Do People With Schizophrenia Know They Have It? Understanding Anosognosia

Schizophrenia is a complex and severe mental illness that can significantly impact a person’s ability to function. While the condition can often be managed effectively with proper treatment, it is not uncommon for individuals with schizophrenia to experience anosognosia, which generally refers to not being aware of their mental illness. If you’re a caregiver for someone with schizophrenia or have a loved one who lives with the disorder, it may be helpful to educate yourself, communicate empathetically, work toward common goals, connect them with their treatment team, and ensure their health and safety. You may also wish to prioritize your own mental health by working with a mental health professional.

Do people with schizophrenia know they have it?

While many individuals with schizophrenia are fully aware of their condition, studies have found that between 57% and 98% of schizophrenia patients may experience poor insight with regard to their diagnosis, a phenomenon known as anosognosia. This can mean that they aren’t aware that they have schizophrenia or that they don’t understand its severity. 

Anosognosia may not be static. Sometimes, a person may be aware of their condition and able to communicate lucidly about it, while at other times, their symptoms may limit their ability to self-reflect. 

Anosognosia can have significant implications for those living with schizophrenia, as it may affect medication conformity, treatment engagement, and social function. 

What is anosognosia?

Anosognosia generally refers to a lack of awareness of one's own condition. It can be a common characteristic of schizophrenia and schizoaffective disorders, and it can also be the result of neurological damage stemming from a stroke, brain injury, or dementia.

Typically, individuals with anosognosia are not simply in denial about their condition out of stubbornness or fear. Rather, the phenomenon is believed to be caused by damage to or dysfunction in specific parts of the brain responsible for self-awareness. 

Signs of anosognosia can include the following:

• Complete or partial unawareness of one's mental health condition
• Confusion when confronted with evidence of their diagnosis
• Outright rejection of their diagnosis
• Refusal to comply with treatment plans
• Not recognizing changes in behavior, mood, or cognitive function related to their condition
• Frustration or anger when the condition is mentioned

There is currently no treatment specifically for anosognosia. For caregivers and clinicians, the focus is usually to work with the individual to treat the underlying condition. 

Understanding anosognosia and schizophrenia

Anosognosia is thought to occur alongside schizophrenia due to the way schizophrenia affects the brain’s frontal lobe, although updated research may be necessary. The frontal lobe is generally responsible for many functions related to self-awareness, judgment, planning, and problem-solving. 

Schizophrenia can impair the frontal lobe's ability to process information correctly, potentially leading to difficulties in understanding one's own condition or the need for treatment.

For this reason, family and social support often play a major role in helping individuals with the condition manage their illness. Anosognosia can cause significant complications surrounding medication adherence and lifestyle choices. Without a strong support system, people with schizophrenia may be at a higher risk of negative outcomes, such as hospitalization, homelessness, and legal issues.

Anosognosia vs. denial: Knowing the difference

If you know somebody who seems not to acknowledge their condition, you may wonder whether they genuinely lack insight, or if they might be using denial as a defense mechanism. There may be a few ways to differentiate between the two.

• Anosognosia is typically characterized by a consistent lack of awareness, whereas denial is often selective or situational. 
• When confronted with evidence of their condition, a person with anosognosia may express genuine confusion rather than defensiveness. 
• Anosognosia often appears alongside other neurological issues, such as cognitive impairments or inconsistencies in understanding other aspects of reality. 
• Denial is often emotionally charged, while anosognosia may present without apparent emotional distress. 
• A person in denial may offer alternative explanations for their symptoms or rationalize their behavior in ways that align with an underlying awareness of their condition.

Addressing anosognosia: Practical tips and strategies

Whether you are the caregiver of a person with schizophrenia, play a supportive role in their life, or encounter the condition in your job duties, it can be helpful to understand how to help someone who is unaware of their condition. 

1. Build trust with empathetic communication

You might start by establishing yourself as a trustworthy person with respectful, kind, and non-judgmental communication. It may not be helpful to try to convince them that they have schizophrenia. Rather, it may be more effective to show empathy for any distress they are experiencing.

Consider asking them questions about what they are thinking or feeling. Not only can this help you establish trustworthiness, but it might also give you some actionable insights. Try to maintain truthfulness, as deception can upset the individual and fracture the relationship. A foundation of trust can create an environment in which the person is receptive to help, even if they do not fully recognize their illness.

2. Establish common goals

Try to establish and work toward common goals that focus on the individual's overall well-being and quality of life, rather than directly confronting the concern of schizophrenia or their lack of awareness about it. This could be as simple as improving daily routines, or, in an acute mental health crisis, getting to a place where the person’s basic needs can be addressed.

3. Ensure their health and safety

Those with schizophrenia may be more vulnerable to situations or circumstances that jeopardize their health and safety. As such, those in supportive roles can monitor them to keep them safe and maintain their physical well-being.

This could involve setting up systems to ensure a safe living environment, encouraging treatment conformity, and implementing an emergency plan in case of a mental health crisis. 

4. Connect them with their treatment team

Connecting with the person’s treatment team can help ensure they get the support they deserve. This may involve reaching out to their emergency contacts, calling a local crisis intervention team, or working directly with the clinicians, social workers, and other professionals involved in their care. 

5. Educate yourself

Supporting individuals with schizophrenia—whether day-to-day or during times of crisis—can be complicated and overwhelming at times. However, it can be helpful to educate yourself about the condition and learn some best practices for managing it. Consider these resources:

• Supporting a Loved One with Psychosis by the National Alliance on Mental Illness (NAMI)
• Responding to Persons Experiencing a Mental Health Crisis by the International Association of Chiefs of Police (IACP)
• First-Episode Psychosis and Co-Occurring Substance Use Disorders by the Substance Abuse and Mental Health Services Administration (SAMHSA) Publications and Digital Products

Caring for someone with a mental illness can be challenging

Practice self-care with online therapy

Psychotherapy for caregivers

Schizophrenia can place significant stress on caregivers, families, and support systems, particularly when the person with the condition is unaware of it. This stress can jeopardize one’s own mental health, potentially leading to burnout and other mental health conditions. As such, those in supportive roles may benefit from mental health support.

Psychoeducation can be an effective intervention for caregivers, while therapies like CBT can be helpful for learning effective self-care and coping strategies. 

For convenient, accessible, and affordable mental health care, it may be worth considering online therapy through a platform like BetterHelp. Online therapy may be a particularly valuable resource if your caregiving responsibilities make it challenging to leave the house. 

Research suggests that online therapy is just as effective as in-person therapy, and it may be able to treat a wide range of mental health concerns, including stress, burnout, anxiety, depression, and more. For those who may struggle to balance caring for their own needs alongside those of others, online therapy may be a way to prioritize self-care and receive professional support.

Takeaway

People with schizophrenia do not always know that they have the condition, a phenomenon generally known as anosognosia. Anosognosia is thought to be caused by the neurological effects of schizophrenia, which can affect the parts of the brain associated with self-awareness. This phenomenon can complicate treatment, making it important for those in supportive roles to implement systems and strategies aimed at ensuring the health and safety of the individual with schizophrenia. If you need help balancing your own mental health needs with those of your loved one, consider connecting with a licensed therapist online or in your local area.