Anosognosia and Dissociative Fugue and Potential Effects from Psychological Trauma

Principal Category: Neurology / Psychology

Authors:
•  Vianey Gonzalez B.Sc(Psych) – Licensed Psychologist, Specialty in Crime Victim Trauma Therapy, Neuropsychologist, Certified Deception Professional, Psychology Advisory Panel & Director of the Society of Citizens Against Relationship Scams Inc.
•  Tim McGuinness, Ph.D. – Anthropologist, Scientist, Polymath, Director of the Society of Citizens Against Relationship Scams Inc.

 

Abstract

Anosognosia and dissociative fugue represent distinct but related disruptions of self-awareness that can arise from neurological injury or severe psychological trauma. Anosognosia involves a lack of awareness of specific deficits due to impaired self-monitoring, while dissociative fugue involves loss of autobiographical memory and identity as a psychological defense. Trauma can produce anosognosia-like states through prolonged amygdala hyperactivation and disruption of brain networks responsible for reflection, identity integration, and insight. These functional changes suppress awareness rather than eliminate consciousness. In severely traumatized individuals, especially scam victims, this impairment can block recognition of symptoms, resistance to help, and increased vulnerability to re-victimization. Understanding these processes reframes unawareness as a brain-based injury, emphasizing the importance of trauma-informed professional support to restore regulation, insight, and a coherent sense of self.

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Anosognosia and Dissociative Fugue and Potential Effects from Psychological Trauma

Anosognosia and Losing Your Sense of Self

The question of whether a person can be conscious without a sense of self is a profound one that neuroscience, psychology, and philosophy have been exploring for decades. The evidence strongly suggests that consciousness and the sense of self are not the same thing and can, in fact, be dissociated from one another.

To understand this, we first need to differentiate between two fundamental types of consciousness and two corresponding types of self.

Two Types of Consciousness

1. Primary (or Phenomenal) Consciousness: This is the most basic form of awareness. It is the raw, subjective experience of what it is like to be. It is the perception of sensations, emotions, and thoughts in the present moment, without any reflection or conceptual overlay. It is the “movie” of sensory experience playing in your mind, the redness of an apple, the warmth of the sun, the feeling of sadness.
2. Higher-Order (or Reflexive) Consciousness: This is the awareness of being aware. It is the capacity for introspection, self-reflection, and abstract thought. It is the part of you that can think, “I am feeling sad right now,” or “I am a person who is thinking about their own consciousness.” This is the consciousness that allows for planning, narrative-building, and creating a coherent life story.

Two Corresponding Senses of Self

1. The Minimal (or Core) Self: This is the most basic, pre-reflective sense of “I.” It is not the narrative of who you are, but the immediate, first-person perspective of experience. It is the feeling of being the subject of your own consciousness, the “I” that the movie is happening to. It is the sense of ownership over your body and your immediate perceptions.
2. The Narrative (or Autobiographical) Self: This is the story you tell yourself about who you are. It is a constructed identity built from memories of your past, your beliefs about your present, and your hopes for the future. It is your name, your job, your relationships, your personality traits, and your personal history, all woven into a coherent tale.

Dissociation: Consciousness Without a Narrative Self

A person can absolutely be conscious (in the primary sense) and have a minimal self (“I am experiencing this”) without an active narrative self (“I am a scam victim named John who is struggling to recover”). This state is not just a theoretical concept; it is a well-documented and achievable state of mind.

Here are the key examples:

1. Meditation and Mindfulness: This is the most accessible example. In deep states of mindfulness or meditation, a person observes their thoughts and feelings as they arise and pass away, without getting caught up in them. The goal is to rest in pure, primary consciousness. In this state, the “narrative self”, the inner critic, the planner, the storyteller, quiets down. The person is still fully conscious of sensations (the breath, the sound of a bell) and emotions, but they are not identifying with them. They are experiencing a state of pure awareness, a conscious “being” without the overlay of their “story.”
2. Flow States: Athletes, musicians, and artists often describe being “in the zone” or in a state of flow. In this state, they are performing at their peak, fully absorbed in the present moment. Their sense of time distorts, and their inner monologue, the narrative self, goes silent. The tennis player isn’t thinking, “I am a tennis player who needs to win this point to maintain my ranking.” They are simply being the act of playing, reacting with pure, embodied consciousness. They are fully conscious and have a minimal sense of self as the “doer,” but their narrative self has temporarily vanished.
3. Altered States of Consciousness: Psychedelic experiences (like with psilocybin) can induce a state called “ego death” or “ego dissolution.” In this state, users frequently report a complete loss of their narrative self. The story of who they are, their name, their past, and their worries completely dissolves. What remains is often described as a pure, boundless, and interconnected consciousness. They are undeniably “conscious” of reality, but the “I” that is experiencing it is no longer a separate, defined entity.
4. Certain Neurological Conditions: In severe cases of depersonalization/derealization disorder, individuals can feel detached from their own body, identity, and reality, as if they are an outside observer of their own life. While often distressing, it represents a state where consciousness is functioning, but the narrative self is profoundly disrupted.

Default Mode Network

The brain’s “default mode network“ is heavily associated with the activity of the narrative self; it’s the part of your brain that runs when you are daydreaming or thinking about yourself. In meditation and flow states, activity in this network decreases. This suggests that the narrative self is a function the brain performs, not the essence of consciousness itself.

You can be conscious without a sense of self, at least without the complex, narrative-driven sense of self that we usually identify with. In fact, many spiritual and psychological traditions view the ability to temporarily quiet the narrative self and rest in pure, primary consciousness not as a defect, but as a profound and healing state of being.

Learn more about this here.

Having No Sense of Self

There is a specific neuropsychiatric disorder that describes the state of having little to no sense of self, particularly in the context of being unaware of one’s own deficits or condition. This condition is called Anosognosia.

Anosognosia is a neurological condition in which a person is unaware of their own neurological deficit or psychiatric condition, such as psychological trauma.

It is not a psychological defense mechanism like denial, where a person knows the truth but actively avoids it. Instead, anosognosia is a deficit of self-awareness caused by physiological damage to the brain.

The person’s brain literally cannot recognize or integrate the reality of their condition into their self-image.

How It Creates a “No Sense of Self”

While not always a complete erasure of self-aware identity (not to be confused with amnesia), severe anosognosia can profoundly disrupt the sense of self in several ways:

• Inability to Update Self-Image: The core mechanism of anosognosia is believed to be the brain’s inability to update its self-model in response to new information about deficits. If you have a stroke that paralyzes your left side, a healthy brain updates its self-image to reflect that new reality. A brain with anosognosia cannot perform this update. This creates a fundamental disconnect between the physical self and the conscious self, effectively shattering a coherent sense of one’s own body and abilities.
• Disconnection from the Narrative Self: Our narrative self is built on a continuous story of our experiences. Anosognosia creates a major roadblock in this story. A person with Alzheimer’s who insists their memory is perfectly fine, or a person with schizophrenia who cannot recognize their hallucinations as symptoms, is unable to incorporate a major part of their lived experience into their life story. This leads to a fragmented and incoherent narrative self, as large, defining chapters of their life are missing from their own awareness.
• Co-occurrence with Other Disorders: Anosognosia frequently co-occurs with conditions that directly attack the sense of self. For example, in frontotemporal dementia, which can cause dramatic changes in personality, values, and social behavior, patients often have anosognosia for these changes⁴. They are unaware that they are no longer the person they once were, leaving their conscious self clinging to an outdated identity while their behavior and personality have moved on.

Anosognosia and Psychological Trauma

Profound psychological trauma can induce or cause a form of anosognosia, though the relationship is complex and often mediated by how trauma impacts the brain. While the search results primarily focus on neurological causes like stroke, traumatic brain injury (TBI), and degenerative diseases, they provide a crucial framework for understanding how severe trauma can lead to a similar state of impaired self-awareness.

Anosognosia is fundamentally a deficit in the brain’s ability to update its self-image in response to new information about deficits or illness. Profound psychological trauma, particularly when it is chronic or occurs during critical developmental periods, can cause significant changes in brain structure and function that mirror the damage seen in neurological conditions. The key mechanisms through which trauma can induce a form of anosognosia include:

1. Frontal Lobe Damage: The frontal lobe is essential for metacognition, the ability to think about one’s own thoughts, and for integrating self-related information. Severe trauma is known to impact the frontal lobe, particularly the prefrontal cortex. This can impair a person’s ability to accurately self-assess their emotional state, behaviors, and functional limitations. They may lack the executive function to connect their current distress or maladaptive behaviors to the past traumatic event, leading to a state where they are unaware of the trauma’s ongoing effects.
2. Disruption of the Right Hemisphere: Many studies have linked anosognosia to damage or decreased volume in the right hemisphere of the brain. Profound trauma can disrupt the brain’s hemispheric balance and function. This can manifest as an inability to recognize emotional or behavioral changes, as the right hemisphere is heavily involved in self-awareness, emotional regulation, and body perception.
3. Impact on Neural Networks: Anosognosia is increasingly seen as a “disconnection syndrome,” arising from disruptions in the brain’s communication networks, particularly the frontoparietal networks and the default mode network (DMN). The DMN is critical for self-referential thought and maintaining a coherent sense of self. Severe psychological trauma is known to dysregulate these same networks. This traumatic disruption can sever the lines of communication necessary for a person to have accurate insight into their own condition, effectively creating a functional anosognosia even without a physical lesion.

In psychiatric conditions like schizophrenia and bipolar disorder, which can be triggered or exacerbated by trauma, anosognosia is a recognized and common symptom, affecting up to 60% of individuals with schizophrenia. In these cases, the lack of insight into the illness is considered a symptom of the illness itself, stemming from the underlying neurobiological changes⁴. By extension, trauma that causes significant neurobiological changes can produce a similar symptom of impaired self-awareness.

Therefore, while a person might not have a stroke or TBI, the profound neurological and psychological impact of severe trauma can create a state functionally identical to anosognosia. The person is not in psychological denial; their brain has been altered in a way that prevents them from recognizing the extent of their deficits or the connection between their past trauma and their present struggles. This explains why some trauma survivors may seem completely unaware of their own maladaptive behaviors or emotional dysregulation, and why they may strongly resist help or therapy, as they genuinely do not perceive the problem that others see so clearly.

SCARS Institute Hypothesis: Amygdala Hyperactivation, Temporoparietal Junction (TPJ) Disruption, and Trauma-Related Loss of Self-Awareness

Modern neuroscience increasingly supports the idea that psychological trauma does not simply affect emotions or memory in isolation. Instead, it alters the balance and coordination of large-scale brain networks responsible for threat detection, self-awareness, and meaning-making. One of the most important and often misunderstood consequences of this disruption is a trauma-related loss of self-awareness that can resemble anosognosia, not because of denial or stubbornness, but because the brain’s self-monitoring systems are functionally suppressed or impaired.

At the center of this process is the amygdala, a key structure involved in detecting threat and assigning emotional significance to incoming information. In trauma-related disorders such as post-traumatic stress disorder, the amygdala frequently becomes hyperactive. This hyperactivation places the nervous system into a persistent state of heightened alertness, where the brain remains oriented toward detecting danger even when no immediate threat is present. Research has shown that this pattern is not only a symptom of trauma but can also predict the development and persistence of trauma-related symptoms following exposure.

Importantly, the amygdala does not operate in isolation. It is a core component of the brain’s salience network, which determines what deserves attention and urgency. When this network becomes chronically dominant, it can overwhelm other systems responsible for reflection, integration, and self-awareness. One of the most affected systems in this process is the default mode network, which includes the temporoparietal junction.

The temporoparietal junction (TPJ) plays a critical role in constructing a coherent sense of self. It helps integrate emotional states, memories, and social information into an ongoing internal narrative. It is central to perspective-taking, distinguishing self from others, and recognizing one’s own mental and emotional states. These functions are essential for insight, self-monitoring, and the ability to recognize personal difficulties or limitations.

In trauma-related conditions, growing evidence (see below in Reference) shows that temporoparietal junction function is altered rather than destroyed. Neuroimaging studies consistently demonstrate disrupted default mode network activity in individuals with post-traumatic stress disorder, including abnormal connectivity involving the temporoparietal junction and closely related regions such as the posterior cingulate cortex. Interventions that reduce trauma symptoms, including neurofeedback approaches, have been shown to normalize activity in these regions, further supporting their involvement in trauma pathology.

The interaction between amygdala hyperactivation and temporoparietal junction disruption is best understood at the network level. In a healthy brain, the salience network and default mode network operate in dynamic balance. The salience network identifies what is important, while the default mode network contextualizes experience, supports reflection, and integrates information into a stable sense of self. Trauma disrupts this balance. A hyperactive amygdala keeps the salience network locked in threat-detection mode, while default mode and temporoparietal junction-mediated processes are suppressed or fragmented.

This network imbalance creates a neurological state in which higher-order self-awareness becomes difficult or temporarily inaccessible. The individual remains conscious, intelligent, and capable of functioning, yet lacks accurate awareness of their own trauma-related impairments. Emotional dysregulation, avoidance behaviors, distorted threat perception, and impaired judgment may be present without being fully recognized by the individual experiencing them.

This phenomenon closely resembles anosognosia, normally a condition traditionally associated with structural brain damage, such as stroke. However, in trauma-related conditions, the impairment is typically functional rather than structural. The temporoparietal junction and related systems are not destroyed. They are inhibited by a dominant threat-response system. For this reason, the condition is best understood as a form of functional or state-dependent anosognosia.

This distinction is critical. Trauma-related loss of insight is not denial, resistance, or lack of motivation. It is not a character flaw or a failure of intelligence. It reflects a brain that has adapted to survive prolonged threat by prioritizing external vigilance over internal reflection. When the nervous system perceives danger as ongoing, self-awareness becomes a lower priority. From a survival perspective, this adaptation makes sense. From a recovery perspective, it creates profound challenges.

This mechanism helps explain why, in some cases, trauma survivors may appear unaware of their own symptoms, minimize their difficulties, or resist feedback from others despite clear evidence. It also explains why insight often improves only after safety, regulation, and emotional stabilization are restored. As amygdala hyperactivation decreases and network balance returns, temporoparietal junction, mediated self-awareness can re-emerge.

Understanding this process reframes how trauma-related unawareness should be interpreted clinically and socially. It shifts the question from “Why can’t they see what is happening?” to “What neural systems are preventing self-awareness from becoming accessible right now?” This perspective restores compassion, reduces blame, and supports treatment approaches that prioritize safety, regulation, and gradual restoration of reflective capacity rather than confrontation or forced insight.

In trauma recovery, awareness is not something to be demanded. It is something that becomes possible again when the brain is no longer dominated by threat.

Prolonged Amygdala Hyperactivation Reshapes the Brain and Contributes to a Loss of Self

Amygdala hyperactivation is often described as a temporary survival response, and in many cases, it is. During an acute threat, the amygdala mobilizes attention, emotion, and physiology to prioritize safety. Once danger passes and the nervous system returns to baseline, this heightened state typically resolves. However, when threat exposure is prolonged or repeatedly reactivated, as occurs in chronic trauma, prolonged coercion, or sustained psychological manipulation, evidence suggests that the brain does not simply remain in a temporary alarm state. Instead, it can undergo lasting functional and structural adaptation.

Long-term amygdala hyperactivation is associated with neuroplastic changes across multiple brain systems. The amygdala itself can become more sensitive and reactive, lowering the threshold for threat detection. At the same time, regions involved in regulation, reflection, and identity integration, including the medial prefrontal cortex, anterior cingulate cortex, hippocampus, and temporoparietal junction, may show reduced activation, altered connectivity, or impaired coordination. This imbalance does not represent damage in the classical sense, but it does reflect a reorganization of how the brain allocates resources.

Over time, this reorganization can affect a person’s sense of self. Selfhood depends on the brain’s ability to integrate memory, emotion, bodily signals, values, and social perspective into a coherent narrative. When threat processing dominates for extended periods, this integrative work is deprioritized. The individual becomes oriented toward survival rather than meaning, toward monitoring danger rather than reflecting on identity. Emotional experience may feel fragmented, flattened, or confusing. Personal preferences, long-term goals, and a stable sense of who one is can feel distant or inaccessible.

This process is sometimes described clinically as identity disruption, depersonalization, or loss of self, but it is more accurately understood as a consequence of adaptive neurobiological trade-offs. The brain reallocates energy toward vigilance at the expense of self-referential integration. In extreme or prolonged cases, this state can resemble a functional loss of self-awareness, where individuals struggle to recognize changes in their emotions, behavior, or needs, not because they are avoiding insight, but because the neural systems that support self-monitoring have been chronically suppressed.

Importantly, these changes are not fixed. Neuroplasticity works in both directions. When safety is restored and threat processing decreases, reflective and integrative networks can gradually re-engage. With appropriate support, therapy, and time, the brain can relearn how to balance survival with selfhood. The loss of self seen in prolonged trauma is not evidence of permanent damage. It is evidence of a nervous system that adapted too well to danger, and that now requires conditions of safety to recover its full range of human awareness.

The Importance of Seeking Professional Psychiatric or Psychological Support

If the experiences described above resonate on a personal level, it is an important signal that professional psychiatric or psychological support may be needed. Trauma-related changes in perception, emotional regulation, self-awareness, and identity are not problems that can reliably be resolved through willpower, logic, or self-education alone. These experiences arise from alterations in how the brain and nervous system are functioning, and they often require skilled, structured intervention by professionals trained in trauma and dissociation to reverse safely.

Mental health professionals trained in trauma and dissociation understand that symptoms such as emotional numbing, hypervigilance, confusion about one’s own reactions, or a diminished sense of self are not personal failures. They are adaptive responses to overwhelming or prolonged threats. A qualified clinician can help assess whether these responses reflect post-traumatic stress, complex trauma, dissociative processes, depression, anxiety, or overlapping conditions that may not be immediately obvious to the individual experiencing them.

Professional support provides several critical benefits.

• First, it establishes a stable and safe therapeutic environment where the nervous system can begin to downshift from chronic threat activation.
• Second, clinicians can apply evidence-based treatments that are specifically designed to restore regulation, improve self-awareness, and reintegrate disrupted neural networks. These may include trauma-focused psychotherapy, somatic approaches, cognitive and emotional regulation strategies, or, when appropriate, psychiatric evaluation for medication support.

Importantly, seeking professional help is not an admission of weakness or incapacity, nor that you are mentally ill. Remember that trauma is an injury. It is a recognition that the brain, like any other organ, can be injured by prolonged stress and requires specialized care to heal. Early intervention can prevent symptoms from becoming more entrenched and can significantly reduce long-term impairment. When trauma begins to affect identity, judgment, emotional stability, or daily functioning, professional guidance is not optional care. It is essential care.

Other Disorders Where Anosognosia is Common

Anosognosia is not a standalone disease but a symptom of various underlying conditions, both neurological and psychiatric:

• Neurological Disorders: It is most famously associated with right hemisphere stroke, where patients may be unaware of paralysis (hemiplegia) on their left side. It also occurs frequently with traumatic brain injury, brain tumors, and neurodegenerative diseases like Alzheimer’s dementia, where up to 81% of patients show some form of it
• Psychiatric Disorders: Anosognosia is a hallmark of severe mental illness. It is estimated that 50-90% of patients with schizophrenia and 40% of patients with bipolar disorder demonstrate a severe lack of insight into their condition. This is a major reason for non-compliance with treatment, as from their perspective, there is nothing wrong with them.

In essence, while a person with anosognosia is still “conscious” in a basic sense, they are operating with a profoundly distorted and incomplete map of themselves. The disorder severs the connection between reality and the self-concept, leading to a state where a person can be physically or mentally impaired, yet their conscious self has no knowledge of it. This represents one of the most severe disruptions to the sense of self that can result from brain dysfunction.

Anosognosia vs. Dissociative Fugue

Anosognosia and what used to be called a “Fugue State” (now clinically known as Dissociative Amnesia or Dissociative Fugue) are related in that they are both profound disturbances of self-awareness and memory, but they are fundamentally different in their core mechanism, presentation, and duration. They represent two very different ways the mind can break its connection to a coherent sense of self.

The simplest way to understand the difference is: Anosognosia is a lack of awareness of a deficit, while a Fugue State is a lack of memory for personal identity.

Anosognosia: The Unawareness of a Deficit

As we’ve discussed, anosognosia is a neurological or psychiatric deficit of self-awareness. The person’s sense of self is intact, but it is inaccurate because their brain cannot recognize a specific problem.

• Core Problem: The brain’s “self-monitoring” or “error-checking” system is damaged. It fails to update the internal model of the self to reflect a new reality, such as paralysis, memory loss, or mental illness.
• Sense of Self: The person’s core identity and personal history are usually present. They know their name, where they are from, and who their family is. The problem is that they believe they are perfectly fine, even when they are demonstrably not.
• Example: A man who has had a right-hemisphere stroke insists he can move his paralyzed left arm. His sense of “I” is there, but it is disconnected from the physical reality of his body. He is unaware of his deficit.

Dissociative Fugue (Fugue State): The Loss of Personal Identity

Dissociative Fugue is a rare dissociative disorder, now categorized under Dissociative Amnesia. It is a psychological defense mechanism, not a neurological deficit of awareness. The mind actively blocks out autobiographical information to protect itself from overwhelming trauma or stress.

• Core Problem: A severe psychological stressor triggers a dissociative break. The person’s autobiographical memory, their name, past, relationships, and personal identity is lost.
• Sense of Self: The core sense of self is gone or replaced. The person may create a new identity, with a new name and a new life story. They are not unaware of a deficit; they are unaware of their entire previous identity. They may appear confused about who they are, but they don’t perceive this as a problem because the “I” that is missing is not accessible to them.
• Example: A person who experiences immense trauma disappears from their life. They are found hundreds of miles away, working a new job under a new name, with no memory of their former life, family, or the event that triggered the flight. They are not unaware of a problem; they are living as a different person.

Key Relationships and Differences

Core Mechanism

• • Anosognosia – Neurological Deficit: Brain damage prevents recognition of a deficit.
  • Dissociative Fugue – Psychological Defense: The mind blocks traumatic memories to protect itself.

What is Lost?

• • Anosognosia – Awareness of a specific deficit (e.g., paralysis, illness).
  • Dissociative Fugue – Memory of personal identity and past.

Sense of Self

• • Anosognosia – Present but Inaccurate: The person knows who they are, but has a distorted view of their abilities or state.
  • Dissociative Fugue – Absent or Replaced: The person’s original identity is inaccessible. They may adopt a new one.

Awareness of Problem

• • Anosognosia – None: The person genuinely believes they are fine.
  • Dissociative Fugue – None: The person is not aware they are “missing” a past because the “I” that is missing is gone.

Cause

• • Anosognosia – Stroke, TBI, dementia, schizophrenia, severe trauma-induced brain changes.
  • Dissociative Fugue – Overwhelming psychological stress or trauma.

Duration

• • Anosognosia – Often persistent or chronic, tied to the underlying brain injury.
  • Dissociative Fugue – Typically acute and temporary, lasting hours, days, or, rarely, months.

How They Are Related

The primary relationship between the two is that they are both dramatic failures of the brain to create a coherent and accurate model of the self. In both conditions, there is a profound disconnect between the objective reality of the person and their subjective experience of who they are. They both highlight that our “sense of self” is not a magical, immutable entity but a complex and fragile construct that can be shattered by both physical injury and overwhelming psychological pain.

In essence, if the self is a story we tell ourselves, anosognosia is a story with a major factual error that the narrator refuses to acknowledge, while a fugue state is when the narrator forgets the entire plot and the main character and starts writing a new book.

Review: Anosognosia-Like Affects on Severely Traumatized Scam Victims

Anosognosia-like symptoms caused by amygdala hyperactivation can have a devastating and specific impact on severely traumatized scam victims, creating a profound barrier to recovery that is often misunderstood by both the victims themselves and their support systems. It transforms the healing journey from a difficult but navigable path into an impossible one, as the victim lacks the fundamental awareness of their own injury.

For a scam victim, the trauma is not just a financial loss but a deep neurological injury, particularly a form of betrayal trauma that disrupts brain systems responsible for trust, memory, and self-perception

This manifests in several critical ways that sabotage recovery

• First, it creates a complete rejection of the trauma narrative. A victim with anosognosia may intellectually acknowledge the scam happened but will be unable to genuinely connect it to their current emotional and cognitive state. They cannot see that their hypervigilance, their sudden rages, their inability to trust, or their social withdrawal are direct symptoms of the trauma. Instead, they may attribute these changes to other factors, “I’m just stressed,” “Other people are untrustworthy,” or “I’m getting older”, never once considering that the scam was the catalyst. This isn’t denial; it’s a neurological blind spot. The brain’s self-monitoring system is impaired, preventing the victim from seeing the cause-and-effect relationship between the event and their current suffering.
• Second, anosognosia leads to fierce resistance to help. Because the victim does not perceive themselves as “traumatized” or “injured,” they see no need for therapy, support groups, or trauma-informed care. Offers of help are not just declined; they are often met with anger and frustration. The victim may view loved ones and therapists as alarmist, condescending, or even accusatory. They might say, “Why does everyone keep treating me like I’m broken? I’m fine. I just made a mistake, and I’ve moved on.” This resistance is a core symptom of the condition, as the person genuinely cannot recognize the problem that others are trying to help them solve
• Finally, it often creates a dangerous cycle of re-victimization and compounded trauma. Without the awareness of their vulnerability, a victim with anosognosia-like symptoms does not learn the necessary lessons from the scam. They may not recognize the red flags they missed, understand the psychological tactics used against them, or appreciate their own need for caution in future relationships. This leaves them highly susceptible to being scammed again or engaging in other risky behaviors. Each new negative experience is not integrated into a narrative of “I need to heal because I was traumatized,” but instead becomes another isolated event, further confusing their reality and deepening the unseen wound.

For a severely traumatized scam victim, anosognosia-like symptoms are like having a broken leg but being neurologically incapable of feeling the pain or seeing the fracture. They will try to walk on it, will fail, and will become angry at anyone who suggests they need a cast and crutches. The condition makes the victim their own biggest obstacle to recovery, as the fundamental first step, acknowledging the injury, is rendered neurologically impossible. This underscores that for many, the aftermath of a scam is not a choice or a matter of willpower, but a profound brain-based injury that requires specialized clinical intervention to restore the very awareness needed to begin healing

Conclusion

Anosognosia (neurological or psychologically triggered) and dissociative fugue illustrate how profoundly psychological trauma can disrupt self-awareness, identity, and insight without eliminating consciousness itself. Trauma does not merely affect memory or emotion. It alters the coordination of brain networks that allow a person to recognize their own internal state, update their self-image, and integrate experience into a coherent narrative. When threat detection systems remain dominant for prolonged periods, reflective and self-monitoring functions can become suppressed, leading to functional unawareness that closely resembles neurological anosognosia. In this state, individuals may sincerely believe they are unaffected, even as their behavior, emotions, and judgment show clear signs of injury.

Understanding these mechanisms is essential for compassionate and effective recovery. A lack of insight following trauma is not denial, stubbornness, or character weakness. It is often a brain-based limitation shaped by survival-driven adaptations. This perspective reframes resistance to help, emotional numbing, and identity confusion as signals of unmet neurological and psychological needs rather than personal failure. It also explains why insight frequently emerges only after safety, regulation, and stabilization are restored.

Recovery depends on recognizing that awareness cannot be forced. It must be supported. Professional trauma-informed care creates the conditions in which threat responses quiet, integrative networks re-engage, and self-awareness gradually returns. With appropriate support, even severe disruptions of selfhood can improve. Trauma-related loss of insight is not a permanent state. It is a reversible consequence of a nervous system that adapted to survive overwhelming conditions and now requires safety and care to recover its full capacity for self-understanding.

Final Note

If a person is suffering from Anosognosia (neurological or psychologically triggered) symptoms, their friends and family are not going to be able to help them effectively and may damage the trust that exists between them. It is always recommended to seek professional psychiatric or psychological support immediately to help them. The sooner the person is in front of a professional, the sooner they can begin the road to recovery.

Glossary

• Agency — Agency refers to a person’s capacity to make choices and take purposeful action, even when trauma has reduced confidence and clarity. Recovery typically improves when agency is rebuilt in small, repeatable steps that restore control.
• Altered States of Consciousness — Altered states of consciousness describe temporary shifts in perception, attention, and self-experience that differ from ordinary waking awareness. Trauma can increase vulnerability to distressing altered states, so grounding and clinical guidance may be needed.
• Amygdala — The amygdala is a brain structure that helps detect threat and assign emotional importance to experiences. After trauma, heightened amygdala activity can keep the body on alert and interfere with calm reflection.
• Amygdala Hyperactivation — Amygdala hyperactivation is a prolonged or easily triggered threat response that keeps attention and physiology oriented toward danger. This state can narrow thinking, intensify emotions, and reduce access to self-monitoring skills.
• Anosognosia — Anosognosia is a condition in which a person is unaware of a neurological or psychiatric deficit and cannot integrate it into self-understanding. It differs from denial because the limitation is rooted in impaired self-awareness rather than avoidance.
• Anosognosia-Like Symptoms — Anosognosia-like symptoms refer to functional loss of insight that resembles anosognosia but may occur without a clear structural brain lesion. Trauma-related network disruption can reduce awareness of impairment even when intelligence and consciousness remain intact.
• Anterior Cingulate Cortex — The anterior cingulate cortex helps monitor conflict, regulate emotion, and support flexible attention. Trauma can alter its functioning, which may contribute to difficulty noticing internal signals and shifting out of threat-focused thinking.
• Attachment — Attachment describes the emotional bond patterns that shape how people seek safety, support, and trust in relationships. Trauma and betrayal can destabilize attachment, making closeness feel unsafe or confusing.
• Autobiographical Memory — Autobiographical memory is the store of personally meaningful experiences that support identity and life narrative. Trauma can fragment or distort autobiographical memory, which may affect confidence and self-continuity.
• Autobiographical Self — The autobiographical self is the sense of identity built from personal history, roles, beliefs, and relationships over time. Trauma can disrupt this self-story, leaving a person feeling unfamiliar to themselves.
• Betrayal Trauma — Betrayal trauma occurs when harm comes from a trusted person or relationship that the victim relied on for safety or belonging. It often produces confusion, shame, and difficulty accepting what happened, especially in scams.
• Brain Network Balance — Brain network balance refers to healthy coordination between systems for threat detection, reflection, and attention. Trauma can shift this balance toward survival mode, reducing capacity for insight and integration.
• Cognitive Labor — Cognitive labor is the social reality that people rely on specialists to understand complex systems, such as medicine, law, or technology. This reliance can be helpful, but it can also create false confidence when expertise is assumed but not understood.
• Coherent Self-Model — A coherent self-model is the brain’s integrated map of one’s abilities, identity, and internal state. Trauma and neurological conditions can disrupt updating this model, creating confusion about what is happening.
• Compounded Trauma — Compounded trauma occurs when multiple stressors or victimizations add layers of injury over time. It often increases symptoms, reduces resilience, and makes recovery require more structured support.
• Consciousness — Consciousness refers to the basic capacity for awareness of sensations, thoughts, and emotions. The text distinguishes consciousness from identity, showing that awareness can persist even when self-narrative is disrupted.
• Core Self — The core self is the immediate, first-person sense of being the subject of experience in the present moment. Trauma can leave the core self intact while weakening the broader identity story.
• Default Mode Network — The default mode network is a set of brain regions active during self-focused thought, autobiographical memory, and personal narrative. Trauma and dissociation can alter this network, changing how a person experiences identity.
• Denial — Denial is a psychological defense in which a person avoids acknowledging painful reality despite having access to the information. The text contrasts denial with anosognosia, where the brain cannot recognize the deficit.
• Depersonalization — Depersonalization is a dissociative experience in which a person feels detached from their body, emotions, or sense of being real. It can feel frightening, but it often reflects an overwhelmed nervous system protecting itself.
• Derealization — Derealization is a dissociative experience in which the world feels unreal, distant, or dreamlike. Trauma can trigger derealization, and consistent grounding practices can help reduce episodes.
• Disconnection Syndrome — Disconnection syndrome describes impairments that arise when brain regions cannot communicate effectively, even without obvious structural damage. Trauma-related network disruption can function like a disconnection and reduce insight.
• Dissociation — Dissociation is a disruption in the normal integration of memory, identity, emotion, and perception. It can be protective during overwhelming stress, but can interfere with recovery when it becomes persistent.
• Dissociative Amnesia — Dissociative amnesia involves the inability to recall important personal information, often linked to traumatic stress. It is not ordinary forgetfulness and may require professional assessment and treatment.
• Dissociative Fugue — Dissociative fugue is a rare form of dissociative amnesia in which a person may travel or assume a new identity with limited awareness of their prior life. It reflects extreme stress and requires urgent clinical evaluation.
• Emotional Numbing — Emotional numbing is reduced access to feelings that can develop after trauma as a protective adaptation. It may reduce pain short term but can also limit connection, motivation, and self-recognition.
• Ego Dissolution — Ego dissolution is a temporary reduction of the usual identity boundaries, sometimes reported in psychedelic states. In trauma contexts, similar experiences can occur involuntarily and may feel destabilizing.
• Ego Death — Ego death is a term used to describe a profound disruption of the narrative self, often in psychedelic experiences. When it happens outside a controlled setting, it can intensify fear and confusion about identity.
• Emotional Dysregulation — Emotional dysregulation refers to difficulty modulating emotions, including sudden surges of anger, panic, or despair. Trauma can disrupt regulation systems, making reactions feel intense and hard to predict.
• Executive Function — Executive function includes planning, impulse control, and self-monitoring abilities supported by frontal brain regions. Trauma and chronic stress can weaken these skills, affecting judgment and follow-through.
• External Hypervigilance — External hypervigilance is constant scanning for threats in people, messages, and environments. Scam victims may experience this after betrayal, and it can crowd out reflective awareness of internal needs.
• Flow State — A flow state is an absorbed performance mode marked by focused attention, reduced self-talk, and efficient action. The text uses flow to show that the narrative-self can be quiet while consciousness remains active.
• Frontal Lobe — The frontal lobe supports decision-making, insight, and the ability to reflect on one’s own thoughts. Trauma can impair frontal lobe functioning, making self-assessment and behavioral change more difficult.
• Functional Anosognosia — Functional anosognosia refers to a state-dependent loss of insight driven by altered brain functioning rather than a clear structural lesion. This concept helps explain trauma-related unawareness without blaming the survivor.
• Grounding — Grounding refers to practical techniques that reconnect attention to the present moment through body sensation and environmental cues. It can reduce dissociation and help restore a sense of control during distress.
• Higher-Order Consciousness — Higher-order consciousness is awareness of being aware, which supports introspection, planning, and meaning-making. Trauma can reduce access to this level of reflection during periods of intense threat activation.
• Hippocampus — The hippocampus supports memory integration and context, including distinguishing past from present. Trauma can affect hippocampal functioning, which may contribute to intrusive memories and time confusion.
• Identity Disruption — Identity disruption is a change in how a person experiences who they are, what they value, and what feels familiar. Prolonged threat states can reduce access to stable identity and long-term goals.
• Insight — Insight is the ability to recognize one’s condition, patterns, and needs with reasonable accuracy. Trauma can temporarily suppress insight, so support should focus on safety and gradual restoration.
• Institutional Response Stress — Institutional response stress describes additional harm caused when systems respond with blame, disbelief, or procedural coldness. For scam victims, hostile responses can deepen shame and avoidance.
• Intellectual Functioning — Intellectual functioning includes reasoning, vocabulary, and problem-solving, which can remain intact during trauma. The text emphasizes that lack of insight is not the same as lack of intelligence.
• Introspection — Introspection is the capacity to look inward and observe thoughts, feelings, and motivations. Trauma can make introspection feel unsafe or inaccessible, especially when threat networks dominate attention.
• Meditation — Meditation is a practice of training attention and awareness, often reducing narrative self-activity. For trauma survivors, structured, trauma-informed approaches are typically safer than unstructured intensive practice.
• Meaning-Making — Meaning-making is the process of integrating experiences into values, identity, and a coherent life story. Trauma can disrupt meaning-making, and recovery often involves rebuilding personal interpretation and purpose.
• Medial Prefrontal Cortex — The medial prefrontal cortex supports emotional regulation, self-referential processing, and perspective. Trauma can reduce its regulatory influence, allowing threat responses to dominate.
• Memory Fragmentation — Memory fragmentation refers to trauma memories being stored as disconnected sensations, images, or emotional states rather than a coherent narrative. This can interfere with self-story and increase confusion.
• Metacognition — Metacognition is the ability to think about one’s own thinking and notice cognitive errors. Trauma can impair metacognition, making it harder to recognize avoidance, distortion, or vulnerability to manipulation.
• Minimal Self — The minimal self is the immediate sense of “I” as the subject of experience, separate from a life story. The text emphasizes that minimal self can persist even when narrative identity collapses.
• Neural Connectivity — Neural connectivity refers to the coordinated communication between brain regions needed for stable awareness and regulation. Trauma can alter connectivity patterns, affecting insight and emotional control.
• Neurodegenerative Disease — Neurodegenerative disease involves progressive loss of brain function, which can include anosognosia in conditions like Alzheimer’s disease. The text uses this comparison to clarify how insight loss can be symptom-based.
• Neurofeedback — Neurofeedback is a training approach that aims to modify brain activity patterns through feedback signals. Some studies in trauma-related conditions suggest symptom improvement may be linked to changes in self-related networks.
• Neuroplasticity — Neuroplasticity is the brain’s ability to change structure and function in response to experience. It explains how trauma can rewire threat and self networks, and how recovery can also reshape them.
• Nervous System Regulation — Nervous system regulation is the capacity to return from activation into calm states after stress. Trauma can reduce this capacity, so recovery often begins with stabilization and pacing.
• Narrative Self — The narrative self is the identity story built from memories, roles, and future plans. Trauma and dissociation can disrupt this story, producing a sense of being disconnected from one’s own life.
• Perspective-Taking — Perspective-taking is the ability to recognize other viewpoints and distinguish self from other. The temporoparietal junction supports this function, and trauma can disrupt it through network imbalance.
• Posterior Cingulate Cortex — The posterior cingulate cortex is a central region within the default mode network linked to self-referential processing. Trauma-related interventions sometimes track changes in this region as symptoms improve.
• Primary Consciousness — Primary consciousness is raw present-moment awareness of sensations, emotions, and thoughts without reflective labeling. The text emphasizes that primary consciousness can remain even when identity feels unstable.
• Psychiatric Insight Impairment — Psychiatric insight impairment refers to reduced awareness of symptoms in conditions such as schizophrenia or bipolar disorder. The text notes that insight loss can be part of illness processes rather than a choice.
• Psychological Defense — A psychological defense is a mental strategy that reduces distress by avoiding or reshaping painful information. Dissociative fugue is described as a defense mechanism, unlike anosognosia, which is deficit-based.
• Re-Victimization — Re-victimization refers to being harmed again due to unresolved vulnerability, impaired insight, or ongoing manipulation. The text highlights that unawareness of injury can increase the risk of repeated scams.
• Salience Network — The salience network detects what seems urgent and redirects attention accordingly. When trauma locks this network into threat mode, reflective networks may become quieter and harder to access.
• Self-Awareness — Self-awareness is the capacity to recognize internal states, behavior patterns, and limitations with reasonable accuracy. Trauma can temporarily suppress self-awareness, especially during chronic hyperarousal.
• Self-Image Updating — Self-image updating is the brain’s ability to revise identity and ability beliefs based on new reality. Anosognosia involves failure of updating, which creates a mismatch between experience and self-story.
• Self-Monitoring — Self-monitoring is the ongoing process of noticing one’s behavior and internal signals and making corrections. Trauma can impair this ability, which may look like stubbornness but often reflects neurobiology.
• State-Dependent Functioning — State-dependent functioning means abilities such as insight and reflection change based on arousal and threat level. Trauma recovery often focuses on lowering arousal so higher-order awareness can return.
• Structural Brain Lesion — A structural brain lesion is physical damage, such as a stroke injury, that can cause lasting deficits, including anosognosia. The text contrasts structural causes with trauma-related functional suppression.
• Temporoparietal Junction — The temporoparietal junction is a brain region involved in perspective-taking, self-other distinction, and self-referential integration. Trauma-related network disruption may reduce its contribution to insight.
• Threat Detection — Threat detection is the brain’s capacity to identify danger and mobilize survival responses. After trauma, threat detection can become oversensitive, leading to persistent alertness and reduced reflection.
• Traumatic Brain Injury — Traumatic brain injury is a physical injury to the brain that can cause cognitive, emotional, and insight-related deficits. The text includes it as a common neurological context in which anosognosia appears.
• Trauma-Informed Care — Trauma-informed care is an approach that prioritizes safety, choice, collaboration, trustworthiness, and empowerment. It reduces retraumatization by recognizing that symptoms often reflect survival adaptations.
• Treatment Resistance — Treatment resistance describes refusal or avoidance of care, which can have many causes, including impaired insight. In anosognosia-like states, resistance may arise because the person cannot perceive the problem.
• Willpower Myth — The willpower myth is the belief that trauma symptoms should resolve through determination and logic alone. The text counters this idea by framing symptoms as brain and nervous system injuries requiring care.

Reference

In Support of the SCARS Institute Hypothesis

Amygdala Hyperactivation in Trauma and PTSD: The amygdala becomes hyperactive in trauma and PTSD, driving persistent threat detection and predicting symptom development.

Key sources:

• • Rauch, S. L., Shin, L. M., and Phelps, E. A. (2006). Neurocircuitry models of posttraumatic stress disorder and extinction: Human neuroimaging research past, present, and future. Biological Psychiatry, 60(4), 376–382.
    https://pubmed.ncbi.nlm.nih.gov/16919525/
  • Shin, L. M., and Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35, 169–191.
    https://pubmed.ncbi.nlm.nih.gov/19625997/
  • McLaughlin, K. A., and Lambert, H. K. (2017). Child trauma exposure and psychopathology: Mechanisms of risk and resilience. Current Opinion in Psychology, 14, 29–34.
    https://pubmed.ncbi.nlm.nih.gov/27868085/

Salience Network Dominance and Network Imbalance: Amygdala hyperactivation biases the salience network and disrupts interaction with reflective networks.

Key sources:

• • Menon, V. (2011). Large-scale brain networks and psychopathology: A unifying triple network model. Trends in Cognitive Sciences, 15(10), 483–506.
    https://doi.org/10.1016/j.tics.2011.08.003
  • Seeley, W. W., et al. (2007). Dissociable intrinsic connectivity networks for salience processing and executive control. Journal of Neuroscience, 27(9), 2349–2356.
    https://doi.org/10.1523/JNEUROSCI.5587-06.2007

Default Mode Network Disruption in PTSD: PTSD involves abnormal default mode network activity, impairing self-referential processing.

Key sources:

• • Bluhm, R. L., et al. (2009). Alterations in default network connectivity in posttraumatic stress disorder related to early-life trauma. Journal of Psychiatry and Neuroscience, 34(3), 187–194.
    https://pubmed.ncbi.nlm.nih.gov/19448848/
  • Lanius RA, Terpou BA, McKinnon MC. The sense of self in the aftermath of trauma: lessons from the default mode network in posttraumatic stress disorder. Eur J Psychotraumatol. 2020 Oct 23;11(1):1807703.
    https://pubmed.ncbi.nlm.nih.gov/33178406/
  • Aldrich Chan. The fragmentation of self and others: the role of the default mode
    network in post-traumatic stress disorder 
    https://digitalcommons.pepperdine.edu/cgi/viewcontent.cgi?article=1659&context=etd

Temporoparietal Junction and Self-Awareness: The temporoparietal junction is central to self-awareness, perspective-taking, and integration of internal states.

Key sources:

• • Decety, J., and Lamm, C. (2007). The role of the right temporoparietal junction in social interaction: How low-level computational processes contribute to meta-cognition. Neuroscientist, 13(6), 580–593.
    https://pubmed.ncbi.nlm.nih.gov/17911216/
  • Saxe, R., and Kanwisher, N. (2003). People thinking about thinking people: The role of the temporoparietal junction in theory of mind. NeuroImage, 19(4), 1835–1842.
    https://pubmed.ncbi.nlm.nih.gov/12948738/

Temporoparietal Junction and PTSD-Specific Alterations: Trauma alters temporoparietal junction function and connectivity without structural damage.

Key sources:

• • Lanius, R. A., et al. (2015). The dissociative subtype of PTSD: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 32(4), 215–226.
    https://pubmed.ncbi.nlm.nih.gov/22431063/

Functional Anosognosia and Loss of Insight Without Structural Damage: Loss of awareness can occur due to network dysfunction rather than brain lesions. While these studies focus on classical anosognosia, they establish the distinction between structural damage and functional network disruption, which trauma research extends into psychiatric contexts.

Key sources:

• • Vocat, R., Staub, F., Stroppini, T., and Vuilleumier, P. (2010). Anosognosia for hemiplegia: A clinical-anatomical prospective study. Brain, 133(12), 3578–3597.
    https://pubmed.ncbi.nlm.nih.gov/21126995/
  • Prigatano, G. P. (2009). Anosognosia: Clinical and ethical considerations. Current Opinion in Neurology, 22(6), 606–611.
    https://pubmed.ncbi.nlm.nih.gov/19809315/

Trauma-Related Impaired Insight and Self-Awareness: Trauma survivors may lack insight into symptoms due to neurobiological suppression of reflective processing.

Key sources:

• Herman, J. L. (1992). Trauma and Recovery. Basic Books.
  (Foundational work describing trauma-related alterations in self-awareness and integration.)
  https://psycnet.apa.org/record/1992-97643-000
• van der Kolk, B. A. (2014). The Body Keeps the Score. Viking.
  (Details how trauma suppresses self-reflective networks while prioritizing threat processing.)

More Sources

• Anosognosia – Aninda B. Acharya; Juan Carlos Sánchez-Manso.
• Anosognosia – Causes & Symptoms
• Anosognosia [PDF] – Shanti Silver & Elizabeth Sinclair Hancq
• Enduring Neurological Consequences of Psychological Betrayal Trauma
• Explaining Anosognosia – Lack Of Insight – In Psychotic Illnesses
• Anosognosia – NAMI. Anosognosia. National Alliance on Mental Illness.
• Anosognosia – Definition, Videos, and Stats
• LEAP Institute. Anosognosia: The Root of the Problem
• Cleveland Clinic. Dissociative Fugue: What It Is, Causes, Symptoms & Treatment
• Cleveland Clinic. Dissociative Amnesia
• Cleveland Clinic. Dissociative Identity Disorder
• Dissociative disorders in DSM-5 – Spiegel D, Loewenstein RJ, Lewis-Fernández R, et al. 
• Dissociative Disorders. Diagnostic and Statistical Manual of Mental Disorders – American Psychiatric Association. 
• Anosognosia and patterns of impaired self-awareness observed in clinical practice – Prigatano GP. 
• The evaluation of anosognosia in stroke patients – Orfei MD, Caltagirone C, Spalletta G. 
• Incidence and diagnosis of anosognosia for hemiparesis revisited – Baier B, Karnath HO. 
• Insight in first-admission psychotic patients – Fennig S, et al.
• Insight and Psychosis – Amador XF, David AS. 
• American Psychiatric Association. Schizophrenia Spectrum and Other Psychotic Disorders
• Possible mechanisms of anosognosia of hemiplegia – Heilman KM. 
• A Framework for Ethical Decision Making in the Rehabilitation of Patients with Anosognosia – Egbert AR. 
• Early prediction of long-term tactile object recognition performance after sensorimotor stroke – Abela E, et al.