People who suffer from prosopagnosia are unable to recognize a person they know personally by their face. In German, this condition is also called face blindness.
What is face blindness?
There are several different forms of prosopagnosia: apperceptive, associative, and congenital. The congenital form is congenital face blindness. Most affected people are not even aware of their condition because they consider this condition normal. They cannot comprehend that other people can perceive faces differently. People with apperceptive prosopagnosia are not able to estimate the age of the person based on a face. They are also unable to read the person’s gender from the face. In addition, they have difficulty inferring the person’s emotions from facial features. Persons suffering from associative prosopagnosia, on the other hand, can infer the person’s age and gender when looking at a face. Concrete attribution, such as recognizing prominent people, is also not possible for them.
Causes
The cause of congenital prosopagnosia, i.e., the congenital form of face blindness, is not yet fully understood. An altered genetic information could be considered as a trigger. For example, the mutation of a gene that is responsible for the function of the brain nerve cells. In severe cases of face blindness, it may also be impossible to distinguish between people and objects. In this case, several areas of the brain are often damaged. The congenital form of face blindness is a hereditary disorder and is sometimes accompanied by autism or Asperger’s syndrome. The cause of apperceptive and associative prosopagnosia is damage to the brain. This can be caused by a disease such as a stroke or by a traumatic injury. The degree of damage here affects the severity of the facial blindness.
Symptoms, complaints, and signs
The clinical picture of prosopagnosia decides the symptoms associated with this partial power deficiency. For example, first of all, almost all sufferers of face blindness are able to recognize a face. The other information that can be obtained from the face varies. Also, some face blind people can only remember faces for a very short time. Apperceptive prosopagnosics cannot infer information such as age or gender from a face. Reading out emotions causes them severe problems. A shown face of a known person does not establish a link to other information about this person. Associative prosopagnosics can distinguish faces, can match gender and age, but also cannot retrieve more detailed information. Congenital prosopagnosics may experience their face blindness in a variety of ways. It ranges from a complete inability to recognize faces to difficulties in matching. However, since this is congenital, compensatory strategies are usually created, which is why the limitations caused by this are minor. If there are also problems with the recognition of emotions, the behavior occasionally reminds of the symptomatology of Asperger. Signs of a form of face blindness are difficulties to keep faces in mind and the inability to infer a person from a face. It can also be a sign when people who are actually familiar are difficult to recognize in an altered context.
Diagnosis and course
Diagnosing congenital face blindness is not easy in practice. Affected individuals usually automatically develop ways to recognize people around them by other features. For example, a particular hairstyle, clothing or even the voice and movements are assigned to a particular person. Outsiders often do not notice that it was not the person’s face that was decisive for recognition. If frequent confusions of known persons occur, this can be a sign of prosopagnosia. Often, the affected persons do not look into the faces of their fellow human beings, because this seems to be completely uninteresting for them.However, a young child’s lack of eye contact may also indicate other conditions, such as autism, and is not a sure sign of face blindness. In forms of face blindness acquired through accident, injury, or disease, affected individuals and caregivers recognize that perception and the ability to match people to faces have changed.
Complications
Visual agnosia or prosopagnosia is a severe acquired or congenital symptom. Affected individuals must expect complications in their lives throughout their lives. Social interaction is problematic in the case of congenital face blindness. Those affected do not recognize people they should know. In acquired face blindness, recognizing familiar people has become impossible. Affected persons must learn to recognize their counterparts on the basis of altered strategies, otherwise social isolation is imminent. The biggest problem is that the affected persons are not recognizable as face-blind for their fellow men. This leads to numerous misunderstandings and complications. In prosopagnosia, those affected are also unable to correctly match objects, although they are often highly gifted. In the most severe form of face blindness, acquired apperceptive prosopagnosia, sufferers cannot even correctly match the age or gender of the person opposite them. Often triggered by severe head injuries, strokes or brain tumors, face-blind people may experience additional complications. These are caused by the brain damage present. Depending on the severity of prosopagnosia, the severity of possible complications may also vary. In the most severe degree, those affected can only recognize shadowy shapes. For example, parking meters can be mistaken for faces because of their shape. They are mistaken for children or teenagers because of their size. Myriad problems arise from this.
When should you go to the doctor?
If abnormalities in perceptual processing are noticed in everyday life, a review of sensory impressions is necessary. Prosopagnosia is not noticed for a long time in many cases. The disease already exists at birth, so that the affected person is initially not aware of the limitations of vision. Frequently, the person is recognized as a matter of course via the voice, the physique or the clothing of the person opposite. Therefore, the help and support of persons from the close environment is often needed in the case of the disease. If the affected person cannot sufficiently describe the face of another person when asked directly, a doctor must be consulted. Prosopagnosia is limited to a disorder of face recognition. Therefore, all other visual sensory impressions can be fully processed and recognized. This makes it difficult in everyday life to detect the existing disorder. Children should always have regular check-ups with a doctor during their first years of life. This is especially true if the disorder has already occurred within the family.
Treatment and therapy
There is no therapeutic option by which face blindness can be remedied. However, affected individuals can learn certain strategies to be able to reliably identify people in their environment. Instructions for this can be given by a neuropsychologist. To achieve optimal results, the skills must be trained again and again. To recognize persons, many other elements can be used. These can be, for example, the voice, gait, stature or posture of the person. Gestures can also be included. In addition, information about the clothing, hairstyle or physical features, such as scars, can be helpful. Certain objects of the person, such as the person’s watch, jewelry, or glasses, also facilitate recognition. Face-blind people who practice these skills are often able to recognize certain people in the environment in which they usually encounter them. For example, they can tell their colleagues apart in the office. However, if they meet these people in a different place, such as a shopping mall or a restaurant, recognition takes much longer or is sometimes even impossible. People with the congenital form of prosopagnosia benefit if the condition is detected very early. Parents and other caregivers can then specifically promote the learning of the alternative assignment possibilities.
Prevention
Prevention is not possible for any of the three forms of prosopagnosia described. All that can be done is to try to minimize the known risk factors for stroke and other diseases by adopting a healthy lifestyle. Many head injuries can be prevented by wearing crash helmets.
Follow-up
The extent of any prosopagnosia present cannot be reduced by specific follow-up care. The main goal now is for affected individuals to manage their daily lives well with facial blindness and lead relatively normal lives. In the case of congenital prosopagnosia, it is much easier to deal with the limitation than when the disorder has arisen, for example, as a result of an accident or illness. A similar situation can be observed with other disabilities, such as blindness or deafness. Patients who were born with face blindness have already acquired other strategies in early childhood with which they can tell different people apart to a certain extent. This also explains why many prosopagnosics are often not even aware that they are affected by this disorder. In such cases, therefore, follow-up care is usually not necessary and is also usually not desired by the affected person. If prosopagnosia occurs at a later stage, on the other hand, alternative recognition strategies have to be learned laboriously. In this case, targeted training can help under certain circumstances, but it is not part of standard aftercare. In some regions and on the Internet, there are also self-help groups for those affected. Here, patients have the opportunity to exchange information with other prosopagnosiacs. Already the certainty of not being alone with the restriction can significantly improve the quality of life of those affected.
Here’s what you can do yourself
Prosopagnosia (face blindness) cannot be cured. However, many affected individuals develop strategies early on to compensate for the inability to recognize faces by developing other skills. Through much training, prosopagnosics can learn how to recognize a corresponding person using other features. Such features include voice, gait, or gestures. Often the hairstyle, certain scars or birthmarks, certain glasses and other features also play a role. Sometimes a written or mental list also helps to find out which persons can be met at certain places with certain characteristics. Then, if other characteristics match, the person can be identified. Developing these skills is imperative for individuals to navigate the social environment. Training in these skills can be done under the guidance of a neuropsychologist. In order to avoid exclusion, it sometimes also helps to disclose the problems within the family or among trusted acquaintances. At the very least, this can refute accusations of being unkind, rude, or ignorant. There are also self-help groups for prosopagnosics, where experiences in dealing with the environment can be exchanged. Furthermore, the exchange of interesting strategies for recognition also takes place here. Among other things on the Internet there is the possibility to search for these self-help groups and to make contacts.
