The purpose of this prospective, between-subjects study was to look at impaired awareness cross-culturally in patients with traumatic brain injury (TBI) and to relate impaired awareness after injury to the initial estimates of disturbed consciousness at time of injury. The study was conducted in community and inpatient and outpatient rehabilitation centers in Barcelona and Madrid. Participants were 30 persons with primarily moderate to severe TBI who could complete a written questionnaire concerning their functioning and 28 age- and gender-matched controls. A Spanish translation of the Patient Competency Rating Scale (PCRS) was administered to each participant. Relatives or significant others also completed this scale on each participant using the relative's version (PCRS-R). Difference scores, obtained by subtracting PCRS-R from PCRS-P (PCRS-P minus PCRS-R), were used as a marker of impaired awareness. Individuals with TBI were rated (by self and significant others) as being less competent than controls. Forty percent of Spanish patients with TBI who suffered severe injuries tended to overestimate their behavioral competencies. The PCRS-P minus the PCRS-R difference scores tended to correlate with admitting Glasgow Coma Scale (GCS) scores and retrospective estimates of posttraumatic amnesia (PTA). Initial disturbances of consciousness, one measure of severity of brain injury, appeared to relate to later measures of impaired self-awareness in Spanish patients with TBI. Non-brain-injured controls did not tend to report levels of competency that differed from their relatives' reports.