عوارض روانی اجتماعی پروزوپاگنوزیا تکاملی: مشکل شناسایی

Abstract Objective To provide the first systematic in-depth description of the consequences of developmental prosopagnosia (DP; ‘face blindness’) for psychosocial functioning and occupational disability, in order to determine what kind of professional intervention may be needed. Methods Semi-structured telephone interviews were carried out with 25 people whose self-reports of face recognition problems were confirmed by impaired scores on the Cambridge Face Recognition Test. Thematic analysis was used to inductively identify and understand common psychosocial consequences of DP. Results All participants described recurrent and sometimes traumatic social interaction difficulties caused by recognition problems, such as failing to recognize close friends, work colleagues, and family members. These problems often led to chronic anxiety about offending others and feelings of embarrassment, guilt, and failure. Most participants described some degree of fear and avoidance of social situations in which face recognition was important, including family and social gatherings, and meetings at work. Long-term consequences could include dependence on others, a restricted social circle, more limited employment opportunities, and loss of self-confidence. Conclusion The potential for negative psychosocial consequences and occupational disability posed by DP is as great as that posed by conditions which are currently afforded professional recognition and support, such as stuttering and dyslexia. Wider recognition of the problems prosopagnosia can cause could reduce anxiety about social interaction difficulties by making it easier to explain and justify recognition problems to other people, including employers. Greater professional awareness could facilitate detection and referral of those requiring support with coping with social interactions.

Introduction Developmental prosopagnosia (DP) is a condition defined by severe difficulty in recognising familiar faces [1] and [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] and [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] and [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] and [11]. It has even been suggested that DP could contribute to some cases of social developmental disorder [12] and [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

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 afforded explicit professional recognition and support, such as stuttering and dyslexia. As the title of this paper implies, recognition of the problems posed by DP could help to reduce its impact. Greater public awareness of the condition would make it easier to explain and justify social interaction difficulties to other people, including employers. Greater professional awareness could facilitate appropriate detection and referral of those who may require social skills training and/or treatment for social anxiety disorder.