Prosopagnosia (Face Blindness)

What is prosopagnosia?

Prosopagnosia (pro-so-pag-no-zee-ah) is a condition where your brain can’t recognize faces or facial expressions in spite of having normal vision. This can make it hard for you to recognize the faces of familiar coworkers, friends or even close loved ones.

Prosopagnosia falls under a family of conditions, agnosias, which interfere with how your brain processes information from your senses. Most of these conditions happen because of damage to your brain from any number of causes. However, prosopagnosia can also happen without that damage.

Who does it affect?

Also known as face blindness, prosopagnosia can happen in two different ways, either as an acquired condition (meaning a person develops it because of damage to part of their brain) or as a congenital problem (this means a person is born with it). Available research suggests the congenital version of this condition might be genetic, as it seems to run in some families.

How common is this condition?

Experts aren’t sure exactly how common this condition is in either form. There’s little to no data available for acquired prosopagnosia. There is some data available for congenital prosopagnosia (also known as developmental prosopagnosia), with some research showing as much as 2.5% of people have it to some degree.

However, there’s disagreement on whether or not that percentage is accurate. That disagreement exists partly because this condition is so difficult to diagnose. Another part of that disagreement is that there's no clear line between this condition and having a below-average ability to remember faces.

How does this condition affect my body?

Prosopagnosia is a condition that affects your brain only. However, it doesn't just interfere with your ability to recognize faces. This condition is often a source of anxiety for people. That's because many feel embarrassed or ashamed that they struggle to remember faces while others have no trouble with it. That shame and anxiety lead many with this condition to avoid social situations.

What are the symptoms of prosopagnosia?

There are two forms of prosopagnosia, and the symptoms depend on the form. The two forms are apperceptive and associative:

• Apperceptive prosopagnosia. This is when you can’t recognize a person’s facial expressions or other non-verbal cues.
• Associative prosopagnosia. This form is when you can’t recognize a person’s face even if you’re familiar with them. You can still recognize them by other means like their voice or the sound of how they walk.

What causes prosopagnosia?

The causes of the condition depend on how they happen. Most agnosias are acquired, meaning you develop them at some point in your life. The most common reason people develop agnosias, including prosopagnosia, are injuries to their brain. These injuries, called lesions, can happen for many different reasons.

People with congenital prosopagnosia don't have a brain injury that explains this problem. There are only a few ways — some confirmed and some not — that congenital prosopagnosia can happen.

Acquired prosopagnosia

Potential causes of brain lesions that cause prosopagnosia include, but aren’t limited to, the following:

• Alzheimer’s disease.
• Brain tumors (including cancerous and non-cancerous growths).
• Dementia.
• Developmental disorders.
• Head injuries such as traumatic brain injuries (TBIs).
• Cerebral hypoxia (brain damage from lack of oxygen).
• Infections (such as those that cause encephalitis).
• Seizures and epilepsy.
• Stroke.
• Toxins like carbon monoxide poisoning.

Congenital prosopagnosia

Researchers have identified several DNA mutations that are more common in people with congenital prosopagnosia. Experts first suspected this condition had a genetic connection because it tends to run in families.

But some of the mutations aren’t inherited. These “de novo” mutations — meaning new, spontaneous mutations that neither parent had — also seem to happen more frequently in people with congenital prosopagnosia.

Prosopagnosia might also have a connection to other developmental conditions like autism spectrum disorder. However, more research is necessary to confirm this.

Is it contagious?

Prosopagnosia isn't contagious. While some of the infections that can ultimately cause it are contagious, having one of these infections doesn't guarantee that you'll develop this condition.

How is prosopagnosia diagnosed?

Diagnosing prosopagnosia takes a combination of a neurological exam, asking questions about your history, diagnostic imaging and testing.

The neurological exam and tests will likely include:

• Sensory tests. These tests make sure that your vision works correctly and rule out any vision-related conditions.
• Cognitive and mental status tests. These tests ensure the problem isn't with your mental abilities, including your ability to think, focus or problem-solve.
• Memory tests. This ensures that the problem with recognizing faces isn't because you have a problem with your memory.
• Face recognition tests. These test your ability to identify, remember and distinguish faces. You may take more than one of these. Healthcare providers might also ask you to look at pictures of famous people. They may also have you identify specific facial expressions if they suspect you have the apperceptive form of this condition.
• Object recognition tests. Prosopagnosia has many similarities with other types of visual agnosia. Object memory tests help ensure that your condition isn't one of these agnosias. These tests can also determine if you have more than one kind of agnosia.

What diagnostic and imaging tests are likely for this condition?

The following tests are possible for prosopagnosia.

• Computerized tomography (CT) scan.
• Electroencephalogram (EEG).
• Evoked potentials test.
• Genetic testing.
• Magnetic resonance imaging (MRI).
• Spinal tap (lumbar puncture).

How is prosopagnosia treated, and is there a cure?

Prosopagnosia isn’t curable directly. However, some of the causes of acquired prosopagnosia are curable. Resolving those problems might help with this condition. Prosopagnosia is usually permanent, and these recoveries aren't common.

In cases of congenital prosopagnosia or where acquired prosopagnosia is permanent, there are still options to help you compensate and adapt. Ultimately, healthcare providers will show you ways to work around your condition, limiting its impact on your life.

What medications and treatments are used?

The treatments and methods depend on what the goal is. The treatments for underlying conditions that cause prosopagnosia are different from treatments that help a person learn to adapt to and live with the condition.

Treatments for conditions that cause prosopagnosia

These treatments address the underlying problem that caused your prosopagnosia. They may or may not help your prosopagnosia itself. The possible treatments include, but aren’t limited to, the following:

• Medications. These range from antibiotics for infections to anti-dementia medications.
• Surgery. Prosopagnosia can happen when tumors press on certain areas of your brain. Removing those tumors with surgery, when possible, can alleviate pressure on your brain and hopefully let it function normally.

Treatments to help you adapt to prosopagnosia

Even in cases where recovery is possible, healthcare providers may recommend that you participate in therapy and rehabilitation programs that specialize in helping with conditions like prosopagnosia. Those programs aim to help you adapt and compensate for this condition. The ways they teach that include:

• Perceptual training. This method works by teaching you how to look for and remember the features of a person’s face. It can also teach you to identify people by certain facial features. This can also help teach you to identify facial expressions and cues if you have apperceptive prosopagnosia.
• Coping strategies. This type of rehabilitation focuses on helping you use hearing and context clues to identify people. Improving your ability to identify people by voice can help you overcome your problems with identifying them visually.

Complications/side effects of the treatment

The complications from medications, surgery or other treatments depend strongly on the treatments themselves, as well as the severity of your condition, your overall health and other factors. Your healthcare provider is the best person to tell you what side effects or complications you should watch for or expect.

How do I take care of myself/manage symptoms?

If you develop prosopagnosia partway through your life, it isn't a condition you should try to diagnose or treat yourself. It is difficult to make this diagnosis, even for trained professionals. It may be related to serious neurological conditions, so you should see a healthcare provider.

Many people with congenital prosopagnosia don’t realize they have it because they’re used to it, and they’ve had their whole life to develop ways to adapt to it.

If you’ve had prosopagnosia all your life and learning about the condition makes you suspect you have it, you should talk to a healthcare provider. They can answer questions and refer you to a specialist if necessary, so you can get answers about what you experience. They can also refer you to programs that can help you adapt to this condition, so it is less disruptive to your life.

How soon after treatment will I feel better?

The time to recover after treatment depends strongly on the severity of your case, the underlying condition and the treatments you received. In some cases, prosopagnosia improves or goes away after a few months, but it can also take up to a year. In most cases, however, this case is permanent to some degree.

How can I prevent prosopagnosia from developing or reduce my risk of developing it?

Many of the conditions that cause acquired prosopagnosia happen unpredictably, so you can’t prevent them. All you can do is reduce your risk of having these conditions or circumstances. The best things you can do include the following:

• Eat a balanced diet and maintain a weight that's healthy for you. Many heart and circulatory conditions, especially stroke, can damage areas of your brain, causing problems like prosopagnosia. Preventing stroke and similar conditions is one way to prevent this condition or reduce your risk of developing it.
• Don’t ignore infections. Don’t wait to get treatment for eye and ear infections. Preventing these infections from spreading is vital because they can cause serious or even deadly effects if they reach your brain. They can also cause damage that leads to prosopagnosia.
• Wear safety equipment. Head injuries are a major cause of all agnosias, including prosopagnosia. Safety equipment at work or play is a must-have to avoid these injuries.
• Manage your health conditions. Several chronic conditions can result in brain damage, such as epilepsy or sleep apnea. By managing those conditions, you make it less likely that you’ll develop brain damage that causes prosopagnosia.

What can I expect if I have this condition?

In most cases of acquired prosopagnosia and all cases of congenital prosopagnosia, this condition is permanent. However, the condition isn't dangerous to your health or safety on its own. But it does have the potential to affect your mental health. That's because most people with this condition experience anxiety or fear of social situations where they might struggle to recognize someone they’ve met previously.

What’s the outlook for this condition?

While this condition is permanent and not directly curable, it’s not dangerous to your health and safety. It’s often treatable. In many cases, it’s possible to learn alternate strategies to help you identify people, which can help you in social situations.

How do I take care of myself?

Your healthcare provider is the best person to guide you in living with prosopagnosia. They can provide resources and refer you to specially trained, experienced healthcare providers or qualified programs that can help you adapt to and live with this condition. They can also help monitor this condition to see if it changes in any way.

Mental health care

People with prosopagnosia commonly struggle with anxiety in social situations. This is because of feelings of shame or embarrassment at struggling to recognize people. Some people will go so far as to isolate themselves and limit social interactions, leading to depression and other problems.

Your healthcare provider can also help refer you to behavioral health specialists, such as counselors or therapists. Those trained experts can help you cope with the stress and anxiety that often come with this condition.

When should I see my healthcare provider?

Prosopagnosia isn’t a common condition overall. If it develops quickly, you should call your healthcare provider and schedule an appointment. That’s because a fast onset of this condition is possible when the condition happens because of problems like a brain tumor.

You should also talk to a healthcare provider if you notice this problem because it’s interfering with your life. This is true whether you've had problems identifying faces all your life or if this is a new development.

When should I go to ER?

You should get immediate medical attention if you notice a very sudden inability to recognize faces, especially along with any symptom of a stroke or brain injury. The symptoms of stroke include:

• Weakness, numbness or paralysis on one side of your body.
• Slurred or garbled speech.
• Droop on one side of your face or vision loss in one eye.
• Trouble swallowing.
• Confusion, irritability or agitation.
• Trouble focusing, thinking or remembering.
• Sudden headache that is severe or keeps you from going about your usual activities.

A note from Cleveland Clinic

Prosopagnosia can be a source of major anxiety for people who experience it. Many experience shame, anxiety or embarrassment because they struggle to recognize people in social situations. This condition is usually permanent, but modern medicine can help treat underlying conditions, which may help this condition improve. Therapy and rehabilitation can also help you learn ways to compensate for this condition, limiting its impact on your life. That way, you can rest a little easier because you can handle social situations without worrying about this problem.