for functions like memory, emotions, impulse control, problem-solving, socializing, motor function, and of course, self-reflection and image.

Regardless of your age or status, your self-image is constantly being updated. Whenever you gain new information – whether it’s a new haircut or weight changes – it affects how you think about yourself. As you can imagine, this is a never-ending, complex process. For this process to go smoothly, the frontal lobe of your brain has to absorb the new information, process it, and use it to basically “edit” your self-image.

When the brain’s frontal lobe is damaged, which is a common issue in people with conditions like schizophrenia and bipolar disorder, your self-image is affected. Your brain can no longer absorb and process new information to update how you see yourself. For a person who requires schizophrenia or bipolar disorder treatment, this can be a hindrance to their recovery.

However, anosognosia isn’t an either-or condition. Some people only partially lose the ability to see themselves clearly, and in others, the condition comes and goes. This can be especially confusing to loved ones who are trying to help. It’s hard to understand how someone can completely understand their condition in one moment and then claim they’re perfectly fine in the next. That’s why people are always comparing anosognosia vs denial.

Identifying Anosognosia Symptoms

Why it Matters

Being able to recognize anosognosia in a loved one is important. When someone with a serious mental disorder insists that they’re perfectly fine or aren’t as sick as they’re believed to be, the situation can quickly spiral out of control. When a person with a mental disorder develops anosognosia, they may not take their medications or complete their treatment. In their head, they’re thinking, “Why would I take a drug if there’s nothing wrong with me?”

As a result of not taking their medication, their symptoms may come back or get worse. Depending on their condition, they may begin to suffer from episodes of psychosis, mania, depression, or even engage in risky or reckless behaviors. Homelessness, arrest, and even suicide become more likely risks, as well.

Symptoms

The most notable symptom of anosognosia is a lack of understanding, awareness, or acceptance of your condition. It’s even possible for you to develop this condition even if there’s extensive evidence that you do.

Some other signs of anosognosia include:

• Bluntly acknowledging that they think they’re fine or that nothing is wrong with them
• Avoiding talking about their condition because they think no one believes them
• Becoming frustrated or confused when people contradict what they believe to be true
• Missing appointments or treatments with their physicians or therapists
• Skipping or forgetting to take their medication
• Acknowledging some symptoms of their conditions, but not others

Remember that anosognosia isn’t an all-or-nothing condition but rather a spectrum that people can move back and forth on. Therefore, it’s important to pay attention to the person’s behavior. While you may think that they’re just trying to ignore their condition to cope, they may actually believe that they’re fine when they aren’t. Be sure to communicate with them.