Objective: The purpose of this study was to investigate impaired awareness of deficits in relation to treatment motivation and depressive symptoms in patients with neuropsychiatric symptoms after acquired brain injury. Method: The study had a Cross-sectional design with 93 outpatient brain injury patients with neuropsychiatric symptoms in the chronic phase after injury. Awareness was measured by the discrepancy in answers between patients and significant others and/or clinicians. Patients were divided into 3 awareness groups: underestimation, accurate estimation, and overestimation of competencies. Treatment motivation and depressive symptoms were measured with self-report questionnaires. Results: Average discrepancy scores suggested patients had accurate awareness of deficits. However, when dividing patients into 3 awareness groups, 30% underestimated, 38% accurately estimated, and 32% overestimated their competencies. Linear regression analysis with discrepancy scores showed overestimation of competencies (positive discrepancy scores) was associated with less depressive symptoms, whereas underestimation (negative discrepancy scores) was associated with more depressive symptoms (β = -.28 to -.42, p <.05). Group analysis revealed that the underestimation group reported significantly more depressive symptoms than the overestimation group (β = .43 to.44, p <.05). No significant difference between the accurate estimation and overestimation group was found (p>.05). An association between awareness and treatment motivation was not statistically confirmed. Conclusion: This study demonstrated that when considering awareness groups, more nuanced results arise than when only considering discrepancy scores. From a clinical and scientific standpoint, it is important to distinguish awareness groups in addition to considering mean discrepancy scores. © 2014 American Psychological Association.