1.4. Describe how insight impairment can affect a person’s behaviour

This guide will help you answer 1.4. Describe how insight impairment can affect a person’s behaviour.

Insight means having a clear awareness and understanding of your own condition, behaviour, thinking, and feelings. In health and social care, insight often gets discussed in the context of mental health, neurological conditions, or brain injuries. When a person lacks this awareness, this is called insight impairment.

Insight impairment can relate to:

• Not recognising personal health problems
• Failing to see the consequences of actions
• Not realising when extra support is needed

People with insight impairment might truly believe they are acting normally or that nothing is wrong, even if the evidence says otherwise. This lack of awareness can affect many areas of life, especially behaviour.

Causes and Types of Insight Impairment

Insight impairment can result from different conditions, such as:

• Brain injuries (for example, from trauma or stroke)
• Mental health conditions (such as schizophrenia or severe depression)
• Dementia
• Certain learning disabilities
• Neurological challenges, for example, Alzheimer’s disease

The level of insight impairment can differ. Some people might have partial insight, where they sense something is not right but cannot explain it. Others may have no insight at all.

Behavioural Changes from Insight Impairment

A person’s behaviour can change in many ways due to insight impairment. Workers need to recognise these changes so that the right support can be given.

Denial of Illness or Condition

Some people with insight impairment might insist that they are healthy. They may deny having any problems, even if the issue is clear to family, friends, or staff.

This denial is not stubbornness or an attempt to be difficult. It is a real lack of awareness. The person is not pretending—they genuinely cannot see their illness or disability.

Behaviour examples:

• Refusing medical support or medication
• Ignoring dietary restrictions or health advice
• Insisting they do not need help with tasks they cannot perform safely

Poor Decision-Making

Without insight, a person might not see risks for themselves or others. Their ability to weigh up the consequences of actions reduces.

Possible behaviours:

• Taking unsafe risks, such as leaving the house unsupervised when confused
• Handling sharp objects or kitchen equipment unsafely
• Trying to drive a car, even if their condition makes it dangerous
• Spending money unwisely, with little regard for bills or living costs

Poor decision-making can increase the risk of harm. Staff must remain vigilant and support people to reduce these risks.

Lack of Engagement with Support

Some people may not attend appointments or refuse to take prescribed medication. Others may turn down occupational therapy, physiotherapy, or care plans.

This happens when the person does not see the point of the support. If they do not believe they have a problem, they cannot value the support offered.

This leads to:

• Missed appointments
• Refusing home visits
• Non-compliance with treatment

Frustration and Anger

Confusion about support or ongoing interventions can cause frustration. Repeated attempts to explain things, when the person lacks insight, might feel like nagging.

They may feel that people are interfering or trying to control their life, which can lead to:

• Short tempers
• Outbursts of anger
• Aggressive responses
• Withdrawal from friends, relatives, or carers

Sometimes, the person blames others for problems caused by their own actions or condition.

Social Effects

Insight impairment can lead to behaviour that others find odd or inappropriate. The person may not pick up social cues, or may fail to apologise when their actions upset someone.

This can result in:

• Arguments
• Social isolation
• Breakdown of friendships
• Family conflict

Self-Neglect

Failing to recognise declining health can mean self-care is neglected. The person may not wash, eat properly, or keep themselves safe. This is often because they genuinely do not think there is a problem.

Possible effects:

• Wearing dirty clothes
• Failing to eat, drink, or use medication properly
• Refusing help with personal care
• Ignoring signs of infection, injury, or weight loss

Lack of Motivation for Recovery or Self-Improvement

Some people with insight impairment lose motivation to stick to treatment plans. If you do not believe you are ill or disabled, following steps for recovery can feel pointless.

Signs of this behaviour:

• Dropping out of therapy
• Not following rehab exercises
• Ignoring advice from health professionals

Communication Issues

Insight impairment sometimes affects how people talk about their health and how they interact.

• Repeating the same story without realising
• Dismissing offers of support as unnecessary
• Talking over the top of others
• Failing to ask for help when in difficulty

Insight impairment can also affect how people interpret what is said to them. They may not understand why daily routines have changed or why staff make certain decisions.

Impact on Daily Life

Behaviour changes caused by insight impairment can have wide-reaching effects.

• Increased risk of accidents and injuries
• Neglect of essential needs
• Missed opportunities for social connection
• Higher stress for carers and family
• Greater pressure on health and social care workers

Early identification of these behavioural signals can help staff plan care that is respectful, safe, and effective.

Professional Responses to Insight Impairment

When working with a person with insight impairment, staff need to adjust their approach. Using patience and good communication, support can be adapted to reduce risks and promote wellbeing.

strategies for supporting people

• Use clear, simple explanations for actions and routines
• Avoid confrontation or argument about whether the person is ill
• Focus on keeping routines regular and predictable
• Use visual reminders, such as notes or picture cards for tasks
• Encourage gentle participation in support activities
• Respect the person’s dignity and privacy
• Involve family and friends in planning whenever possible
• Celebrate small steps towards engagement

Importance of Documentation

Recording changes in behaviour is critical. This helps the wider team adapt care plans and spot trends or warning signs early. Detailed, regular notes about daily behaviour and incidents help flag increasing risk or changes in illness.

Legal and Ethical Considerations

Insight impairment can mean the person sometimes lacks capacity to make certain decisions. It is not fair or legal to assume they cannot decide for themselves across all areas.

Staff are guided by the Mental Capacity Act 2005. This means capacity must be assessed for each decision, at the time it is made. The least restrictive support must always be used to help the person to make their own choices where possible.

Where a person cannot make a safe choice because of insight impairment, staff can support in the least intrusive way, always acting in their best interests.

Example:

If someone with dementia insists on going for a walk without safe shoes or a coat in winter, staff might gently offer a choice of two jackets, rather than insist the walk cannot happen.

Insight Impairment in Mental Health

Insight impairment is very common in mental health conditions like schizophrenia or bipolar disorder. A person may not accept the diagnosis, even if they become unwell regularly. With time, some people gain insight, while others do not.

Behavioural effects can include:

• Refusal to take medication
• Lack of attendance at appointments
• Distrust towards professionals
• Paranoia about support

Workers need to build trust, avoid judgement, and focus on practical support to build engagement over time.

Insight Impairment with Brain Injuries and Dementia

Brain injuries, stroke, or types of dementia can harm awareness in specific ways. Memory may be affected, or the person may forget instructions or fail to notice their physical limitations.

Behaviour might include:

• Attempting to climb stairs without mobility aids
• Eating foods warned against by dieticians
• Trying to go out alone if wandering is a risk

Family and staff can become frustrated, believing the person is being stubborn. Information and training can help everyone understand the difference between insight impairment and choice.

Supporting Staff and Family

Working with someone who has insight impairment is demanding. Workers can feel powerless or frustrated if support is refused or misunderstood.

It helps to:

• Attend supervision regularly
• Share worries with senior staff
• Use team meetings to share ideas
• Access training resources
• Keep communication open with relatives

Families need support and information. Understanding why a loved one behaves in this way can ease guilt and help improve relationships.

Case Study Example

Peter’s Story

Peter is 74 and had a stroke six months ago. Before his stroke, he was independent, enjoyed gardening, and managed his own bills.

Since leaving hospital, Peter denies he has any ongoing problems. He tries to walk without his stick and has fallen twice. He has not paid his rent for several months, as he says he does not need help with money.

His daughter worries, but Peter grows angry when she raises her concerns. He refuses to let his care worker help with bathing, saying he can manage fine alone.

Staff work closely with Peter’s daughter, use short reminders about routines, and praise his efforts. Over time, Peter starts to accept help for his bills, though he still insists he is independent.

Key Points:

• Peter’s lack of insight leads to unsafe behaviour
• Denial is genuine, not deliberate
• Support balances safety with respect for Peter’s wish to be independent

Final Thoughts

Insight impairment changes how a person responds to illness, risk, company, and support. The effects can be subtle or obvious, temporary or long term. People may refuse help, deny illness, make unsafe decisions, or become angry and withdrawn. Self-neglect and social problems are common.

Staff and families need patience and strong teamwork. Using clear communication and flexible support improves safety and wellbeing. Recording behaviour and adapting support are both key. Insight impairment is always rooted in genuine lack of awareness, not misbehaviour.

Understanding this helps workers provide kind, effective care.