Schizophrenia Symptoms: Anosognosia

by Christina Bruni Patient Expert

This SharePost inaugurates a new series with a focus on schizophrenia symptoms.

Here I will give a detailed analysis of anosognosia, or the lack of awareness that you have an illness (also observed in stroke victims and in bipolar.)
It's one of the hidden symptoms not often talked about, yet is a real symptom, frequently more disabling than the others.

For nearly 15 years, the DSM has recognized anosognosia as a symptom of schizophrenia: first in the DSM IV-TR (p. 304) and now in the DSM V (p. 101).

According to Dr. Xavier Amador, Ph.D., the leading expert on the topic:

"Schizophrenia has multiple causes and results in many different kinds of damage to the brain.
So some patients develop hallucinations while others don't.
Some have flat affect and hallucinations but no delusions.
Yet they all have schizophrenia.
The same holds true for anosognosia.
That said, we have more data on the likely underlying brain dysfunction responsible for anosognosia than we do for any other symptoms of schizophrenia (including hallucinations and delusions, of which there are only a handful of studies)."

Dr. Amador is clear:

"Anosognosia, like delusions and hallucinations, emerges in the first episode.
Unlike some positive symptoms it remains more stable across the course of the illness, much like negative symptoms.
Delayed treatment does not cause anosognosia: all first episode studies find the same rate of unawareness as found in studies of chronic patients who had long duration to first treatment (about 50%)."


"Early treatment is very important, but it does not protect against anosognosia.
To overcome the barriers to treatment that anosognosia causes one needs to intervene with LEAP and like approaches-accept the person's point of view and work with it instead of against it."

You can visit the LEAP Institute Website to obtain free information about LEAP (Listen-Empathize-Agree-Partner).

Some facts about this little-known symptom:

50 percent of the individuals diagnosed with schizophrenia are estimated to have anosognosia.

Just as heart victims suffer an attack, upwards of 50 percent of individuals that are psychotic have a little known symptom: Anosognosia, the lack of awareness that you have an illness, is the root of the lack of insight that causes people to believe their delusions are true.

After all, they're not sick and don't need help: the problem is the CIA has implanted a computer chip in their brain.
This belief makes perfect sense to a person afflicted with anosognosia.

Dr. Amador wrote the classic guide to helping a loved one get treatment and stay in treatment: I Am Not Sick, I Don't Need Help (Vida Press, 2010).
In it, he documents over 15 research studies that link anosognosia to frontal lobe lesions in the brain.

Anosognosia is caused by frontal lobe lesions in the brain.

The areas of the brain that appear ruptured in individuals with anosognosia are the medial frontal lobe (including the anterior cingulate), and insula, and the inferior parietal lobule, especially on the right side.
These areas are part of the brain network involved in the schizophrenia disease process, according to E. Fuller Torrey, M.D., author of Surviving Schizophrenia (6th edition, December 2013).

Lack of awareness is one of the greatest barriers to treatment.

Lack of insight is the single greatest cause of the need for involuntary hospitalization and medication, the "revolving door" or "frequent flier" syndrome.

The catch is some individuals with schizophrenia have complete awareness of their illness, others have partial awareness and a significant number have no awareness.
It depends on the specific brain areas affected for that person.
In times of remission, a person could have good awareness.
In a relapse, he might not be aware because he is symptomatic.

The LEAP technique can often be used to help your loved one agree to get treatment and stay in treatment.

For detailed information on the LEAP (Listen-Empathize-Agree-Partner) technique used to combat a person's resistance to treatment, log on the LEAP Institute Website.
The Institute helps families help their loved ones get and stay in treatment using the LEAP technique.

It's unbelievable, yet most professionals deny or are unaware of the existence of anosognosia in their patients.
A number of anti-psychiatry and anti-medication therapists don't think anosognosia exists at all even though research studies prove it's a real medical condition.

Your loved one's treatment team might not be aware of anosognosia.

You need to ascertain that your loved one's treatment team is skilled in using techniques to combat anosognosia, like LEAP and motivational interviewing.
Motivational interviewing is an interaction where the provider or family member gets the patient to articulate his own goals and his role in changing what he sees as the problem.

Obviously, arguing with your loved one and trying to convince him he's sick isn't going to work.
You've tried it before and it hasn't worked so trying again and again isn't going to be effective either.

Using LEAP and motivational interviewing are techniques that could help when you remember a person will agree to take medication, even though he doesn't think he's sick, if he can see that doing so provides relief from what he's

articulated is the problem.

Professionals must assess the level of anosognosia to develop the most effective treatment plan.

Dr. Amador has suggested psychiatrists and other mental health staff routinely assess whether their patients have anosognosia in order to create the most effective treatment plans.
The first line of defense might be an LAI, or long-acting injectable drug, as opposed to pill form, for a person experiencing anosognosia.

Until there's a cure for this hidden symptom, it's here to stay.
Those of us cursed with a lack of insight deserve better treatment.
The time is now for professionals and family members to get wise about anosognosia.

I've clued you in: you can pass this knowledge on.

Christina Bruni
Meet Our Writer
Christina Bruni

Christina Bruni wrote about schizophrenia for HealthCentral as a Patient Expert. She is a mental health activist and freelance journalist.