Impaired awareness of illness is a strange thing. It is difficult to understand how a person who is sick would not know it. Impaired awareness of illness is very difficult for other people to comprehend. To other people, a person’s psychiatric symptoms seem so obvious that it’s hard to believe the person is not aware he/she is ill.
What is impaired awareness of illness?
Impaired awareness of illness means that the person does not recognize that he/she is sick. The person believes that their delusions are real (e.g. the woman across the street really is being paid by the CIA to spy on him/her) and that their hallucinations are real (e.g. the voices really are instructions being sent by the President) Impaired awareness of illness is the same thing as lack of insight.
How big a problem is it?
Many studies of individuals with schizophrenia report that approximately half of them have moderate or severe impairment in their awareness of illness. Studies of bipolar disorder suggest that approximately 40 percent of individuals with this disease also have impaired awareness of illness. This is especially true if the person with bipolar disorder also has delusions and/or hallucinations. This condition also occurs in some individuals with strokes, brain tumors, Alzheimer’s disease and Huntington’s disease.
Is impaired awareness of illness the same thing as denial of illness?
No. Denial is a psychological mechanism which we all use, more or less. Impaired awareness of illness, on the other hand, has a biological basis and is caused by damage to the brain, especially the right brain hemisphere.
Can a person be partially aware of their illness?
Yes. Impaired awareness of illness is a relative, not an absolute problem. Some individuals may also fluctuate over time in their awareness, being more aware when they are in remission but losing the awareness when they relapse.
Are there ways to improve a person’s awareness of their illness?
Studies suggest that approximately one-third of individuals with schizophrenia improve in awareness of their illness when they take anti-psychotic medication. Studies also suggest that a larger percentage of individuals with bipolar disorder improve on medication.
Why is impaired awareness of illness important in schizophrenia and bipolar disorder?
Impaired awareness of illness is the single biggest reason why individuals with schizophrenia and bipolar disorder do not take medication. They do not believe they are sick, so why should they? Without medication, the person’s symptoms become worse. This often makes them more vulnerable to being victimized and committing suicide. It also often leads to re-hospitalization, homelessness, being incarcerated in jail or prison and violent acts against others because of the untreated symptoms.
Note: With education, support, empathy, and the ability to communicate with the person who has impaired awareness of illness, there is HOPE.