Diagnosing and treating anosognosia, the disorder that hides itself

By Salma Mahmoud | Medically reviewed by Amanda Zeglis, DO, MBA
Published December 22, 2022

Key Takeaways

  • Patients with anosognosia are often unaware of their existing health conditions.

  • Diagnosing patients is possible through talk therapy as well as MRIs, CTs, and EEGs.

  • While there is no cure for anosognosia, there are several treatment options available, including antipsychotics and behavioral therapies.

Anosognosia—the inability to be self-aware—is a common condition in people with certain neurological diagnoses. Due to the nature of the condition, many individuals who have it may not realize they do and will therefore refuse treatment or help.

This condition is common in people who suffer from schizophrenia, bipolar disorder, stroke, Alzheimer's disease, and other neurological conditions that could have resulted from a brain injury or lesion.

For many of these disorders, the frontal lobe is affected, causing anosognosia.

Although there is no cure for anosognosia, there are some treatment options that could help patients with this condition.


The Diagnostic and Statistical Manual of Mental Disorders, 5th edition does not classify anosognosia as a disease on its own but rather as an additional symptom or condition that patients can experience when they have a neurodegenerative disease or a brain lesion.

According to research published by the Cleveland Clinic, almost 80% of people with Alzheimer’s disease have anosognosia, while about 40% of people with bipolar disorder have the condition.[]

In patients who have schizophrenia, between 50% to 98% could be affected by anosognosia. It occurs in nearly 18% of patients who experience one-sided paralysis after having a stroke.

According to an article published by the Treatment Advocacy Center, anosognosia is one of the main reasons why patients with schizophrenia and bipolar disorder do not seek treatment.[]

Related: Can this common class of drugs alleviate cognitive impairment?


Diagnosing anosognosia can be challenging.

Healthcare professionals (HCPs) may need to know that a patient has a serious condition they are not acknowledging or seeking treatment for before considering a diagnosis of anosognosia.

Some patients may try to hide health concerns because their brain isn’t cognizant of these issues and therefore tries to fill in the gaps of what’s missing. However, there are other ways to diagnose anosognosia if the HCP isn’t aware of the patient’s previous condition and the patient isn’t cognizant of it.

If a patient is diagnosed with other conditions that are known to alter brain pathways such as Alzheimer’s disease, bipolar disorder, dementia, Huntington’s disease, or schizophrenia, HCPs may want to refer patients to a specialist who may be able to better diagnose suspected cases of anosognosia.

According to an article published by PsychCentral, a mental health specialist can use the scale to assess unawareness in mental disorder (SUMD) to diagnose a patient with anosognosia.[]

The LEAP (listen, empathize, agree, partner) method has also been shown to be useful in diagnosing anosognosia. In addition to referring patients to a specialist, HCPS can also do physical and neurological exams on them, as well as diagnostic tests, such as CTs, EEGS, and MRIs. 

Treatment options 

While anosognosia has no cure at present, certain treatments have been effective in helping patients, according to research published by Healthline.[]

For example, HCPS can prescribe antipsychotics, such as chlorpromazine, loxapine, clozapine, and aripiprazole. Because these drugs work differently on each individual, patients will have to follow-up closely with their PCP—or their specialist, if they are seeing one.

Other than prescribing antipsychotics, a possible treatment option to consider for anosognosia is motivational enhancement therapy (MET). MET helps patients better understand that they have a condition and should seek treatment for it.

Once patients understand the nature of their disease and symptoms, they can take positive steps toward dealing with those conditions—and may have a healthier outlook on life as a result.

If it becomes evident that a patient has anosognisa, clinicians should talk through the symptoms with them and let them know their treatment options. A strong support system for their patients outside of the doctor's office, as well as maintaining a healthy lifestyle, may also help these patients feel more in control of their lives.

What this means for you 

Anosognsia is a difficult condition to diagnose, so for HCPs, it is important to have conversations with patients, especially those with diseases that commonly coincide with this condition, to see if they could be experiencing it. If a patient has anosognisa, discuss the symptoms and potential treatment options with them. Maintaining a healthy lifestyle, along with your support, may help these patients feel more in control of their lives and leave them with a better outlook on life.

Read Next: Treating patients who are in denial

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