What is the difference between denial and lack of insight?

Denial and lack of insight are different. They can both cause a person with dementia not to understand or accept their diagnosis. 

What is denial?

Denial is when a person doesn’t acknowledge certain facts or events, even when they may seem obvious to those around them.

It is a psychological reaction that enables a person to cope with a difficult situation that may otherwise make them feel afraid, depressed, ashamed or worried. They may feel – or think other people may feel – there is a stigma about having a diagnosis of dementia.

Denial as a coping mechanism

Denial is not someone’s deliberate attempt to deny reality – it is likely that they’re not even aware they are in denial. They may have developed their own way of explaining or coping with things they find difficult or uncomfortable.

For example, a person may dismiss a question they don’t know the answer to as not being important, or they may insist that they can still drive because they’ve ‘driven for many years’, even though they are no longer driving safely.

Can a person in denial accept their dementia diagnosis?

Over time, a person may come to accept their diagnosis and how it is affecting them. As their condition progresses and they start to have more problems, they may begin to talk about these with you or other people they trust.

What is lack of insight?

Lack of insight is when a person with dementia is unable to recognise changes in their behaviour and emotions (that are caused by physical changes in their brain).

Lack of insight is related to loss of activity in areas in the front of a person’s brain (known as the frontal lobes). It is more common in some types of dementia that are linked to damage in this part of the brain, such as frontotemporal dementia (FTD). But a person with any type of dementia can have lack of insight.

Understanding lack of insight

Like denial, lack of insight can be difficult to understand if a person is having problems that are very obvious to others. However, they may be aware of some symptoms or changes and be completely unaware of others.

For example, the person may mention that they often forget where they have left their keys, while at the same time not recognising that they no longer cook certain meals. This can sometimes look like the person is deliberately avoiding issues that you think are obvious. It is important to remember that this isn’t the case.

Can a person with lack of insight accept their diagnosis?

Unlike denial, which sometimes lessens over time, lack of insight tends to get worse as dementia progresses.