Impaired Self Awareness - Fact Sheet

Lack of self awareness is a common outcome for people with frontal lobe injuries and is related to emotional and personality variables.

They may not recognise disabilities that are obvious to others, and insist they are back to normal. In other cases they may not realise the extent of a disability and believe that others are exaggerating their impairments. They will often exaggerate their own abilities in terms of social skills or emotional control and have unrealistic ideas about the future.

This lack of self-awareness is not denial. Denial involves rejecting knowledge. Where there is lack of self-awareness, there is no knowledge to reject – the individual is, due to their brain injury, simply incapable of understanding their true situation.

Not surprisingly this inability to recognise deficits causes many problems for rehabilitation. The need for rehabilitation services will be questioned and there is often a complete lack of understanding of how their cognitive problems impact upon their relationships with family and friends. People with a lack of self awareness may go back to their job and not understand why they fail in the workplace. They are unable to set achievable goals at work or evaluate their own performance realistically. Understandably this can impair one’s vocational confidence.

Three Types of Awareness Impairment

The Family Takes the Brunt

The impact on the family can be immense. If they confront the family member there can be an angry reaction. At times the family may try to believe nothing is wrong in their desire to see the family member get well even though this could lead to dangerous situations such as driving with a visual impairment. A family should set specific goals that have to be met before the family member can forego medication, treatment or supervision. Ideally this should happen with any rehabilitation professionals involved.

Families should continue to be honest with feedback in a non-judgemental fashion and, when safe, allow someone to try a task even when failure seems certain. The family member should be encouraged to continue with therapy or support even if they say they don’t need it.

It’s your fault, not mine

Another impact on the family is that external causes may be wrongly blamed for problems that develop. Linked with lack of self awareness can be a refusal to own up to having made a mistake. If someone is unaware of their deficits they may actively seek to find explanations elsewhere. A useful strategy is encouraging them to look at a situation from an outside viewpoint and analyse what happened. Ideally a problematic situation could be videotaped to aid this process. The hardest part of being blamed for something is to not take it as a personal insult. Arguing will only worsen the situation so usually it is best to agree to disagree. A common response could be “We both see this from different angles so let’s leave it there”. If blame is a constant problem the whole family should look at adopting the most suitable response along these lines.

Seeking Professional Help

If lack of self awareness is treated professionally the first step is usually a neuropsychological assessment. This will assess the person’s cognitive strengths and weaknesses, specify the impaired awareness and suggest a treatment plan. Usually the family will be included in this process.

There are various psychotherapeutic techniques used to help increase a person’s self awareness. The therapist first gains the person’s trust then gently helps them to see the discrepancy between their perceived level of performance and their actual level of functioning. The next step is normally to help the person anticipate and plan for the problems their deficits may bring about by teaching strategies to deal with them. Treatment methods will vary depending on the type of awareness impairment.

The Long Road to Awareness

Lack of awareness can lead to poor recovery. Family members should be on the lookout for this and seek treatment when required to enhance the quality of life for the family member with brain injury.

Impaired self-awareness can be one of the most frustrating, even infuriating, deficits to encounter in your loved one, and can take the longest time to overcome. It is important to be realistic about this, and to take your of yourselves during this process. With time and commitment, awareness will grow.