Prosopagnosia (Facial Blindness): Symptoms, Diagnosis, And Treatment
Being unable to recognize the face of someone you know or with whom you are familiar is usually referred to as facial blindness, a term for a medical condition called prosopagnosia. Prosopagnosia can be genetic or acquired, and the condition is often distressing for those who live with it. There are two forms of prosopagnosia, and understanding their symptoms and how to receive a diagnosis can be a way to find proper treatment and support. Therapy may help individuals cope with the emotional impacts of experiencing facial blindness.
What is facial blindness?
- Associative prosopagnosia: This condition generally involves being unable to identify others by looking at their facial features, even if a person knows these individuals well. Although individuals with associative prosopagnosia can usually perceive faces, all faces may appear to be the same to them.
- Apperceptive prosopagnosia: With this type of facial blindness, a person usually cannot recognize a person’s face or facial expressions and may fail to cognitively process a person’s face altogether.
With both types of facial blindness, individuals may be able to identify others by their scents, voices, or other distinguishing characteristics.
Prosopagnosia is a medical condition and can be diagnosed when it has a defining cause. Struggling to remember the face of an acquaintance or understand facial expressions may not be prosopagnosia if these difficulties are not severe, frequent, and stem from a specific medical cause.
Other challenges, such as memory loss and neurodevelopmental conditions, may lead to differences in how individuals perceive social information, but these symptoms may not qualify for a diagnosis of facial blindness.
Causes of facial blindness
Face blindness is generally considered to have two causes: genetics and brain damage. Genetic facial blindness is usually called congenital prosopagnosia, and facial blindness stemming from brain damage is normally referred to as acquired prosopagnosia.
Genetics
Although updated evidence may be needed, approximately 2.5% of all people are thought to be born with facial blindness and have difficulty with facial recognition. In these people, the fusiform gyrus area of the brain generally does not function properly and thus does not allow them to respond to faces in the way most people do. This can make it difficult to assign meaning to the faces of people they know. Individuals may inherit this gene from their parents or experience it randomly.
Brain damage or lesions
Acquired prosopagnosia is currently believed to impact approximately one in 30,000 people worldwide. This condition can be caused by an illness, injury, or brain malfunction impacting one’s facial recognition abilities. Conditions that may cause brain injuries or lesions impacting facial recognition can include, but are not necessarily limited to, the following:
- Dementia, such as Alzheimer’s disease
- Brain tumors
- Infections in the brain or spine
- Epilepsy or seizures
- Stroke
- Exposure to toxins
- Traumatic brain injuries (TBIs)
- Concussions
Depending on the cause of brain damage, facial processing difficulties may be reversible, and a person may retain the ability to recognize familiar faces. In addition, facial blindness may exist on a spectrum, with some people experiencing milder symptoms than others.
Does neurodivergence cause facial blindness?
In recent years, popular media appears to have promoted the idea that neurodivergent people, such as those diagnosed with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD), may be more likely to struggle to recognize familiar faces. However, research doesn’t currently support this idea. Autistic people may have trouble accurately reading facial expressions, but this doesn’t necessarily mean that they cannot recognize individuals’ faces altogether.
Some neurodivergent people may also have difficulty picking out faces from a crowd or recognizing acquaintances they’ve only met a few times. However, this difficulty tends to differ from prosopagnosia because it is often situational and may be attributed to other factors, like social anxiety, a fear of unfamiliar situations and people, or a lack of eye contact. People with neurodevelopmental disorders can experience facial blindness, but it is generally caused by genetics or brain damage rather than the neurodevelopmental disorder itself.
How is prosopagnosia diagnosed?
Prosopagnosia can be diagnosed by a medical professional, often a neurologist, as it is generally considered a neurological disorder. When a client comes in for testing, the doctor may ask about their personal and family history and perform a physical examination.
Two tests that may be used include the Cambridge Face Memory Test (CFMT) and a visual acuity assessment. Depending on an individual’s test results, the doctor may order additional tests, such as blood tests, a CT scan, or an MRI scan, to look for acquired prosopagnosia. Genetic prosopagnosia is often diagnosed at a young age, as a parent might notice that their child is unable to recognize them or others.
The mental health impacts of prosopagnosia
Because prosopagnosia usually impacts the way individuals view those they love, the condition can lead to significant mental distress and may be associated with conditions like depression and anxiety.
Relationships may also be negatively impacted by prosopagnosia, as others may not understand why individuals with facial blindness cannot recognize them. Fear related to meeting new people may also occur, as those with facial blindness may struggle to trust themselves regarding whether the person is someone they know or someone new.
Having a healthy support system may be helpful and can reduce stress for individuals with facial blindness. However, some people may also find it advantageous to speak to a therapist. A licensed mental health professional may help them learn coping skills, such as ways to remind themselves of who other people are and how they know them.
Can facial blindness be treated?
Because facial blindness is a neurological condition often caused by severe brain damage or genetics, it is generally not considered “curable.” However, some people with acquired face blindness may find that it is a temporary condition for them, as in the case of a stroke or seizure whose impacts heal over time.
For those with long-term brain conditions like dementia, this condition may not be likely to go away on its own or with treatment. However, mental health treatment can help individuals with facial blindness cope with distressing symptoms and manage daily life more effectively.
Treatment options for facial blindness
Below are some of the most common treatment options that people with facial blindness might try.
Medications or surgery
Prescription medications might be used to treat symptoms of conditions that can cause facial blindness, such as seizure disorders like epilepsy. Treating the overall cause may reduce symptom severity for some people. Always speak to your doctor regarding medication questions and any side effects you experience.
In some cases, a doctor might also recommend surgery to repair brain damage, such as by removing a tumor. However, each case is different, so talk to your neurologist about what might work for you.
Recognition improvement training
Because facial blindness is not considered curable, people often turn to recognition improvement training to learn techniques for identifying people despite being unable to recognize their faces.
For example, they may learn to identify people by the sound of their voice, the way they walk, their hairstyle, or their accessories, like certain glasses or jewelry that the person frequently wears. This technique might not be helpful for everyone, as these aspects of individuals’ appearances can change. However, frequently keeping up with these changes might be helpful.
Loved ones can also make a point to remind the individual of who they are each time they meet. Being empathetic toward the challenges associated with someone’s neurological disorder may reduce any shame and embarrassment they may experience.
Therapy
If you’re living with facial blindness and experiencing mental distress due to your symptoms, you’re not alone. Talking to a therapist may be one way to cope with your condition, learn more about memory strategies, and recognize the people you love using other techniques. If you struggle to access in-person therapy, you can also talk to a therapist online via a platform like BetterHelp.
With an online platform, an individual can meet with their therapist from a familiar environment, like their home. In addition, they can connect with their therapist via phone, video, or live chat, giving them multiple options to enhance their comfort with the therapy process. Having more control over the session may make therapy seem less overwhelming for those with facial blindness.
Studies also show that online therapy can reduce symptoms of common mental health conditions like depression and anxiety, which may be comorbid with prosopagnosia. In a 2018 study, internet-based interventions appeared to be more effective than in-person therapy for reducing depression and anxiety symptoms and increasing quality of life. In addition, the online option tended to be more affordable for participants.
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