Mind Help

Capgras Delusion

Capgras Delusion

Capgras delusion is a psychological condition where a person has an irrational belief that someone they know has been replaced by an imposter.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Capgras Delusion is a psychiatric condition where a person holds a delusion that their loved one or a close member has been replaced by an exact or identical imposter. This condition is named after French psychiatrist, Joseph Capgras. It is classified 1 as a “delusional misidentification syndrome” which is a class of delusion beliefs that involves misidentification of people, places, or objects. It is also known as imposter syndrome (not to be confused with impostor phenomenon or impostorism).

People with this condition have an irrational belief that someone close to them has been replaced by someone else. For instance, they can accuse their parents of being an imposter. This can cause significant distress for the person experiencing the delusion and who is believed to be the imposter. In some extreme cases, they may even believe an animal, object, or even a house to be an imposter. This condition can affect anyone. However, it is more common in women. If your loved one is experiencing similar symptoms, it is important to seek professional help to arrive at a correct diagnosis. The doctor will devise a treatment plan to ease the symptoms of the disorder.

Understanding Capgras Delusion

Delusions commonly occur in individuals diagnosed with paranoid schizophrenia. However, it is also seen in cases of brain injury, dementia with Lewy bodies, and other forms of dementia. It is also found in neurodegenerative diseases, particularly in old age. A 2018 study also reported its occurrence to be associated with diabetes, hypothyroidism, and migraine attacks. A 2002 study 2 found it unclear whether this condition occurs as a result of brain injury to specific areas of the brain since a 2005 study 3 reported it to be a manifestation of an underlying psychiatric condition.

A 1986 study 4 reported its prevalence rate to be 0.12 percent of the general population. A 1999 review 5 reported that the study of Capgras Delusion will lead to a greater understanding of the neurological basis of psychotic experiences and may even provide a paradigm for how psychosis should be investigated. Some studies 6 found that patients reported the “imposter” resembles the original virtually but they lack feelings of familiarity, closeness, and intimacy with the misidentified person.

Read More About Brain Science Here

Symptoms Of Capgras Delusion

Symptoms Of Capgras Delusion
Capgras Delusion


The primary symptom of this condition is when the individual starts to believe that a close member is replaced by an imposter. Other symptoms include:

  • Acting normally with others except the person they believe to be an imposter
  • Extreme anxiety
  • Changes in behavior with the person concerned
  • Believing that they can see through the disguise of the imposter
  • Being violent towards the imposter
  • Stress, anger, or arguments between the person affected and those around them
  • Trying to find the “real” person replaced by the imposter

Causes of Capgras Delusion

The exact cause of this condition is unknown. However, experts have certain theories that could explain the cause of this disorder. Some of them are explained below:

1. Brain injury

One theory suggests that this condition occurs as a result of brain injury that involves lesions in the brain. A 1997 study 7 found that more than one-third of documented cases of Capgras delusion had traumatic lesions in the brain. A 1999 study 8 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 study 9 found that the misidentification of the person can be due to this disconnection. In a case report, a man was found to 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 recognize his parents with voice or sound but not their visual representation.

3. Other theories

Apart from these, there are some other theories that suggest that there may be underlying conditions, such as Alzheimer’s disease or dementia involved in the development of this condition. Such illnesses tend to alter the perception of one’s reality. Schizophrenia and epilepsy are also believed to be a cause of this condition. A 2015 study 10 found a relation between hypothyroidism or an underactive thyroid gland. Hormonal imbalances may also be a contributing factor for developing this condition.

Capgras Delusion Case Reports

Studying case reports of this condition is often found to be helpful to get a correct diagnosis. Some popular case reports that were studied under Capgras Delusion are as follows:

1. Case of 59 Year old Caucasian Man

This case report 11 studied a 59-year-old Caucasian man, who was diagnosed with bipolar disorder and 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 who he believed he knew. This led to hospitalizations and even jail time. He tried to minimize his actions by blaming his “strange state of mind”. He engaged in repetitive stalking behaviors because of his strong belief that each woman he followed represented the same woman he met when he was 15.

2. Case of Lost Wilma

In the case of lost Wilma 12 , a 59-year-old man was seen to experience a variety of symptoms over the years, that includes language deterioration, restlessness, and obsessiveness over personal hygiene. He saw his wife as an imposter and began to look for his “real” wife. The man was not found to display any aggressive behavior but continued to believe that his wife was an imposter despite receiving treatments. He addressed her in a doubtful and inquisitive way. However, he was able to recognize other people with little difficulty.

Diagnosis For Capgras Delusion

Since it is a rare condition, there are no definitive ways to diagnose it. 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.

Treatment For Capgras Delusion

There is no standard treatment plan for people affected by Capgras delusion since research is limited. However, there are several treatment options available to help relieve the symptoms. The treatment is primarily focused on the underlying cause. For instance, someone with schizophrenia may also experience the symptoms of Capgras syndrome. So treating the symptoms of one condition can subdue the symptoms of the associated condition. In case the underlying condition is Alzheimer’s disease, the treatment options may be limited.

The most effective form of treatment is creating a safe and positive environment for the person affected. Another treatment method that may be adopted is validation therapy. In this therapy, the delusions experienced by the patient are validated and supported instead of rejecting it. A 2003 study 13 found validation therapy to be effective in patients with dementia. This therapy was found to reduce anxiety and panic in the person experiencing delusions. Reality orientation techniques may also be used for patients with this condition. In this technique, the caregiver gives frequent reminders of time and location to help the patient stay focused. It can also include an update of major life events or any substantial changes. A 2000 study 14 found reality orientation techniques have both benefits on cognition and behaviors for people with dementia.

Other forms of treatment can include:

  • Medications such as cholinesterase inhibitors that are responsible for boosting neurotransmitters involved in memory and judgment (in case of dementia or Alzheimer’s disease)
  • Antipsychotics 15 and therapy (in case of schizophrenia)
  • Surgery (in case of brain lesions or head trauma)

How To Help Someone With Capgras Delusion

It can be quite challenging to care for someone with this disorder, especially when you are seen as the imposter. But there are some strategies you can try to help the patient. They are:

  • Understand the situation and the “reality” from their perspective and realize how terrifying it must be for them to see someone replace their loved one.
  • Being patient and sympathizing with the affected individual
  • Avoid arguing or trying to correct them
  • Try to make them feel safe and secure. If you are not sure what to do, ask them what they need.
  • Acknowledge what they are feeling
  • 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.
  • If you know someone with this condition, make sure that the first way they register your appearance is with sound. Try to greet them out loud before you see them.

Recovery From Capgras Delusion

People with this condition may never achieve a full recovery. However, medications and therapy may help to ease the symptoms of this condition. Sometimes they may even be admitted to psychiatric wards to receive 24/7 treatment. It is important to seek medical attention if you are experiencing any symptoms, to ensure that it does not get worse.

Capgras Delusion Reviewed By :


References:
  1. Ellis, H. D., & Lewis, M. B. (2001). Capgras delusion: A window on face recognition. Trends in Cognitive Sciences5(4), 149-156. https://doi.org/10.1016/s1364-6613(00)01620-x []
  2. Lykouras L, Typaldou M, Gournellis R, Vaslamatzis G, Christodoulou GN. Coexistence of Capgras and Frégoli syndromes in a single patient. Clinical, neuroimaging and neuropsychological findings. Eur Psychiatry. 2002 Jul;17(4):234-5. doi: 10.1016/s0924-9338(02)00660-0. PMID: 12231272. []
  3. Papageorgiou C, Lykouras L, Alevizos B, Ventouras E, Mourtzouchou P, Uzunoglu N, Christodoulou GN, Rabavilas A. Psychophysiological differences in schizophrenics with and without delusional misidentification syndromes: a P300 study. Prog Neuropsychopharmacol Biol Psychiatry. 2005 May;29(4):593-601. doi: 10.1016/j.pnpbp.2005.01.016. Epub 2005 Mar 17. PMID: 15866363. []
  4. Dohn HH, Crews EL. Capgras syndrome: a literature review and case series. Hillside J Clin Psychiatry. 1986;8(1):56-74. PMID: 3744300. []
  5. Edelstyn NM, Oyebode F. A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. Int J Geriatr Psychiatry. 1999 Jan;14(1):48-59. PMID: 10029936. []
  6. Salvatore, P., Bhuvaneswar, C., Tohen, M., Khalsa, H. M., Maggini, C., & Baldessarini, R. J. (2014). Capgras’ syndrome in first-episode psychotic disorders. Psychopathology47(4), 261–269. https://doi.org/10.1159/000357813 []
  7. Hirstein, W., & Ramachandran, V. S. (1997). Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proceedings. Biological sciences, 264(1380), 437–444. https://doi.org/10.1098/rspb.1997.0062 []
  8. Edelstyn NM, Oyebode F. A review of the phenomenology and cognitive neuropsychological origins of the Capgras syndrome. Int J Geriatr Psychiatry. 1999 Jan;14(1):48-59. PMID: 10029936. []
  9. Hirstein, W., & Ramachandran, V. S. (1997). Capgras syndrome: A novel probe for understanding the neural representation of the identity and familiarity of persons. Proceedings of the Royal Society of London. Series B: Biological Sciences, 264(1380), 437-444. https://doi.org/10.1098/rspb.1997.0062 []
  10. Hines A, Stewart JT, Catalano G. A Case of Capgras Syndrome Related to Hypothyroidism. J Psychiatr Pract. 2015 Nov;21(6):445-8. doi: 10.1097/PRA.0000000000000108. PMID: 26554328. []
  11. 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. []
  12. Lucchelli, F., Spinnler, H. The case of lost Wilma: a clinical report of Capgras delusion. Neurol Sci 28, 188–195 (2007). https://doi.org/10.1007/s10072-007-0819-8 []
  13. Neal M, Barton Wright P. Validation therapy for dementia. Cochrane Database Syst Rev. 2003;(3):CD001394. doi: 10.1002/14651858.CD001394. PMID: 12917907. []
  14. Spector A, Orrell M, Davies S, Woods B. Reality orientation for dementia. Cochrane Database Syst Rev. 2000;(4):CD001119. doi: 10.1002/14651858.CD001119. Update in: Cochrane Database Syst Rev. 2000;(3):CD001119. PMID: 11034699. []
  15. Seida JC, Schouten JR, Boylan K, Newton AS, Mousavi SS, Beaith A, Vandermeer B, Dryden DM, Carrey N. Antipsychotics for children and young adults: a comparative effectiveness review. Pediatrics. 2012 Mar;129(3):e771-84. doi: 10.1542/peds.2011-2158. Epub 2012 Feb 20. PMID: 22351885. []