Failure to acknowledge illness (denial of illness)

A lack of insight into one’s illness—known in the field as anosognosia (from the Greek for “lack of knowledge of the illness”)—refers to a person’s failure to recognize their own condition as an illness. This is common in eating disorders, psychoses, and other serious mental illnesses. In cases of psychosis, many affected individuals do not perceive themselves as ill, either temporarily or permanently.

Important for you as parents: Your child is not refusing treatment because they are stubborn or ungrateful. They simply do not see a problem. In the case of anorexia, many people view control over food, weight, and exercise as something positive—as a personal achievement—rather than as a symptom. It is precisely this distorted perspective that is part of the clinical picture of the illness.

In anorexia, a person’s perception of their own body changes. Even severely underweight adolescents see themselves in the mirror as too fat or believe they have problem areas that objectively do not exist. Fasting and exercise provide a sense of stability and success. As long as this feeling persists, any external criticism feels like an attack on something good.

In psychosis, the lack of insight is often rooted in a physical cause. Imaging studies point to changes in specific brain regions involved in assessing one’s own condition. In such cases, the lack of insight is not a personality trait but a consequence of the illness itself. This explains why mere arguments and evidence usually fall on deaf ears. At that moment, the brain does not classify the symptoms as symptoms.

You notice that your child is losing weight, withdrawing, or saying things that worry you. Your child doesn’t see any of this. This gap between what you observe and what your child is experiencing almost inevitably leads to conflict. Mealtimes become a source of arguments and crises that take a toll on the whole family.

Many parents then slip into a daily battle: explaining more, proving more, applying more pressure. The child feels misunderstood and shuts down. You become exhausted. It helps to know that a lack of understanding isn’t a parenting failure and can’t be resolved with the perfect argument. Your job isn’t to convince your child that they’re sick. Your job is to maintain the relationship and keep the door open to getting help.

Arguing over who’s right about the diagnosis rarely accomplishes anything. A more effective approach is one based on motivational interviewing: focusing on what matters to your child, rather than arguing against their resistance.

• Talk about specific difficulties your child might actually be experiencing: feeling cold, fatigue, trouble concentrating, arguments with friends. These topics often open the door more easily than the word “sick.”
• Stick to your own observations and concerns instead of assigning labels. “I’m worried because you’ve lost so much weight in four weeks” comes across differently than “You’re anorexic.”
• Set clear, calm boundaries at mealtimes without turning them into a daily power struggle. You can find specific strategies for this under “Avoiding Mealtime Escalation.”

For children and adolescents, the family is involved in treatment. In cases of anorexia, parents temporarily take over responsibility for nutrition in family-based therapy, precisely because the child is unable to assess the danger for themselves.

Seek professional help early on, even if your child doesn’t want to come with you. As parents, you are entitled to seek counseling on your own. For minors, you have a say in medical treatment decisions, and a doctor’s appointment is possible even if your child doesn’t think it’s necessary.

The situation becomes serious in cases of severe or rapid weight loss, circulatory problems, self-harm, or thoughts of taking one’s own life. In such cases, physical safety is at stake, and hospitalization may be necessary—in rare cases, even against the child’s will. You can read about what to expect in the section “Supporting Hospital Admission.” In cases of acute danger, call the medical emergency service (116117) or, in an emergency, dial 112.

Janike The team at Rückenwind will support you as parents through this time with coaching, strengthening your role and your resilience. However, a diagnosis, the assessment of physical risk, and any treatment must be handled exclusively by a child and adolescent psychiatry (KJP) facility or a medical or psychotherapeutic specialist.