Understanding Prosopagnosia

Some may joke about not being able to place a face, but a small percentage of people have a very real condition called prosopagnosia or face blindness. While reports of the disorder date back to the 19th century, it would take a 1947 publication to bring this rare disorder to the attention of the neuroscientific community. Studies suggest one in 50, or two percent of people, have this disorder.

What is Prosopagnosia?

Prosopagnosia is the severe inability to recognize people by face, both familiar and unfamiliar. This goes beyond not being able to put a name to a face. For people with face blindness, faces appear blurry, like an unfocused photo, or completely blank. Some are unable to discern age or gender as well, and in many cases, may even be unable to recognize their own reflection.

Prosopagnosia Types

There are two types of prosopagnosia: developmental or congenital, and acquired. Those with developmental prosopagnosia never develop the ability to recognize faces. Research suggests that there may be a genetic component, as those with developmental prosopagnosia generally have at least a parent or sibling who is also unable to recognize faces. Acquired prosopagnosia is mostly found in adults and is a result of brain injury.

Causes of Acquired Prosopagnosia

Acquired prosopagnosia is rare and is the result of brain damage from trauma, such as stroke. The fusiform gyrus, a fold in the brain that is part of both the temporal and occipital lobes, is responsible for recognizing faces. Damage to the right fusiform gyrus, specifically, can lead to acquiring this condition.

Apperceptive vs. Associative Prosopagnosia

There are two classifiable degrees of severity of this condition. Associative prosopagnosia is the common form of the disorder. People with this variety cannot identify specific people but can identify the differences between faces and may even be able to discern gender and age. Apperceptive prosopagnosia is the more severe of the two. These individuals cannot recognize familiar or unfamiliar faces but may be able to tell someone’s age or gender, suggesting they have some facial reconstruction ability.

Hallmark Symptoms

Symptoms of this condition range from mild to severe. Aside from the inherent inability to recognize faces, people with face blindness consistently avoid using people’s names and may not introduce themselves to anyone or two people to each other. They may become lost in large crowds. When meeting someone who appears to know them, people with prosopagnosia often ask generic questions to help them identify the person to whom they are speaking. The necessary adjustments such people must make sometimes lead others to assume they have other developmental disorders or disabilities.

Associated Disorders

Because being able to identify faces is a feature of memory, prosopagnosia has a link to other disorders that affect a similar region in the brain, including topographical disorientation, achromatopsia, and left hemianopsia. Topographical disorientation is when someone has difficulties identifying familiar landmarks and environments. Achromatopsia is total color blindness while left hemianopsia is the loss of vision on the left side of the vertical midline in each eye. All of these disorders occur due to damage to temporal and occipital lobe regions.

Diagnosing Prosopagnosia

Prosopagnosia diagnosis is not standardized. Doctors must use neuropsychological assessments including BFRT and RMF. The Benton Facial Recognition Test is a three-part test to match unfamiliar faces. The Warrington Recognition Memory for Faces is a subset of the Recognition Memory Test, which involves testing patients on verbal and nonverbal items. Some specialists strongly contest both tests, but they inform a physician’s evaluation and do not act as an absolute diagnostic tool.

Social Difficulties

Social activities such as dating are already challenging, but for people with prosopagnosia, they are even more difficult. Face blindness means individuals cannot readily recognize their dates’ faces or associated facial cues. Watching movies or TV is also complicated. Because they cannot tell the difference between each character’s appearance, following plots and storylines becomes extremely challenging.

Psychological Challenges

Because prosopagnosia is so selective and is still under investigation in the medical community, those with the disorder may experience anxiety and embarrassment over the limitations of their condition. Guilt and feelings of failure are also common, and as a result, many people avoid social gatherings. This isolation can lead to depression, loss of self-confidence, and low self-esteem, which can lead to roadblocks in both professional and personal spheres.

Living with Prosopagnosia

Successfully living with this condition involves developing strategies to compensate and navigate. One common way is to learn alternatives for identifying people, using unique attributes such as voice, clothing, or markings like tattoos. In some cases, ethnicity is a factor — some people with prosopagnosia find it easier to recognize certain ethnic groups. There are some support groups on social media for people with this condition, as well as professional organizations with resources.