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Prosopagnosia, also known as Face Blindness, is a neurological disorder characterised by an inability to recognise faces.
People with prosopagnosia do not suffer from any visual abnormalities, nor do they have any memory deficits, instead their difficulty is in the specific recognition of faces. Some individuals are born with prosopagnosia and live their whole lives with the condition, whereas others develop it as a result of brain damage.
There are different degrees of impairment, with some common difficulties including:
- Inability to recognise their own face in a mirror or photographs.
- Inability to recognise familiar faces, such as family members or friends.
- Inability to discriminate or identify any differences between unfamiliar faces.
- Inability to differentiate between faces and objects.
- Difficulties recognising other stimuli, such as objects, cars or animals.
Those diagnosed with prosopagnosia may also have difficulties or deficits with other areas associated with facial processing, including:
- Difficulty judging age or gender.
- Difficulty recognising facial expressions and emotions.
- Difficulty following an individual’s gaze.
Some people may have difficulties with all of these, whereas others will only report a deficit with a couple of them. It is estimated that as many as 1 in 50 people have prosopagnosia, although many people will go through their whole lives without being diagnosed. Recent studies have suggested that between 2% and 2.5% of people have prosopagnosia. This equates to 1.5 million people in the UK alone.
Many people who are born with prosopagnosia never realise they have the condition, as they have never known any different. Furthermore, the lack of awareness of the condition has resulted in fewer diagnoses. In recent years, however, more awareness has been raised about prosopagnosia, resulting in more individuals approaching doctors or researchers to receive a formal diagnosis.
Many people with prosopagnosia will develop alternative strategies and use social cues to help them recognise people, such as focusing on their voice, hairstyle, clothing or even the way they move and walk. However, these strategies may not always be effective, for example if someone has a haircut, or you are meeting them in a restaurant, and they are already sitting down.
The impact of Prosopagnosia
The impact of prosopagnosia can vary greatly. Some individuals cope very well and develop complex coping strategies that help them to compensate for their difficulties. This helps them to function successfully in everyday situations.
Sometimes, people who have developed coping strategies may be less likely to seek a formal diagnosis, as they may believe the disorder is not having a negative impact on their life, or they may not even realise they have prosopagnosia.
For other individuals, prosopagnosia can have a profound impact on their lives. Being unable to recognise other people’s faces can result in difficulty forming relationships. This can impact both social and professional relationships.
Individuals with the condition may be concerned that they appear rude or disinterested when they do not acknowledge a person they know. Unfortunately, other people who are not aware of their condition may in fact think they are rude. This can cause feelings of embarrassment, stress and anxiety.
Some people with the condition may avoid social situations and may deliberately exclude themselves from situations that they may find difficult because of their condition. This could be because they catastrophise the social situation before it even occurs.
The anxiety and stress people feel as a result of face blindness can cause social isolation or even social anxiety. Some people who have prosopagnosia are also diagnosed with Social Anxiety Disorder. Social Anxiety Disorder often causes extreme fear in social situations and can affect an individual’s ability to talk to people, meet new people and be involved in social situations.
Some people with prosopagnosia also have a diagnosis of depression or report having depressive episodes. The higher incidence of depression could be because of social isolation, or feelings of loneliness, or could be related to the stress and everyday difficulties they may face when dealing with their condition.
Many people with prosopagnosia also experience difficulties with navigation or directions. This could be because they find it difficult to recognise places, objects and landmarks. It could also be related to the difficulties of processing distance or angles which are reported by some people with the condition.
Another unexpected impact can occur when watching films or TV shows. Some people with prosopagnosia report that they do not enjoy films or TV shows or do not understand them. Following the plot can be extremely difficult for a person who cannot recognise the characters.
In fact, unless the characters wear the same clothes throughout, or have another standout feature that the individual can focus on, following the plot may be almost impossible.
The symptoms of Prosopagnosia
Symptoms of prosopagnosia can manifest in a variety of different ways. Recognising symptoms in other people can be even more difficult – especially if they have developed their own coping strategies.
Symptoms of prosopagnosia can include:
1. Unable to recognise, or poor recognition of, familiar people, either in person or in photographs – This is one of the most common symptoms of prosopagnosia. Even if a person is a close family member, you may not be able to identify them from their face or distinguish who they are in a group. Some people with the condition are not able to identify their own child without focusing on other features or mannerisms.
2. Not recognising yourself in the mirror or photographs – This may not happen all the time and can instead be an infrequent occurrence. It is much more common when looking at older photographs or when looking at photographs that feature you and a person who looks similar to you, such as a sibling. Some people find that if they have a haircut or change another feature that they use to recognise themselves, they no longer recognise themselves in the mirror.
3. Using other distinguishing features, such as hairstyle, clothing or mannerisms to identify people – This suggests that you have developed strategies to help you cope with your face blindness. Some people do not realise that they do this or do not realise that it isn’t ‘normal’. If you find yourself focusing on other distinguishing features, or do not recognise a familiar person when a distinguishing feature has been changed, you may have prosopagnosia.
4. Differences in the way they describe faces – Although people with prosopagnosia can see individual features of a face, they may not see how that is different from other faces. For example, they may be able to tell you the eye colour is blue but may not notice that the nose is big, as they cannot differentiate the size of the nose compared to another person. They may also focus overwhelmingly on one feature, such as a long beard, as this is how they would usually discriminate between faces.
5. Confusion regarding characters and plots when watching films or TV programmes – Being unable to recognise faces can make it difficult to recognise characters. This can make it much harder to follow the plot and understand what is happening. Some movies or TV shows may be easier to understand. For example, cartoons are usually easier to follow as the differences between characters are usually more obvious, such as the characters being different animals or always wearing the same clothes.
6. Feeling disoriented in crowds – Being in a crowd of people may be disorienting for those with prosopagnosia as they are likely to find it more difficult to discriminate between different people in the crowd or recognise faces and emotions. If someone in a busy location waves or greets you in some way, it may be even more difficult to identify them.
7. Feelings of stress or anxiety in social situations – The knowledge that you may not be able to identify people you know and the subsequent embarrassment you might feel can cause stress and anxiety. Many people with face blindness worry that they will appear rude or disrespectful if they ‘ignore’ people they know. Some individuals will avoid social situations altogether.
8. Navigational difficulties – As some people with prosopagnosia also have difficulties recognising objects, buildings and places, navigation can be more difficult. Some people also have difficulty processing distance or angles, which can also increase their navigational difficulties.
9. Refusal or difficulty greeting people by name – If you consistently avoid using people’s names and instead use pet names or generic terms to avoid embarrassment when you do not know someone’s name, it could be that you have difficultly recognising people.
The causes of Prosopagnosia
Although there is no conclusive evidence, it is thought that prosopagnosia is caused by a deficit in the right fusiform, which is in the temporal lobe. This region is highly specialised for facial recognition.
Abnormalities, impairment or damage to this region could result in an inability to identify or differentiate between faces. The right fusiform consolidates the individual features of the face to create a complete image. This image is then used by other regions of the brain to match the face to a person’s identity.
There are two main types of face blindness:
This is sometimes known as ‘Congenital Prosopagnosia’. Individuals with developmental prosopagnosia are likely to have been born with the condition. It is usually caused by neurodevelopmental impairments.
This type of prosopagnosia can be more difficult to detect as those with the condition have never been able to recognise faces, so the impairment may not be obvious to them. Many people will have developed coping strategies that they rely on throughout their lives. These strategies may make their face blindness even more difficult to detect.
Many of those with developmental prosopagnosia will have normal intellectual and visual functions. There seems to be a genetic link for developmental prosopagnosia. Those with the condition often report family members who also experience some facial processing impairments. In fact, many of those diagnosed with the condition will have at least one first-degree relative who also experiences difficulties.
In the past, it was believed that all cases of face blindness were the result of brain damage. Almost all documented cases featured individuals who acquired prosopagnosia later in life as a result of a stroke, degenerative disease, head injury or another form of brain damage.
This type of prosopagnosia is usually easier to detect and diagnose as those that develop the condition have experienced normal face recognition previously and are more likely to notice the impairment.
Face blindness has also been linked with other developmental disorders, including autism spectrum disorder (ASD). Incidences of prosopagnosia are more common in those with ASD compared to the general population. Other developmental conditions that have been linked with prosopagnosia include Turner’s syndrome and William’s syndrome.
It is difficult to find accurate statistics regarding how many people have the two types of prosopagnosia, as many cases go undiagnosed. It is thought that as many as 1 in 50 people have developmental prosopagnosia, whereas acquired prosopagnosia is much rarer.
Diagnosing and treatment
How is Prosopagnosia Diagnosed?
If you have difficulties recognising faces or have any of the symptoms we have listed today, your GP or primary care physician may refer you to a Neuropsychologist or Neurologist. Depending on where you live, you may also be referred to a researcher at a university who specialises in prosopagnosia.
You are then likely to have a prosopagnosia test that will assess and evaluate your ability to recognise facial features. There will be several components to the assessment, and you will likely be asked some questions about how you recognise faces in your everyday life.
In the prosopagnosia test, the Neuropsychologist or researchers may evaluate your ability to:
- Memorise and recognise unfamiliar faces.
- Identify similarities or differences in the facial features of a set of faces.
- Recognise famous faces.
- Detect emotional expressions and facial expressions.
- Assess additional information such as age and gender.
There is currently no prosopagnosia test that can conclusively diagnose a person with face blindness. The score you receive in the test will usually be combined with the opinion of the doctor or researcher and it is they who will ultimately decide whether you qualify for a diagnosis.
The doctor or researcher will first attempt to determine whether the symptoms you report could be explained by another condition, such as a developmental, visual or neurological condition. If this has been ruled out, a diagnosis of prosopagnosia becomes much more likely.
How is Prosopagnosia treated?
There is currently no treatment for prosopagnosia. Researchers around the world are currently developing training programmes that may help to improve facial recognition.
The Centre for Face Processing Disorders at Bournemouth University has developed a training programme and practise the use of temporary pharmaceutical intervention to help improve face blindness. Anyone who is diagnosed, or believes they have prosopagnosia, can apply to take part in their research.
Treatment may also vary depending on the type of prosopagnosia you have. For those with acquired prosopagnosia, treatment and the success of the treatment may depend on the age that the brain damage occurred, the type and severity of the damage and how quickly they received treatment.
One of the most effective ways to deal with the symptoms of face blindness is to improve any coping mechanisms or compensatory strategies that could improve your facial recognition. Although these strategies are not always reliable, they can help to reduce some of the anxiety surrounding face blindness. Face Blind UK have some helpful advice on some coping strategies you could implement.