This review summarizes early empirical findings that provide a context for integrating more recent clinical and research observations regarding impaired self-awareness (ISA) and denial of disability in post-acute traumatic brain injury (TBI). While several empirical studies have appeared on ISA after TBI over the last 20 years, the relative role of denial (as a psychological method of coping) has typically not been addressed in these studies. The authors propose that this failure has limited the understanding of how ISA and denial differentially affect efforts to rehabilitate individuals with moderate-to-severe TBI. In this article, early research findings in the field are summarized and integrated with more recent observations (i.e., 1999-2019). The authors believe that this synthesis of information and expert clinical opinion will inform future research on ISA and denial as well as approaches to rehabilitation for people with TBI.