Impaired self awareness
March 22, 2013
Lack of self-awareness is a common outcome for people with frontal lobe injuries and is related to emotional and personality variables.
People with a brain injury may be unable to recognise disabilities they have, even when they are obvious to everyone else. In other cases, they may not realise the extent of a disability, and believe that everyone is exaggerating these impairments. They may 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 person is, due to their brain injury, simply incapable of understanding the true state of things. 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 cognitive problems impact upon their relationships with family and friends. People with a lack of self-awareness may return to work but 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 affect one’s vocational confidence.
3 types of awareness impairment
Impaired intellectual awareness is where a person is unable to understand that a deficit exists. The second type is impaired emergent awareness, where a person knows there is a problem but is unable to realise when the problem is occurring, or to compensate for the deficits. The third type is impaired anticipatory awareness, where the person is aware of the deficit, can recognise when the problem is occurring, but is unable to anticipate the likely situations in which the problem will crop up.
The family takes the brunt
The impact on the family can be immense. If they confront the family member with ABI there can be an angry reaction. At times the
family may try to believe nothing is wrong in their desire to see their loved one 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 treatment or supervision. Ideally this should happen with the involvement of rehabilitation professionals.
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 mistakes and blame other people or external causes. A useful strategy is encouraging them to look at situations 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 very consistent responses.
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 for people whose brain injury has resulted in this condition. 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.
This article is reprinted from Acquired Brain Injury: The Facts, our 62-page guide to living with a brain injury. Pick up a free copy from our office, or visit www.synapse.org.au to order a copy.
This story was first seen in the Synapse bridge magazine www.synapse.org.au
People with a brain injury may be unable to recognise disabilities they have, even when they are obvious to everyone else. In other cases, they may not realise the extent of a disability, and believe that everyone is exaggerating these impairments. They may 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 person is, due to their brain injury, simply incapable of understanding the true state of things. 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 cognitive problems impact upon their relationships with family and friends. People with a lack of self-awareness may return to work but 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 affect one’s vocational confidence.
3 types of awareness impairment
Impaired intellectual awareness is where a person is unable to understand that a deficit exists. The second type is impaired emergent awareness, where a person knows there is a problem but is unable to realise when the problem is occurring, or to compensate for the deficits. The third type is impaired anticipatory awareness, where the person is aware of the deficit, can recognise when the problem is occurring, but is unable to anticipate the likely situations in which the problem will crop up.
The family takes the brunt
The impact on the family can be immense. If they confront the family member with ABI there can be an angry reaction. At times the
family may try to believe nothing is wrong in their desire to see their loved one 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 treatment or supervision. Ideally this should happen with the involvement of rehabilitation professionals.
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 mistakes and blame other people or external causes. A useful strategy is encouraging them to look at situations 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 very consistent responses.
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 for people whose brain injury has resulted in this condition. 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.
This article is reprinted from Acquired Brain Injury: The Facts, our 62-page guide to living with a brain injury. Pick up a free copy from our office, or visit www.synapse.org.au to order a copy.
This story was first seen in the Synapse bridge magazine www.synapse.org.au