Capgras delusion is a psychological condition where people have an irrational belief that someone they know has been replaced by an imposter. It is categorized as a delusional mis-identification syndrome.
What Is Capgras Delusion?
Capgras delusion or Capgras syndrome (CS) is a psychiatric condition in which a person holds a delusion that their loved one or a close social member has been replaced by an exact or identical imposter. This condition is named after the French psychiatrist, Joseph Capgras.
It is classified 1 Ellis, H. D., & Lewis, M. B. (2001). Capgras delusion: a window on face recognition. Trends in Cognitive Sciences, 5(4), 149–156. https://doi.org/10.1016/s1364-6613(00)01620-x as a “delusional misidentification syndrome” which is a class of delusion beliefs that involves misidentification 2 Barrelle, A., & Luauté, J. P. (2018). Capgras Syndrome and Other Delusional Misidentification Syndromes. Frontiers of neurology and neuroscience, 42, 35–43. https://doi.org/10.1159/000475680 of people, places, or objects. It is also known as imposter syndrome, though it should not be confused with impostor phenomenon or impostor-ism.
People with Capgras delusion syndrome have an irrational belief that someone close to them has been replaced by someone else. For instance, they can accuse their parents of being impostors. This can cause significant distress for the person experiencing the delusion and those who are mistaken as impostors.
In the more extreme cases, they may even believe an animal, object, or even a house to be an imposter. This condition can affect anyone, though it is more common in women and people with psychiatric conditions.
Symptoms Of Capgras Delusion
Research 3 Bourget, D., & Whitehurst, L. (2004). Capgras syndrome: a review of the neurophysiological correlates and presenting clinical features in cases involving physical violence. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 49(11), 719–725. https://doi.org/10.1177/070674370404901102 claims that the primary Capgras delusion symptoms have already set in when the individual starts to believe that a close social member is replaced by an imposter. Other symptoms of Capgras delusion include:
- Acting in an usual manner with others except the person they believe to be an imposter
- Changing behavioral patterns while addressing the misidentified person
- Believing that they can see through the disguise of the imposter
- Being violent towards the misidentified person
- Experiencing extreme anxiety, stress, anger, or conflict
- Trying to find the “real” person replaced by the imposter
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Famous Capgras Delusion Cases
Some popular 4 Pandis, C., Agrawal, N., & Poole, N. (2019). Capgras’ Delusion: A Systematic Review of 255 Published Cases. Psychopathology, 52(3), 161–173. https://doi.org/10.1159/000500474 Capgras delusion cases are listed below:
1. The case of “Madame Macabre”
The first of the the Capgras delusion cases date back to a 1923-case 5 Jain, S. B., Shah, K., & Wadhwa, R. (2021). Capgras Syndrome. PubMed; StatPearls Publishing. Available from: https://pubmed.ncbi.nlm.nih.gov/34033319/ involving two French psychiatrists, Joseph Capgras and Jean Reboul-Lachaux. They treated a French woman, nicknamed “Madame Macabre”, who alleged that “corresponding doubles had replaced her husband and other persons she knew.” She also believed that there existed a double of herself. At the time, they referred to this disorder as “I’illusion des sosies” meaning “the illusion of look-alikes”.
2. The case of a 59-year-old Caucasian man
This case report 6 Atta, K., Forlenza, N., Gujski, M., Hashmi, S., & Isaac, G. (2006). Delusional Misidentification Syndromes: Separate Disorders or Unusual Presentations of Existing DSM-IV Categories? Psychiatry [Edgmont (Pa. : Township)], 3(9), 56–61. studied a 59-year-old Caucasian man with bipolar disorder, who also had multiple psychiatric hospitalizations and incarcerations. He reported that his past issues were related to his behavioral issues, particularly in stalking women. His stalking behavior was rooted in an event where he met a woman when he was 15 years old.
She was a prostitute and he believed that he could save her. After the relationship with this woman ended, he became different. He started stalking women whom he believed he was acquainted with; this led to hospitalizations and even jail time.
He tried to minimize his actions by blaming his “strange state of mind”. He reported that he engaged in repetitive stalking behavior because of his strong belief that each woman he followed represented the same woman he met when he was 15 years of age.
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3. The case of “Lost Wilma”
Perhaps the most famous of Capgras delusion cases, the case of “Lost Wilma 7 Lucchelli, F., & Spinnler, H. (2007). The case of lost Wilma: a clinical report of Capgras delusion. Neurological Sciences, 28(4), 188–195. https://doi.org/10.1007/s10072-007-0819-8 ” saw a 59-year-old man experience a variety of Capgras delusion symptoms over the years—including linguistic deterioration, restlessness, and obsessiveness over personal hygiene.
He saw his wife as an imposter and began to look for his “real” wife. The man did not display any aggressive behavior, but he continued to believe that his wife was an imposter and treated her in a doubtful manner, despite receiving medical treatment. However, he was able to recognize other people with little difficulty.
Capgras Syndrome Causes
The common 8 Madoz-Gúrpide, A., & Hillers-Rodríguez, R. (2010). [Capgras delusion: a review of aetiological theories]. Revista de Neurologia, 50(7), 420–430. Available from: https://pubmed.ncbi.nlm.nih.gov/20387212/ Capgras syndrome causes are attributed to:
- Miscommunication between brain regions responsible for facial recognition and emotional processing.
- Disruption in the neural pathways involved in familiarity and recognition.
- Neurological conditions such as Alzheimer’s disease, dementia, or traumatic brain injury.
- Psychiatric disorders such as schizophrenia, bipolar disorder, or major depressive disorder.
- Substance abuse or withdrawal from certain medications.
- History of trauma or significant life stressors.
- Genetic predisposition or family history of Capgras delusion.
- Abnormalities in neurotransmitter functioning, particularly dopamine and serotonin.
- Co-occurring cognitive impairments or perceptual disturbances.
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Impact Of Capgras Delusion On Mental Health And Relationships
Capgras delusion can have significant effects 9 Coltheart, M., & Davies, M. (2022). What is Capgras delusion?. Cognitive neuropsychiatry, 27(1), 69–82. https://doi.org/10.1080/13546805.2021.2011185 on mental health, relationships, and overall well-being. Individuals experiencing this condition often struggle with distressing symptoms that can lead to emotional turmoil and psychological distress.
The persistent belief that loved ones or familiar individuals have been replaced by impostors can cause feelings of confusion, anxiety, and paranoia. This can result in a breakdown of trust and strain in relationships, particularly in close and intimate connections.
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Additionally, individuals with Capgras delusion may experience social isolation, as they may withdraw from social interactions to avoid perceived impostors. This may also exacerbate risks of mental health disorders like depression, psychosis 10 Salvatore, P., Bhuvaneswar, C., Tohen, M., Khalsa, H. M., Maggini, C., & Baldessarini, R. J. (2014). Capgras’ syndrome in first-episode psychotic disorders. Psychopathology, 47(4), 261–269. https://doi.org/10.1159/000357813 , schizophrenia 11 Halder, A., Panchami, N., & Harshe, G. (2022). A case of schizophrenia with Capgras delusion responded to donepezil. Indian journal of psychiatry, 64(2), 219–220. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_972_21 , etc. The impact of this delusion can extend beyond personal relationships and affect various aspects of life, including work, social activities, and daily functioning.
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Capgras Delusion Diagnosis
Capgras Delusion Diagnosis is not officially listed 12 Barrelle, A., & Luauté, J. P. (2018). Capgras Syndrome and Other Delusional Misidentification Syndromes. Frontiers of neurology and neuroscience, 42, 35–43. https://doi.org/10.1159/000475680 in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Since it is a rare condition, there are also no definitive clinical ways prescribed to Capgras delusion diagnosis.
There may be a psychiatric evaluation involved, where the patient is brought to the attention of a psychiatrist by a close family member or a friend. Based on the symptoms, a Capgras delusion treatment plan is chalked out.
Capgras Delusion Treatment
Capgras delusion treatment typically involves a combination of therapeutic approaches and medication 13 Bell, V., Marshall, C., Kanji, Z., Wilkinson, S., Halligan, P., & Deeley, Q. (2017). Uncovering Capgras delusion using a large-scale medical records database. BJPsych open, 3(4), 179–185. https://doi.org/10.1192/bjpo.bp.117.005041 :
1. Psychotherapy:
Cognitive-behavioral therapy (CBT) can help individuals challenge and modify their delusional beliefs, as well as develop coping strategies to manage distressing symptoms.
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2. Reality testing:
Therapists may engage in reality testing techniques to help individuals recognize the inconsistencies in their delusional beliefs and provide evidence to challenge them.
3. Medication:
Antipsychotic medications (such as risperidone or olanzapine) may be prescribed to alleviate comorbid psychotic symptoms in Capgras delusion treatment.
4. Family therapy:
Involving family members in therapy can help improve communication, provide support, and facilitate understanding of the condition, leading to a more conducive environment for the individual’s recovery.
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5. Support groups:
Participating in support groups with individuals facing similar challenges can provide validation, emotional support, and an opportunity to learn coping strategies from others.
Living With Someone With Capgras Delusion
Consider the following strategies 14 Dohn, H. H., & Crews, E. L. (1986). Capgras syndrome: a literature review and case series. The Hillside journal of clinical psychiatry, 8(1), 56–74. to deal with a loved one suffering from Capgras delusion:
- Understand the situation and the “reality” from the patient’s perspective and realize how terrifying it must be for him/her to see someone replace their loved one.
- Acknowledge what the affected person is feeling.
- Be patient and empathetic to the affected individual.
- Avoid arguing or trying to correct the person suffering from Capgras delusion.
- Try to make the affected person feel safe and secure around you. If you are not sure what to do, ask him/her about their needs.
- Let the “imposter” leave the room, if possible. If you are the imposter as well as the caregiver, let someone else take charge until the episode is over.
- Make use of your voice or a known sound to induce familiarity in the patient. Try to greet the patient out loud before you see them.
Overcoming Capgras Delusion
People with Capgras delusion may never achieve full recovery in their lifetime. If left untreated, the mental health disorder gradually worsens over time 15 Currell, E. A., Werbeloff, N., Hayes, J. F., & Bell, V. (2019). Cognitive neuropsychiatric analysis of an additional large Capgras delusion case series. Cognitive neuropsychiatry, 24(2), 123–134. https://doi.org/10.1080/13546805.2019.1584098 , affecting the afflicted person’s physical and mental health, social relationships, professional and personal reputation, etc.
The more severe of Capgras delusion cases require hospitalization and admission in mental health establishments for 24/7 treatment, because of which it is important to seek timely and correct medical attention to treat it. In fact, medications or therapy or both may help ease the symptoms of this condition and make it more manageable to live with.
At A Glance
- Capgras delusion is a psychiatric condition in which a person holds a delusion that their loved one or a close member has been replaced by an “imposter”.
- The disorder persists for a lifetime, but Capgras delusion diagnosis can be tricky.
- Capgras delusion cases are common in individuals diagnosed with schizophrenia, dementia, diabetes, etc.
- Common Capgras syndrome causes include brain damage, hormonal imbalances, genetics, etc.
- If left untreated, the disorder can negatively impact the sufferer’s mental and physical health.
- Capgras delusion treatment involves medication, therapy, or both.
Frequently Asked Questions (FAQs)
1. How common is Capgras delusion?
Capgras delusion has a prevalence rate of 0.12% in the adult population. It seems to occur more frequently in black people, women, and individuals suffering from schizophrenia.
2. Is Capgras delusion different from paranoia?
Capgras delusion is different from paranoia, even though it is a significant comorbid condition in disorders like paranoid schizophrenia and Ekbom syndromes.
3. What does it feel like to have Capgras delusion?
Also known as “imposter syndrome” or “Capgras syndrome”, the Capgras delusion makes people harbor the irrational belief that their loved ones are replaced by imposters.
4. Who is most likely to get Capgras syndrome?
People with certain health conditions like Parkinson’s disease, schizoaffective disorders, dementia, epilepsy, traumatic brain injury, or brain damage are at a greater risk of Capgras syndrome.
