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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
- Impaired intellectual awareness is where an individual is
unable to understand a deficit exists.
- The second type is impaired emergent awareness where an
individual knows there is a problem but is unable to realise when the
problem is occurring or compensate for the deficits.
- The third type is anticipatory impaired awareness where the
individual is aware of the deficit, can recognise when the problem is
occurring, but is unable to anticipate the likely situations in which the
problems will crop up.
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.
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Impaired self awareness 
