Insight

What is insight?

Insight is our ability to be aware of our own thoughts, and to use these to decide what we want to do, why we want to do it and how we are going to do it. This includes being aware of our own limitations, as well as being aware of social rules and how to behave around others.

Our ability to reflect on ourselves in this way is largely controlled by a complex network involving various areas of the brain and their connections. One of the most important regions within this network is the prefrontal cortex. This area is responsible for many of our ‘higher thinking skills’, such as our ability to make decisions, plan activities and socialise. Unfortunately, because it is large and at the front of the brain, it is a common site of injury. Damage to it can affect various skills, including insight.

What does ‘insight impairment’ after brain injury mean?

A brain injury can cause a wide range of physical, cognitive, emotional and behavioural effects. In some cases, the brain injury survivor may fail to consciously recognise that they have these effects or underestimate their impact, even when this is pointed out to them. This is called ‘insight impairment’, also known as anosognosia or ‘lacking insight’.

Anosognosia is not a unique effect of brain injury. There are a number of other conditions that are also associated with anosognosia, such as schizophrenia, bipolar disorder and dementia.

It is important to understand that a survivor with impaired insight is not being stubborn about the impact of their injury. The lack of insight is due to genuine organic injury to the brain causing psychological and cognitive effects.

The lack of insight may be for the direct effects of brain injury (such as memory problems), or for the impact of the brain injury (such as no longer being able to handle money safely due to memory problems caused by the injury).

The survivor may have insight for some effects of the injury, but not others. For example, a survivor with mobility problems may understand that they now need to use a wheelchair but fail to recognise that they also now have problems with controlling their anger.

Can insight improve over time?

It is possible for insight to improve over time. Insight may be particularly impaired after the survivor has ‘woken up’ from a coma but can improve as they continue to recover. Insight may also fluctuate so that there are moments when the survivor is aware of the impact of their injury and other times when they are not.

Living with impaired insight can be concerning or frustrating, for both the survivor themselves and others around them. It can cause a range of issues, which are discussed in more detail in the next section.

How can brain injury survivors with insight impairment be supported?

While there is no formal therapy or cure to address insight impairment after brain injury, there are things that families and therapists can do to help a brain injury survivor to manage it and stay safe. This section offers guidance for families on how to support your loved one with insight impairment.

Encourage the survivor to get professional help

Impaired insight is a cognitive effect of brain injury. The professional that supports brain injury survivors with cognitive effects of their injury is called a neuropsychologist. The survivor may already have had support from a neuropsychologist through rehabilitation, but if they have not, or if they may benefit from further support, they can speak to their GP about getting a referral to one or access one privately.

While a neuropsychologist will not be able to ‘treat’ the impaired insight, they can help the survivor and their family to better understand and manage it. A neuropsychologist can also support with other cognitive effects of brain injury that may be associated with the insight impairment.

Education

A brain injury survivor may be unaware of the links between brain injury and their difficulties. Learning about brain injury and the various effects this can have may help the survivor to recognise how this has personally affected them. However, it is important to remember to manage this very carefully, as it can be upsetting for the survivor to gain insight into the impact of their injury.  

Visit Living with brain injury for information on brain injury and tips for coping. 

It can also be helpful to educate others in the survivor’s life about brain injury so that they can be more understanding. Be mindful about how much you choose to share and with whom, as insight impairment can put some survivors at risk of harm.

Be empathetic

It can be difficult to support someone with insight impairment, especially if they resist support. However, it is important to try to not get frustrated and to remember that the survivor is not being stubborn or simply denying their impairment.

Try to stay calm and empathetic when supporting the survivor. It is important to acknowledge their feelings. Remind them that you are trying to support them and keep them safe.

Try to avoid directly challenging them about their insight, as this can lead to conflict, disagreements and anger. If the survivor insists that they do not have an issue, let the conversation drop for the time being and come back to it when they are calmer.

If the survivor gets angry and you need guidance for coping with this, see the section Tips for people around the survivor on Anger. 

Communicate effectively

Give the survivor time to talk about their feelings and concerns. Giving them the opportunity to reflect on their own experiences might make it easier for them to accept and adapt to changes in their life.

Do not discuss the survivor’s insight issues if they are feeling tired, upset or angry. It will be easier to discuss things when they are feeling calmer.

Use clear and direct, but gentle language when explaining to the survivor about their insight. Try to use specific examples related to the situation you are in.

Modify tasks

If the survivor won’t do important activities because of their insight impairment, try to modify these to make them more meaningful and achievable. For example, keep activities simple so that they are easier to complete. Try to relate them to the survivor’s personal goals and plans. Break larger goals into smaller ones.

Provide frequent and non-critical feedback on their performance. Involve the survivor in rating their own performance and discuss any differences you may have with examples of what you have observed.

Ask for feedback from other people close to the survivor who also understand their brain injury, such as family and close friends.

Be risk aware

Be sensitive to any risks or dangers that the survivor may place themselves or others in as a result of their insight impairment. For example, if they are not aware of having a memory problem, they may be at risk of forgetting to lock doors before they leave home or leaving a cooker unattended.

Be aware of new people in the survivor’s life who may appear to be influencing their decisions in a harmful way, as this could be a safeguarding concern.

For more guidance on safeguarding concerns that may affect brain injury survivors, as well as what to do in the event of someone being harmed, see Safeguarding.

Consider requesting a needs assessment

If you think that the survivor needs help with daily living activities, they may benefit from having a needs assessment to identify how their local social services can help. More information on this, including how to apply is available from the NHS website.

What legal systems protect someone at risk from insight impairment?

There are two main pieces of legislation that exist to help or protect people with impaired insight who are at risk in some way: The Mental Capacity Act (2005) and The Mental Health Act (2007). These are discussed in further detail below:

The Mental Capacity Act (2005) provides a framework to make decisions on behalf of people who are clearly not able to make decisions for themselves. This particularly applies to decisions about where to live and financial decisions.

People with insight impairment after brain injury may not have the mental capacity to make these decisions, as they are unable to reflect on and understand exactly how their injury has affected them. The MCA sets down how capacity is assessed and who can make decisions on their behalf in their ‘best interests’.

Further information is available from the Office of the Public Guardian.

The Mental Health Act (2007) details how a person can be detained against their wishes if their behaviour leads to significant risks to themselves or others.

The person has to be shown to have some kind of mental disorder (this includes the types of behavioural changes that occur as a result of brain injury), for it to be severe enough to warrant detention for an assessment, and for it to be in “the interests of the person’s health, safety or the protection of others”. It also has to be shown that the person would not willingly accept treatment. In cases of impaired insight after brain injury, this is commonly that the brain injury survivor does not understand that there is a problem.

Further information on the Mental Health Act is available on the NHS’ website.

This information was produced with expert input from Dr Tracey Ryan-Morgan, Consultant Clinical Neuropsychologist & Clinical Director at Talis Consulting Limited and Visiting Reader at Canterbury Christ Church University, and Dr Gianna Cocchini, Senior Lecturer in Neuropsychology and Director MSc Foundations of Clinical Psychology and Mental Health at Goldsmiths University of London.

This information was last reviewed in 2026.