“I’m Fine” When You’re Not: Understanding Anosognosia in Bipolar Disorder
Imagine your mind is playing a trick on you—not in a spooky way, but in a convincing, quiet way that whispers, “You don’t really have bipolar.” Your spending is out of control. You haven’t slept more than 3 hours in a week, and your loved ones are deeply concerned. Still, part of you thinks: I’m fine. I don’t need meds.
That experience has a name. It’s called anosognosia (uh-no-sog-NO-sia). And if you’re living with bipolar disorder, you might be all too familiar with it.
What Is Anosognosia?
Anosognosia is not stubbornness or denial. It’s a neurological condition. It’s also one of the most common reasons why people with bipolar don’t maintain consistency in treatment. People with anosognosia genuinely can’t see that they’re ill. It’s common in bipolar disorder, especially during manic and hypomanic episodes. It can also show up during depressive episodes.
If you have experienced this, you are not alone. Approximately 50 percent of people with bipolar disorder will experience anosognosia.
Why Does It Happen?
Anosognosia isn’t just stubbornness. It happens when certain areas of the brain (specifically the frontal lobe), which help us with self-awareness and decision-making, aren’t working correctly. This means that your brain is literally unable to notice that you’re unwell.
How It Affects Life
Anosognosia can make it much harder to achieve stability. If you don’t think you have a mental illness, you may not:
Take medications
Participate in therapy
See mood shifts as warning signs
Reach out for help if you are in a crisis
Anosognosia can lead to more hospitalizations, riskier manic episodes, deeper depressive episodes, and difficulty in your relationships with your loved ones.
What Anosognosia is Not
Sometimes anosognosia is confused with denial, but they’re not the same thing. Denial is psychological or emotional—you don’t want something to be true. Anosognosia is neurological—you can’t see it’s true.
That’s why it’s so important to approach it with compassion. If this is happening to you, you deserve compassion. If this is happening to a loved one, approach them with empathy and care.
What Can Help?
There’s no magic cure for anosognosia, but there are some things that can help. Here are a few of them:
Medications: These can help you stay stable. It may take a while to notice, but mood stabilizers and antipsychotics can also bring back insight.
Mood tracking: This can help you identify patterns in your moods, which can help increase insight.
Trusted relationships: Whether it’s a spouse, significant other, therapist, psychiatrist, or parent, having people that you can trust can help you recognize when you might need more help — even if you can’t see it yourself.
Outside interventions: In some cases, your loved ones may need to intervene and obtain crisis support for you.
Real Talk from Lived Experience
On the Thriving with Bipolar blog, we talk a lot about the invisible stuff that makes this disorder harder than it already is. If you want to feel less alone, check out these blog posts:
You’re Not “Non-Compliant”
If you have trouble understanding that you have bipolar disorder or have refused medications, you may have heard the term non-compliant. I hate this term, it’s judgmental and blamey.
Please remember: You’re not “noncompliant.” You’re not broken. And you’re not doing this on purpose.
Anosognosia is one of the hardest parts of bipolar disorder, but it doesn’t have to steal your stability. With support, time, and the right tools, insight can return. And even if you can’t see the storm, someone else can hold the umbrella.
