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Anosognosia After TBI: Causes, Symptoms, and Recovery

Daughter trying to explain anosognosia to her stubborn mother

Anosognosia is a disorder that causes difficulties with self-awareness. In particular, it causes a person to not recognize their deficits after TBI.

Today’s article will explain the possible causes and manifestations of anosognosia after TBI. Then, we’ll look at what you and your loved ones can do to cope with this condition.

Causes of Anosognosia After TBI

Anosognosia refers to impaired self-awareness after a stroke or TBI. It is a lack of ability to perceive the reality of your condition. This occurs despite significant evidence of a disability. Even hearing a doctor explain the problem does not usually help the person accept it.

Anosognosia is not simply a result of stubbornness or denial. Rather, it is caused by changes in the brain. Specifically, it is associated with damage to the frontal lobe.

The frontal lobe plays a crucial role in forming our self-image. This refers to the perception we have of our identity and abilities. If the frontal lobe becomes damaged, it cannot absorb new information as easily, or adjust its self-perception.

As a result, the person with anosognosia still retains the self-image they had before their accident. Because their brain cannot adapt to new information, they will deny that anything has changed.

Symptoms and Impact of Anosognosia

Woman holding hand on senior mother shoulder and comforting her. Mother is looking away and refusing to listen because she has anosognosia after TBI


The primary symptom of anosognosia is a lack of awareness or acceptance of a disability. This can manifest in a number of different ways, however.

Anosognosia is most commonly is seen in patients with hemiplegia or left-side neglect.

With left neglect, the person loses all awareness and most motor skills on the left side of their body. However, most patients with this disorder do not realize they have lost vision or movement on their left side, and in fact insist that they feel completely normal.

Anosognosia can also involve cognitive and emotional disorders. For example, many will not realize that they experience extreme mood swings, or that they often display aggressive behavior. If you point out their behavior, they will usually deny that it occurred.

Unfortunately, when a person has anosognosia after TBI, they often refuse to take their medication or continue with physical therapy. This can have a harmful impact on their recovery.

Diagnosing Anosognosia

man in wheelchair discussing problems with his psychologist

Diagnosing anosognosia can be difficult, since it looks so much like classic cases of denial. It can be hard to tell if your loved one is denying their symptoms out of embarrassment or because they truly do not understand their deficits.

That’s why your doctor might recommend bringing a psychologist on board, who can make an accurate diagnosis. A common diagnostic tool that many psychologists use to assess the severity of anosognosia is the SUM-D. This test grades a person’s insight on a spectrum that includes:

  • Awareness. Can the person recognize that they have a disability? Do they notice that they have more difficulty performing certain tasks?
  • Understanding. Do they understand that they require treatment?
  • Attribution. If they recognize their symptoms, do they believe their symptoms are caused by their TBI or something else?

The results of this test can help determine how severe the anosognosia is.

Treatment and Support for Patients with Anosognosia After TBI

Treatment for anosognosia will mainly involve a form of cognitive therapy known as Motivational Enhancement Therapy (MET).

MET is designed to help patients look at their symptoms objectively. It also works to help them understand the benefits of treatment.

However, MET does not always work, especially in severe cases. Fortunately there are other ways to support your loved one with anosognosia after TBI.

1. Be Patient and Don’t Judge    

While it might seem like the person is being stubborn or difficult, try to remember it is not their fault. They truly do not believe that anything is wrong.

That’s why it is crucial to remain patient with your loved one and avoid arguing with them about their condition. If they insist there is nothing different about them, let the conversation drop for the moment.

Trying to force them to admit that they have a disability often just agitates them further. Instead, try talking about goals they might have, such as keeping a job or living alone. This might motivate them to seek treatment later on.

2. Discuss the Effects of Brain Injury

It sometimes helps to offer the person general information about TBI and what kind of difficulties it causes.

For example, instead of saying, “you are forgetful all the time” try saying “people with brain injury sometimes struggle with memory loss. Have you ever felt that way?”

This will make it feel less like a personal problem and will avoid putting them in a defensive state.

3. Link Therapy to Specific Goals

As mentioned above, it’s not wise to bluntly tell the person with anosognosia that they have a problem, since they won’t believe you.

Rather, you should try to link certain goals they might have to physical therapy. For example, if they want to drive again, you can tell them that the only way to accomplish that is to practice their exercises every day.

For patients with more severe cognitive deficits, you can also encourage them to visit their psychologist or physical therapist by offering a concrete reward. Make sure it is something they can see immediate benefit from, such as extra time on the TV.

While your loved one most likely will never admit they need help, these techniques can at least motivate them to get the treatments they need to progress in their recovery.

Living with Anosognosia After Brain Injury

Anosognosia is a difficult condition to treat, since the person afflicted with it often does not realize they need treatment. This lack of therapy can be harmful for TBI patients and can cause their recovery to stall.

It’s important to remember as well that a person’s level of insight can fluctuate. This means that sometimes they might seem to grasp their condition, and then later revert to their previous state of denial.

As frustrating as this is, family members should stay patient. As time passes, their injury will heal, and they should begin to regain more self-awareness.

If that does not occur, talk to a psychologist for more specific advice on managing anosognosia after TBI. While it may be difficult at first, it is possible to help the person seek treatment and continue their recovery from brain injury.

Featured Image: ©iStock/fizkes

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