Chapter 13.Awareness of Deficits

Traumatic brain injury (TBI) is a disorder characterized by disturbed consciousness or awareness. Persons in a coma or vegetative state have no awareness of themselves or their environment, whereas persons in the minimally conscious state have limited awareness of self and environment (see Chapter 10, “Disorders of Consciousness”). After emergence from the minimally conscious state, patients in the posttraumatic confusional state (see Chapter 11, “Acute Traumatic Encephalopathy”) have disturbed awareness that can be manifested in, for example, delusions, perceptual disturbances, misrecognition of family members, and unawareness of injury. After emergence from the posttraumatic confusional state, a substantial number of patients demonstrate some degree of impairment of the ability to accurately appreciate deficits due to TBI (Sherer et al. 2003). We review the nature, prevalence, and course of recovery of awareness of deficits, as well as associated neuroimaging findings, cognitive impairments, and deficits in social communication. We also discuss measurement of self-awareness, the association of awareness of deficits with outcome, and approaches to treatment.