Original articlePsychosocial consequences of developmental prosopagnosia: A problem of recognition
Introduction
Developmental prosopagnosia (DP) is a condition defined by severe difficulty in recognising familiar faces [1], [2]. Prosopagnosia was first studied as an acquired impairment arising as a consequence of brain injury, but it is now clear that severe face recognition problems can be present from childhood in the absence of any history of serious injury or disease. The reasons for failing to develop normal adult face recognition skills are not currently known, but appear to often include a genetic element [3], [4]. DP may also result from prenatal or early minor brain damage, or inadequate visual input during key developmental periods (for example, due to severe myopia, or suppression of input from the left eye in amblyopia) [5].
It is now believed that the prevalence of DP may be as high as 2% of the general population [4]. However, the condition is seldom diagnosed since people with prosopagnosia can identify people in many situations by using general appearance and manner (including hair and clothes), semantic features (e.g., bushy eyebrows), voice, and contextual cues. Those with lifelong face recognition problems are often unaware that face recognition is typically effortless and reliable for others. Even if individuals notice their relative deficiency in face recognition, they are unlikely to suspect that this is due to a neurological problem, since there is little public awareness of DP.
The case histories and self-reports of some people with prosopagnosia (both developmental and acquired) suggest that it can have a severe impact on people's lives, resulting in avoidance of social interaction, problems with interpersonal relations, damage to career, and even depression [1], [6], [7], [8], [9]. Since DP interferes with social interaction it might predispose some people to develop social anxiety disorder, which is characterized by fear and avoidance of social situations which have the potential to cause embarrassment or humiliation [10], [11]. It has even been suggested that DP could contribute to some cases of social developmental disorder [12], [13].
There have been no previous systematic investigations into the experiences of people with DP, and so the purpose of this study was to provide the first in-depth description of the psychosocial consequences of DP. Our aim was to explore the ways in which DP might contribute to poor psychosocial functioning and occupational disability. This analysis would supply evidence relating to (a) whether there may be a need to provide support for people with DP, since no form of professional support is currently available; and (b) what specific psychosocial problems DP poses, and therefore what forms of support may be needed. We used qualitative methods to achieve our aims, since these are well suited to exploring new topics in an open manner, developing a rich, contextualized understanding of the topic and gaining insight into the diverse experiences of different individuals [14].
Section snippets
Participants
Participants were recruited from a database associated with a website (http://www.faceblind.org) created by two of the authors (BD and KN). UK residents who had registered with the website and indicated their willingness to take part in future research (n=375) were invited by email to take part in a telephone interview.
To establish that these individuals had problems with face recognition, all potential participants were tested with a version of the Cambridge Face Memory Test (CFMT) [15]. This
Results
Accounts of the psychosocial consequences of DP included numerous descriptions of the immediate consequences of recognition failure, which caused significant social interaction difficulties. Because participants felt unable to provide a legitimate justification for these difficulties, they resulted in anxiety about offending others and feelings of inadequacy. The accounts also contained descriptions of longer-lasting psychosocial consequences, including changes in behavior to avoid occurrences
Discussion
This study sought to describe the ways in which DP might contribute to poor psychosocial functioning and occupational disability, in order to identify what forms of support may be needed by people with DP. Our participants all recounted recurring social interaction difficulties, some evidently traumatic. The inability to offer a socially acceptable explanation for recognition failure led to anxiety that others would perceive them as disrespectful or uncaring, often resulting in some degree of
Conclusions
Prosopagnosia clearly causes considerable difficulties for social interaction, which can have a lasting negative impact on social relations and psychological well-being. Many people with DP learn to adapt to and overcome these difficulties to a remarkable extent; indeed, a former UK Prime Minister is believed to have had DP [36]. Nevertheless, the potential for negative psychosocial consequences and occupational disability posed by DP is as great as that posed by conditions which are currently
Acknowledgments
We would like to thank the participants and Laura Germine for help with recruitment.
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