Face blindness may be more common than previously thought

What do legendary primatologist Jane Goodall, actor Brad Pitt, and the late British neurologist Oliver Sacks, author of The Man Who Mistook His Wife for a Hat, have in common? The answer: a condition called prosopagnosia, or face blindness. It’s a neurological disorder in which people struggle to remember and recognize familiar or famous faces—and it may be more common than previously thought.

Generally, prosopagnosia, a term that’s derived from the Greek words prosopon (which means face) and agnosia (which means lack of knowledge), isn’t due to a lack of visual acuity or sensitivity to contrast. It’s that people with the condition have trouble remembering the faces of individuals or telling them apart.

“It’s a disorder of higher visual function—people with the condition can see a visual image but not recognize the face,” says Christopher M. Filley, a professor of neurology, who specializes in behavioral neurology, at the University of Colorado School of Medicine. “Their brains cannot process the elements of the face.”

Long thought to be a rare condition, the disorder may be more prevalent than previously believed, according to a study in a 2023 issue of the journal Cortex. The study found that face blindness lies on a continuum—ranging in both severity and symptoms—rather than representing a discrete group of people. Depending on the criteria used, the condition affects from 1 to 5 percent of adults. 

“People with the more severe form of prosopagnosia may see their partner [from a distance] at the grocery store and won’t recognize them,” says Joe DeGutis, a cognitive neuroscientist and codirector of the Boston Attention and Learning Laboratory at the VA Boston Healthcare System. “They may over-rely on context.” In other words, they’re likely to recognize their partner when they wake up next to them in the morning or when they get home from work. But they may not recognize them in unexpected circumstances.

Context aside, “it takes people with prosopagnosia more exposures to learn a face,” DeGutis says.

Genetic or acquired?

This is not one disorder—it’s a family of disorders, says Jason Barton, a professor of neurology and neuroscience at the University of British Columbia in Vancouver.  With one form, “people may struggle with remembering what [familiar] faces look like but they can see differences in faces if they look at pictures. With another form, people can’t see differences in faces.”

Besides the spectrum of severity, there are two primary forms of prosopagnosia. One is caused by developmental (perhaps genetic) factors, the other is acquired.

On the developmental side, “there are entire families who have this,” says Sarah Bate, a professor of psychology at Bournemouth University in the United Kingdom. “In terms of actually finding a gene, that work hasn’t been done yet.”

In these instances, “we don’t know if it’s something that went wrong during the developmental process or if it’s genetic,” says DeGutis, who is also an associate professor in the department of psychiatry at Harvard Medical School.

In a 2023 review published in the journal Brain Sciences, researchers examined 63 studies comparing brain structure and activity in people with developmental prosopagnosia and those without the condition: They found that those who have the condition have impaired functional and anatomical connectivity between the fusiform face area—part of the human visual system—and other face-recognition regions in the brain, compared to those who don’t.

Those who’ve had face blindness their whole lives may be unaware that their inability to recognize or remember familiar faces is unusual. They may simply blame themselves for being inattentive or having a poor memory.

“The majority of people don’t recognize they have this until their 20s or 30s or sometimes even later,” DeGutis says.

Among those who’ve had the condition their whole lives, researchers have found that prosopagnosia is more common among people with autism spectrum disorder.

(Screening for autism is tricky. This new tool could help.)

“A third to half of people with autism have trouble recognizing faces but it may be for a different reason,” Barton says. It may be at least partly because those with autism often avoid making eye contact with people.

With developmental prosopagnosia, the ability to recognize faces may be linked to the facial processing strategies they use.

Bate and her colleagues discovered that people with face blindness tend to focus on the mouth area and the lower part of the face rather than looking at the eyes. By contrast, “super-recognizers”—people with extraordinary face recognition abilities—focus more on the nose and the zone at the midpoint of the face, which is associated with better face recognition.

You May Also Like

SCIENCE

Not an extrovert or introvert? There’s a word for that.

SCIENCE

Is becoming a dad good for your health?

HISTORY & CULTURE

Gambling is everywhere now. When does that become a problem?

Acquired face blindness

Among people with previously good face-recognition abilities, prosopagnosia can be triggered by a brain injury, tumor, stroke, encephalitis, or a neurodegenerative disease such as Alzheimer’s. In her research, Marie-Luise Kieseler, a doctoral candidate in cognitive neuroscience at Dartmouth College, has seen people with long COVID who have developed facial recognition difficulties, along with navigational challenges.

After having trouble recognizing faces for most of her life, Dacia Reid, now 62, discovered there’s a name for this condition six years ago when she took an online questionnaire from the Prosopagnosia Research Center.

In elementary school, Reid suffered  a head injury that caused a seizure disorder and memory lapses. As a young adult, she had brain surgery to treat her seizures. While the procedure improved the seizures (which are also controlled with medication), it made her face blindness more extreme.

“I can remember a face—I just don’t always remember who it belongs to,” says Reid, who is married with two adult children in Nappanee, Indiana. “If somebody changes their hair style, I’m lost—I don’t know who they are.” 

Getting a proper diagnosis, as Reid finally did, can do a world of good. “Once people recognize they have this, it’s a huge release of this burden—their lives make so much more sense to them,” says DeGutis.

After all, being unable to recognize someone could offend them or make social interactions awkward. Or, people with prosopagnosia may be perceived as aloof or standoffish.

(Schizophrenia in women is widely misunderstood—and misdiagnosed)

“It can be very embarrassing if you go to a party and there are people you know but you can’t recognize who they are,” Filley says. “It’s not that they’re rude or antisocial or eccentric. It’s a brain problem that prevents them from recognizing familiar faces.”

Some people with the disorder also report that it can impact their ability to do their jobs effectively. For example, people in the business world may have trouble retaining clients if they fail to recognize them. And teachers may have difficulty managing their classrooms if they don’t recognize or remember their students’ faces, Bate says.

Treatments and interventions

 In recent years different interventions have been tested to improve face recognition in people with prosopagnosia.  

In one approach, people with developmental prosopagnosia used a single dose of an oxytocin nasal spray or a placebo spray, waited 45 minutes for the spray to kick in, then completed two face-processing tests. (Oxytocin is a hormone that facilitates social bonding and pro-social behavior.) Those who used the oxytocin spray experienced temporary improvements in face-processing and facial-recognition abilities.

By contrast, research has found that when people with developmental or acquired prosopagnosia engaged in a computer training program for 11 weeks that was designed to boost their ability to distinguish between faces, their face recognition abilities improved for at least three months. 

There are also online training programs that can help people get better at focusing on faces and seeing differences between them. Doing these brain training exercises regularly may help people with face blindness improve their facial recognition skills.

“With practice, people can often do it better,” Barton says. “It won’t give you a cure but it can make things a bit easier, by about 30 percent.”

Whether these benefits translate into better recollection or memory for people’s faces remains to be seen.

Fortunately, people often develop smart strategies to help them compensate for their facial recognition deficits. They might try to remember “people’s wedding rings or the way people walk or talk,” says Bate. Teachers might rely on a seating chart to help them ID their students.

In social instances, it can help for people with the condition to plant strategic questions into the conversation to elicit clues about who someone is or to have their partner or friend mention the person’s name in conversation, Bate says. And “some people cope by being overly friendly to everybody,” DeGutis says.

To get around her facial recognition challenges, Reid often asks questions to try to get a sense of context for how she knows someone. If that doesn’t help, she may say that she’s drawing a blank on their name.  

Sometimes it can even help to explain to people that you have this condition, Barton says. “There’s no shame in having this. I tell my patients, don’t let this get in the way of what you want to do. It’s a problem but there are ways to work around this.”