Schizoaffective disorder is a mental health condition characterized by a combination of psychotic symptoms and mood disorder symptoms. One component that may be present in schizoaffective disorder, and many other mental disorders, is anosognosia.
Anosognosia is a condition where you cannot recognize the health condition that you may have.  This lack of awareness about one’s health condition is often prevalent in patients with schizophrenia, but also affects people with schizoaffective disorder, psychotic depression, and bipolar disorder. 
However, many sufferers of schizoaffective disorder do not experience anosognosia and actively take steps to address their condition.
Are people with schizoaffective disorder aware of their condition?
People with schizoaffective disorder can have varying levels of self-awareness regarding their condition. In this instance, self-awareness denotes a person’s ability to recognize and understand their own thoughts, emotions, and behaviors, as well as their recognition of their own mental health condition.
Those who are self-aware of their condition possess insight into best practices for treatment, are consistent with a treatment routine, and tend to have the best chances of managing their symptoms.
However, those with poor insight into their condition commonly neglect their treatment, relapse frequently, and are at higher risk of behaving violently toward themselves and others. 
Minimizing the impact of psychotic symptoms is central to reducing the negative consequences of schizoaffective disorder on both the sufferers and whomsoever they interact with.  This can be achieved with adherence to a consistent medical treatment plan. However, following a treatment plan is extremely difficult to achieve in patients who do not believe they have schizoaffective disorder. 
Can anosognosia change over time?
While anosognosia can persist for some individuals throughout their lives, it is not an unchanging or permanent state for everyone.
There are instances where individuals with anosognosia may gain some level of awareness and insight into their condition over time. This can be influenced by various factors, including the effectiveness of treatment, engagement in therapy, support from loved ones, and personal experiences.
With appropriate treatment and support, some individuals may experience periods of remission or stability during which they gain insight into their condition. At this time, it is important they intensify their treatment – whether medical, therapeutic, or supportive – to foster greater self-awareness and achieve better outcomes.
That said, anosognosia can fluctuate in intensity and self-awareness can vary over time.  At some times, an affected person may acknowledge their illness, while, at others, they might outright reject it. This can seem like they are being stubborn to loved ones, but it is important to note that variations in awareness are characteristic of anosognosia. 
It is important to remain patient with your loved one if they display the above symptoms of anosognosia because, for the individual struggling, they truly don’t believe in the presence of their condition. Challenging this belief, may result in alienating your loved one from the treatment process.
When loved ones are displaying symptoms of anosognosia, it may be best to steer the conversation away from their illness and instead talk about their goals, such as prospective employment or living by themselves. Discussing their goals may motivate them to strive for better outcomes irrespective of their beliefs about their schizoaffective disorder.
Gaining insight and awareness into their schizoaffective disorder can be a painstaking endeavor for someone with anosognosia and requires support. Patience, empathy, and understanding from healthcare professionals, family members, and friends are crucial in assisting individuals with anosognosia to develop a better understanding of their condition. 
Treatment for anosognosia
Treating anosognosia, particularly in the context of mental health conditions like schizoaffective disorder, can be complex and challenging. While there is no definitive cure for anosognosia itself, there are treatment approaches that can be helpful in managing this condition. Here are some steps that can be taken:
- Psychoeducation: Providing education about the specific mental health condition, its symptoms, and its impact can help individuals with anosognosia gain a better understanding of their illness. This can involve discussions with mental health professionals, educational materials, and support groups.
- Family involvement: Involving family members or close friends in treatment can be beneficial. They can provide additional support, share observations, and assist in relaying information about the individual’s condition when their insight is impaired.
- Therapeutic interventions: Psychotherapy, such as Cognitive Behavioral Therapy (CBT) or specialized approaches like Anosognosia-Integrated Treatment (AIT), may be helpful in addressing anosognosia. These therapies aim to enhance insight and self-awareness by providing support, exploring beliefs, and promoting acceptance of the illness.
Whilst there is no medical cure for anosognosia, implementing the above steps may prove helpful to getting on the road to managing both anosognosia and the underlying schizoaffective disorder it impacts.
- Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in Schizophrenia: Hidden in Plain Sight.Innovations in Clinical Neuroscience, 11(5-6), 10–17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140620/
- National Alliance on Mental Illness. (2020).Anosognosia | NAMI: National Alliance on Mental Illness. Nami.org. https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosiaa
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