Have you ever met someone with bipolar disorder who insists that they are not sick or who believe that others are the problem instead of them? Maybe you have felt that way yourself. This is not uncommon. In fact, up to 50% of people with bipolar disorder experience a symptom called anosognosia – inability to recognize their own illnesses. Generally, at least one in five people a serious mental illnesssuch as bipolar disorder, they lack the insight to understand that they are ill, According to the Treatment Advocacy Center. This symptom not only affects the person living with it; it also deeply affects their loved ones. Understanding anosognosia in bipolar disorder is key to understanding its cause treatment inconsistency (or directly drug withdrawal) is happening – and how to fix it. Let's take a look at what this means lack of understanding into bipolar disorder and the wide-ranging effects of anosognosia.

Why do people believe they are not bipolar?

There are many reasons why a person may not believe they have bipolar disorder. there is coping skills such as denial and defense that a person does not have bipolar disorder, but they are not the same thing. If a person is simply in denial, they will recognize that their behavior, thoughts, and feelings have changed, but they will not characterize this change as an “illness.” For example, think of a person who is addicted to alcohol. They may realize that they drink more and miss work because of it, but they deny that it is alcoholism. They deny that they need treatment or that it will help.

It's different when a person has a clinical insight deficit known as anosognosia.

What is anosognosia in bipolar disorder?

In serious mental illnesses such as bipolar disorder, anosognosia is essentially a biological lack of understanding. According to the Treatment Advocacy Center:

“Someone with anosognosia may have no idea that there is any change or decline in their mental state, behavior or functioning. Anosognosia is considered the most common reason for non-adherence to treatment for people with severe mental illness.

There are other diseases, such as Alzheimer's, where anosognosia is also common, and it often occurs in those with certain types of traumatic brain injury.

Brain Differences in Anosognosia in Bipolar Disorder

The brains of people with anosognosia are physically different from those who are aware. Yes, anosognosia can often be seen on brain scans.

Most of the research on anosognosia has been conducted on schizophrenics, as it has been recognized for longer in this group and affects approximately 60% of schizophrenics. However, taking our findings together, Below are examples of brain differences in those with anosognosia (no, you don't have to read or understand every word):

• Associated with low opinion smaller prefrontal gray matter volume, higher frontal lobe dysfunction, and poorer memory for autobiographical life events.
• A link has been found between many studies damage or loss of volume in the right hemisphere of the brain and anosognosia. Specific areas of the right hemisphere affected include the inferior temporal lobe, the dorsal lateral prefrontal cortex, and the inferior parietal lobe.
• Less gray matter found in many areas of the brain of anosognosia people such as medial superior frontal gyrus, inferior frontal gyrus, inferior temporal gyrus, cerebellum, left posterior cingulate cortex, right precuneus, cuneus, left superior, left middle and right inferior. temporal gyrus on both sides of the brain, right inferior parietal lobule, right supramarginal gyrus, right anterior cingulate, left posterior cingulate, and inferior temporal region.
• People with anosognosia have been discovered smaller total brain volume, smaller white matter volume, and smaller cortical thickness in many areas of the brain.
• Associations between anosognosia and disorders of brain connectivity, hemispheric asymmetry, and midline brain structuresamong others has been demonstrated.

Although research has found the above, brain scans are not used when dealing with anosognosia. These relationships are not yet at a stage where they can be conclusive on their own.

Why Are Brain Differences in Anosognosia Important in Bipolar Disorder?

All of this is to make a point: people with anosognosia are not the same as those who are in denial. These people have a functionally different brain can't understand that you are sick. This is a clinical lack of understanding. When they deny they're sick, they're as sure of it as I am sitting in front of my laptop. They refuse treatment for good reason – they believe that there really is no disease, and therefore nothing needs treatment.

Anosognosia can kill people with Bipolar Disorder

And here is the essence of the problem. If bipolar disorder were harmless, it wouldn't matter if a person didn't believe they had it; the thing is, bipolar disorder is the farthest thing from harmless. Bipolar disorder is a devastating illness and, if left untreated, can be dangerous to the affected person and those around them. A very recent study noted that longer duration of untreated illness was associated with higher risk of suicide attempt, poorer response to treatment, poorer overall functioning, and more medical and psychiatric comorbidities. In other words, untreated bipolar disorder makes a person even sicker and puts their life at risk.

Treating the 'Non-Sick' Bipolar Person; Treating someone with anosognosia

Trying to help someone with anosognosia can be very difficult because they don't want treatment. If you are in this situation, there is a great book you should read: I'm not sick, I don't need help! How to Help Someone Accept Treatment — 20th Anniversary Edition. This book, by Xavier Amadorprovides you with information about anosognosia and how to deal with it like no other resource. As for persuading someone with anosognosia to seek treatment, I'll leave the details of the technique up to Amador (that's definitely not a one-liner).

Treatment for anosognosia

There are promising treatments for anosognosia. Lack of clinical understanding of a person's illness does not mean that he is doomed to be treated indefinitely.

Treatment options include:

• Early and effective treatment can prevent or reduce anosognosia. Because anosognosia is common in those experiencing psychosis, this suggests that aggressive treatment of these individuals as soon as psychosis occurs is important. Early psychosis programs exist and can help people in this situation.
• Psychological treatments that may help include cognitive-behavioral therapy, motivational interviewing, metacognitive reflection and insight therapy, and mindfulness-based treatments for psychosis.
• Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that can help develop understanding.

Unfortunately, treatment does not help all people.

It may be important to explore treatment options for a person with bipolar disorder and anosognosia, even if the person ultimately agrees to treatment, because anosognosia can lead to treatment noncompliance over time. You are not alone with a person with bipolar disorder to start treatment as well stay treatment to prevent relapsesforced hospitalization, poor psychosocial functioning, aggressionand worse prognosis.

The downside of treating a person with bipolar disorder who has anosognosia

It sounds counterintuitive, but there are actually downsides to gaining insight into your own illness. Think about what it's like to find out you have bipolar disorder. It's not a fun discovery to make. I remember doing it myself and crying endless tears over it. I couldn't imagine a life where I had to take medicine every day. The idea of ​​it was unbelievable. So yes, this kind of discovery can make one feel worse.

It is associated with high-level ideas about a person's illnesses:

And that list, damn it, is far from the list I could give you where a person with untreated bipolar disorder is on the streets, in jail, or even dead. The above list can be treated. Dealing with the ending in prison is a bit more difficult.

Believing one is not ill and anosognosia

I think I've argued that simply denying you have bipolar disorder is not the same thing as anosognosia. And I think I did cognitive development is important in bipolar disorder. I always tell people that you can't fight an enemy you don't understand – and you certainly can't fight an enemy you can't see.

As frustrating as it can be to deal with someone who believes they are not sick, it is empathy that is critical. Remember that it is their illness that makes them believe this. They are not trying to be difficult. They don't argue with you for the sake of arguing with you. They literally cannot see what you are doing. They are blind. you are not Don't get mad at them crashing into lampposts.

That's not to say it's an easy situation – it clearly isn't. Anyone dealing with this needs empathyalso. But read the book I recommend and take a step. Others came up with the idea. Hopefully your loved one can do it too.

Have you or a loved one experienced anosognosia? Share your thoughts below.

Primary Source

1. Silver, S., Sinclair Hancq, E., & Treatment Advocacy Center. (2023). Anosognosia. In Anosognosia. https://www.treatmentadvocacycenter.org/wp-content/uploads/2023/12/TAC_ORPA_ResearchSummary_Anosognosia.pdf

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