Hepatic encephalopathy (HE) is a common complication of cirrhosis that results in unpredictable neuropsychiatric symptoms and increases the risk of death and disability. In the current issue of Clinical and Translational Gastroenterology, Fabrellas et al. report on a qualitative study that assesses the psychological impact of HE on both patients and their informal caregivers. Both patients and caregivers report diminished quality of life driven by disruptive anxiety and feelings of fear and sorrow. There is a need to optimize therapy for encephalopathy and to address the shared psychological impact of HE experienced by both patients and caregivers.