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Lack of Insight After Brain Injury: Causes and Treatments for Anosognosia

therapist helping brain injury patient deal with lack of insight

Lack of insight, also known as anosognosia, causes significant problems for people suffering from brain injury.

This cognitive deficit may impair a person’s self-awareness about the effects of their injury. In severe cases, the person might not even realize they have any disability at all.

Lack of insight can also have a serious, negative impact on TBI recovery. That’s why it is crucial to learn ways to help your loved one manage their difficulties.

Today you’ll learn the different causes of anosognosia after brain injury, plus some strategies to help the person improve their self-awareness.

Causes of Lack of Insight After Brain Injury

Insight (specifically of one’s own condition) is the ability of a person to recognize, understand, and reflect on their own situation, thoughts, actions, and deficits. After a brain injury, especially an injury to the frontal lobe, this skill is often significantly impaired. When insight is significantly impaired, the person can experience a condition known as anosognosia.

Anosognosia refers to impaired self-awareness of one’s condition, such as 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.

There are several reasons a person’s insight can be lost after a TBI. Some of the most common include:

  • Impaired reasoning. Brain injury makes it more difficult for a person to make logical connections. Therefore, survivors do not always understand the effects their actions will have, or realize their problems are stemming from their injury.
  • Attention and concentration problems. These issues make it difficult for TBI patients to take in new information or notice any changes in their behavior.
  • Impaired memory. Memory problems are common after brain injury, and can cause the person to forget the new difficulties they face.
  • Impulsivity. Many TBI survivors go through phases of being very impulsive, which can cause them to act in unsafe ways before truly thinking through the safety of the action.
  • Emotional problems. Damage to the frontal lobe can make it hard for a person to process and accept the effects of their injury, which can lead to denial.

All of these issues often collide to make a person have limited awareness of their physical, cognitive, behavioral and personality changes after brain injury.

Dangers of Anosognosia After Brain Injury

Because the person does not fully understand the consequences of their injury, lack of insight can be a particularly dangerous impairment.

It can also have a negative effect on the patient’s recovery. For example, if someone lacks the self-awareness to realize how serious their injury was, they often refuse to participate in therapy, believing they don’t need it.

Unfortunately, this can cause them to stall in their recovery, and might even make them regress.

In severe cases, a person with brain injury may be completely unaware of even serious physical difficulties, such as paralysis on one side of their body. This can be dangerous because they may try to get up out of bed or out of their wheelchair on their own, despite not being able to walk independently.

Anosognosia is difficult to treat and usually requires the help of trained therapists. However, less severe forms of this deficit can be successfully managed with the correct strategies.

Tips for Managing Lack of Insight After Brain Injury

The following are a few tips for family members and caregivers to help their loved one’s manage their lack of insight after brain injury:

1. Be Patient     

daughter comforting elderly mother

To help your loved one recover from brain injury, family members must educate themselves on the nature of brain injury.

Understand that even if it might seem like the person is being stubborn or difficult, it’s not truly their fault. Their brain injury has made it difficult for them to understand their own behavior.

That’s why above all 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.

2. Identify the Cause

Figuring out the reason why your loved one struggles with self-awareness can help you determine the best way to approach the problem.

For example, if the primary issue is their attention or memory problems, then cognitive rehabilitative exercises will be crucial. As their memory and concentration improves, their insight into their behavior should as well.

On the other hand, if their problem is more emotional in nature, working with a counselor might help them come to terms with their injury.

3. Talk About the Effects of Brain Injury

Doctor telling patient about lack of insight after brain injury

When the person is in a calmer mental state, try to give them general information about brain injury and what kind of difficulties it causes.

For example, instead of saying, “you are angry all the time.” Try saying “people with brain injury sometimes struggle with their temper. Have you ever felt that way?”

This can make it feel less like a personal problem and won’t put them in a defensive state.

It’s also a good idea to educate new friends on the effects of brain injury, so that they can understand the person’s behavior better.

4. Link Therapy to Goals

People with lack of insight after brain injury often struggle to continue with therapy once they are released from the hospital. They just do not see a value in it.

To help motivate your loved one to continue with therapy, try to relate their exercises to a concrete goal that they can easily grasp. For example, if they require assistance using the bathroom now, help them see how practicing arm, leg, and balance exercise can help them become more independent with toileting again.

Practicing activities that used to be easy for the person but are now difficult can be a good way to help convince them they still need to work on their abilities.

Of course, this is a delicate situation, as you don’t want to agitate or humiliate them. That’s why it is often a good idea to bring along an occupational therapist who knows strategies to keep the person calm.

5. Provide Feedback

TBI patient receiving feedback from daughter to improve self awareness

Finally, it’s important to provide frequent, gentle feedback about the person’s abilities or behavior.

If they want to do something that they are not able to, such as drive, gently tell them that a brain injury makes that less safe. If they still insist, tell them it’s against the law to drive without a doctor’s permission. Most importantly, keep their keys away from them and doors locked to make sure they do not make attempts to drive when it is unsafe.

Once again, do not argue or dwell on their difficulties, as that may only make things worse.

When they make improvements, congratulate them on the progress they have made, but don’t do it in a way that patronizes them. Even with cognitive impairments, most TBI patients can tell if they are being talked down to. Speak to them as an equal.

Dealing with Lack of Insight After Brain Injury

While the advice in this article can get you started on the road to overcoming lack of insight, family members and loved one’s should also make sure to seek professional help.

A neuropsychologist will provide tips that are tailored to the person’s unique situation, and also assist you with your own emotional recovery. This can help you avoid caregiver burnout that is unfortunately common after a traumatic event.

Lack of insight is a difficult cognitive impairment to overcome. But with the right strategies and support, it is possible for a person to improve their self-awareness after brain injury.

  Featured Image: ©iStock/fizkes

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