ABSTRACT

Brain injury can have a profound impact on people's abilities, lifestyle and sense of self. One of the most challenging issues to address in rehabilitation is how to manage impaired self-awareness. Clinicians are often concerned about the impact of developments in self-awareness on psychological well-being. In particular, heightened awareness of deficits is associated with negative self-appraisals and emotional distress. Self-awareness and self-identity are related yet distinct terms that refer to subjective experience of one's self. At a basic level, self-awareness refers to the capacity to consciously perceive one's own actions, abilities and states and to distinguish these from others, and the environment. In the context of brain injury, impaired self-awareness refers to lack of knowledge of changes in personal abilities and the implications of these changes for daily living and the future. Psychosocial explanations for impaired self-awareness emphasise how underreporting of problems after brain injury may reflect the motivated use of denial to protect against emotional distress.