Anosognosia, denial, and other disorders of phenomenological experience

Clinical neuropsychologists frequently evaluate patients who present with poor self-awareness of their neurological and/or neuropsychological status. Understanding the nature of various disturbances of phenomenological experience may be important for differential diagnosis, psychotherapy, and brain injury rehabilitation. In this paper, an attempt is made to briefly review anosognosia and associated disturbances in phenomenological states. This is followed by a brief discussion of impaired self-awareness (ISA) seen in individuals who have a history of severe traumatic brain injury (TBI). It is suggested that in this latter group, ISA represents a partial syndrome of anosognosia. Extensive rehabilitative work with these individuals further suggests that persons with severe TBI may show both ISA and denial as a method of coping. This paper then discusses briefly the phenomenon of denial and how it may be manifested. Suggestions for measuring ISA, denial of disability (DD) and denial of ability (DA) are then made.