Denial, anosodiaphoria, and emotional reactivity in anosognosia.

A central flaw in models of anosognosia is to consider metacognitive awareness and affective regulation and responsiveness as separate functional modular subsystems. This line of reasoning leads to an "either or" conceptualization of the probable causes of implicit awareness in anosognosic patients. Neuroscience research and clinical observations of patients suggest that anosognosia is often associated with a change in the affective status of the individual as well as a change in their explicit verbal descriptions of themselves. Studying anosognosic patients over time and including measures of psychological denial and anosodiaphoria are necessary when interpreting markers of implicit awareness.