Capgras delusion is a psychological condition where people have an irrational belief that someone they know has been replaced by an imposter.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 misidentification 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(CS) is a psychiatric condition in which a person holds a delusion that their loved one or a close social member has been replaced by an exact or identical imposter.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 as a “delusional misidentification syndrome” which is a class of delusion beliefs that involves misidentification 2 of people, places, or objects. It is also known as imposter syndrome, though it should not be confused with impostor phenomenon or impostorism.
People with capgras delusion syndrome have an irrational belief that someone close to them has been replaced by someone else.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 imposters.
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. If your loved one is experiencing the symptoms of Capgras delusion, it is important to seek professional help for its correct and timely diagnosis.
Understanding Capgras Delusion
Delusions commonly occur in individuals diagnosed with paranoid schizophrenia. However, it is also seen in cases of brain injury and dementia, especially dementia with Lewy bodies. People with neurodegenerative diseases, particularly in old age, are also vulnerable to it.
A 2018 3 study also reported its occurrence in people with diabetes, hypothyroidism, and headache disorders. A 2002 study 4, however, debated whether this condition is the cause or manifestation of brain damage or an underlying psychiatric condition 5.
A 1986 study 6 reported its prevalence rate as 0.12 percent of the general population. A 1999 review 7 reported that capgras delusion research will lead to a better understanding of the neurological mechanisms behind this psychotic experience and may even provide a paradigm for the future investigation of capgras delusion cases.
For instance, recent studies 8 found that even though the patients reported the ‘virtual’ resemblance of the imposter with their loved ones, the former ‘lacked’ the feelings of familiarity, closeness, and intimacy associated with the misidentified person.
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What Are The Symptoms Of Capgras Syndrome?
According to research 9, 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 normally 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
What Causes Capgras Delusion?
The exact causes of Capgras syndrome are unknown. However, experts have certain theories that could provide reasonable insight into Capgras delusion cases. Some of them are explained below:
1. Brain injury
One theory attributes capgras delusion causes to brain injury that involves lesions in the brain. A 1997 study 10 found that more than one-third of documented Capgras delusion cases had traumatic lesions in the brain. A 1999 study 11 found evidence of a link between and right hemisphere abnormalities, particularly in the frontal and temporal regions.
2. Disconnection in the brain
Another theory suggests that it can also be caused by a disconnection between the visual part of the brain and the area that processes facial familiarity. A 1997 study 10 found that the misidentification of the person can be due to this disconnection.
In a case report 12, a man could not recognize his parents face-to-face. However, when they spoke over the phone, he recognized them without any difficulty. Hence, the man was able to better recognize his parents with voice or sound but not with visual representation.
3. Other theories
There are other theories that suggest that there may be underlying conditions, such as Alzheimer’s disease or dementia, involved in the development of Capgras delusion. Such illnesses tend to alter the perception of one’s reality.
Schizophrenia and epilepsy are also believed to be associated with this condition, even though the genetics of capgras delusion have no empirical basis. Moreover, a 2015 study 13 found a link between hypothyroidism and hormonal imbalances with the causes of Capgras syndrome.
Capgras Delusion Cases
Studying case reports of this condition is said to be helpful in getting a correct picture of the disorder and its diagnosis. Some popular case reports that were studied under the Capgras syndrome are listed below:
1.The case of “Madame Macabre”
The origins of capgras delusion lie in a 1923-case 14 that involved 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 15, 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.
3. The case of “Lost Wilma”
In the case of “Lost Wilma” 16, a 59-year-old man was seen to 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.
Diagnosis Of Capgras Delusion
Since it is a rare condition, there are no definitive ways to diagnose Capgras delusion. 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.
Capgras Delusion Treatment
Because of limited research, there is no standard treatment plan for people affected by Capgras delusion. However, several treatment options are available to help relieve its debilitating symptoms. The current Capgras delusion treatments is primarily focused on addressing its underlying causes and comorbid conditions.
In this way, treating the symptoms of one condition can subdue the symptoms of the associated condition. But, in case the underlying condition is a complex disorder like Alzheimer’s disease, the treatment options are considerably limited.
The most effective form of Capgras delusion treatment is creating a safe and positive environment for the patient. Another highly recommended treatment method is validation therapy, in which the delusions experienced by the patient are validated and supported instead of rejecting them. In this type of treatment, reality orientation techniques are used to reduce the sufferers’ panic and anxiety.
They are also given frequent reminders related to time, location, substantial changes, and major life events to help them stay mindful and focused. In fact, research 17 shows that reality orientation techniques 18 in validation therapy have a positive impact on the cognition and behavior of people with dementia.
Other forms of Capgras delusion treatments include:
- Medications (like cholinesterase inhibitors) that boost neurotransmitters involved in memory and judgment (in case of dementia or Alzheimer’s disease)
- Antipsychotics and therapy (in case of schizophrenia)
- Surgery (in case of brain lesions or head injury/brain trauma)
How To Help Someone With Capgras Delusion?
It can be quite challenging to care for someone with Capgras delusion, especially when you are seen and distrusted as an imposter. But there are some strategies that you can consider for helping the patient.
- 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 they are feeling
- Be patient and sympathetic to the affected individual
- Avoid arguing or trying to correct them
- Try to make them feel safe and secure around you. If you are not sure what to do, ask them what they need.
- 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 voice or sound to induce familiarity in the patient. Try to greet them out loud before you see them.
Recovering From 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, affecting the afflicted person’s physical and mental health, social relationships, professional and personal reputation, etc.
The more severe of its cases require hospitalization and admission to 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.
Capgras Delusion 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”.
- Capgras syndrome persists for a lifetime.
- Delusions commonly occur in individuals diagnosed with schizophrenia, dementia, diabetes, etc.
- It is caused by a number of factors, including brain damage, hormonal imbalances, etc.
- If left untreated, the disorder can negatively impact the sufferer’s mental and physical health.
- The syndrome can be effectively managed by 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.
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