What is Capgras Syndrome?
Capgras syndrome (CS), also known as “delusion of doubles,” is a mental condition where a person mistakenly believes someone important to them or a familiar object, or even an animal, has been replaced by an identical copy. Despite earlier ideas that CS mainly affected women, it’s found in both men and women. It’s considered the most common type of delusional misidentification syndromes, a group of disorders characterized by fixed false beliefs, and can occur in people with psychiatric conditions as well as non-psychiatric conditions like brain damage.
Damage in specific parts of the brain, particularly the front, right limbic, and temporal regions, can contribute to CS. Such damage can affect our memory, self-awareness, and perception of reality, impairing our ability to correctly process emotional information and recognize faces. CS is not only observed in those with schizophrenia and schizoaffective disorders, but also in patients with Alzheimer’s disease, dementia, Lewy body dementia, epilepsy, stroke, pituitary tumors, advanced Parkinson’s disease, De Clerambault syndrome, and Ekbom syndrome. Because some people with CS can present violent behavior, it’s important to identify and address the condition promptly.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), a standard classification of mental disorders used by mental health professionals, doesn’t specifically mention CS due to its rarity. However, the delusions characteristic of CS could fall under persecutory or unspecified delusion types.
CS is named after Joseph Capgras, a French psychiatrist who first defined the disorder in 1923. He based it on a case involving a woman who believed that doubles had replaced her husband, people she knew, and even herself. Initially, CS was thought to be a psychiatric disorder similar to delusions in schizophrenia and connected to hysteria, which was predominantly seen in females. However, in the 1980s, it was found that CS could also result from physical damages to the brain. This means CS can now be seen as both a psychiatric and neurological disorder, with the delusion primarily arising from degeneration in the brain.
What Causes Capgras Syndrome?
Capgras syndrome is a complex condition caused by physical damage to the brain. It was first explained in 1979 that the disorder is associated with damage to the right side of the brain leading to issues with visually recognizing people, and damage to the frontal lobe causing difficulties with feeling a sense of familiarity.
There are also discussions about a potential link between Capgras syndrome and another condition called prosopagnosia, where people can’t recognize faces.
A theory suggests that people with Capgras syndrome can still recognize faces, but they experience damage to the part of the brain that helps us feel emotionally connected to familiar faces. This means someone suffering from Capgras syndrome can recognize a person but feel as though there’s something ‘wrong’ or unfamiliar about them. In studying a patient with Capgras syndrome, researchers found that a brain injury could lead to a disconnect between the part of the brain where we recognize familiar faces and the part that processes emotions. It was later suggested that individuals with Capgras syndrome, in fact, would not be able to recognize familiar faces.
Sometimes, Capgras syndrome can also go hand in hand with another condition called reduplicative paramnesia. This is a condition where a person believes that a specific location has been duplicated or relocated. These two conditions are linked as they are both related to the disruption of the same areas in the brain.
Risk Factors and Frequency for Capgras Syndrome
Capgras syndrome is a psychiatric condition that is relatively rare. Studies show that it exists in less than 1% of the psychiatric population. Among people with any psychiatric conditions, between 1.3% and 4.1% have Capgras syndrome. The rate goes up to about 3% among hospital patients dealing with psychosis. When considering people admitted to the hospital due to a severe psychotic episode, about one in ten patients may have Capgras syndrome.
- It is the most prevalent among patients with schizophreniform psychosis at 50%, brief psychosis at 34.8%, and unspecified psychosis at 23.9%.
- About 15% of those going through major depressive episodes and 11% of patients with delusional disorders and schizophrenia exhibit symptoms of Capgras syndrome.
The most common diagnoses that go hand-in-hand with Capgras syndrome include schizoaffective disorder, schizophrenia, and bipolar affective disorder. When looking at over 4,000 patients, only six presented with symptoms of Capgras syndrome. Most of these patients showed aggressive behavior towards a person they knew well. They also often had other neurological or medical conditions existing simultaneously. In a larger review of 260 cases of delusional misidentification syndromes, around 67% of patients were found to have Capgras syndrome. Among these cases:
- 73% also had schizophrenia
- 26.4% had dementia
- 16.7% had mood disorders
Capgras Syndrome is also associated with organic disorders in about 25% to 40% of cases.
Signs and Symptoms of Capgras Syndrome
Capgras syndrome is a condition where individuals struggle to recognize familiar faces, resulting in the person thinking that those close to them have been replaced by identical doubles. The syndrome can be caused by a range of underlying conditions. Symptoms can also vary, but the person may display agitation and aggression toward recognized individuals.
- Underlying causes can include schizophrenia and schizoaffective disorders
- Alzheimer’s disease
- Dementia
- Lewy body dementia
- Epilepsy
- Stroke (cerebrovascular accident)
- Pituitary tumors
- Advanced Parkinson’s disease
- Feelings of agitation and aggression toward familiar individuals
Testing for Capgras Syndrome
Capgras syndrome, a condition where a person believes that a familiar person or place has been replaced with an identical impostor, is identified based on a review of the person’s symptoms. There’s no specific test for it, instead doctors diagnose it by assessing the person’s reported experiences and behaviours.
Treatment Options for Capgras Syndrome
Capgras Syndrome (CS) is a condition where a person believes that someone they know, often a close family member or friend, has been replaced by an impostor. This can be difficult to effectively manage due to the patient’s strong conviction in their beliefs. Therapy, especially when combined with antipsychotic medications, is often used to treat this condition. The treatment approach should focus on expressing understanding and empathy towards the patient’s situation and should avoid directly confronting the beliefs related to Capgras Syndrome. Effective treatment also usually involves targeting the primary symptoms of any underlying mental health conditions with medications. Sometimes, it may be necessary for patients with Capgras Syndrome to be hospitalized, particularly if they pose a risk of self-harm or violence. Treatment should also take into account the presence of any other mental health conditions the patient may have.
In addition to treating the patient, caring for someone with Capgras Syndrome can also involve support and education for the caregiver and family members. Because patients with Capgras Syndrome often misidentify and become hostile towards the people close to them, caregivers should use specific communication techniques to avoid confrontations. These techniques can include talking to the patient from out of sight, as this can help circumvent the patient’s difficulties with face-to-face interactions. Caregivers should also aim to understand their own strengths and weaknesses when it comes to managing the condition, and seek support from family, friends, and other relatives as needed.
Capgras Syndrome can develop at the same time as, or after, another psychological condition, like depression or schizophrenia. The outcome of Capgras Syndrome can depend on the course of these underlying mental health condition. For instance, in one study, the symptoms of Capgras Syndrome went away after the patients’ depressive symptoms improved, but the symptoms were more persistent in patients with schizophrenia. The return of a psychotic condition can also trigger the return of Capgras Syndrome symptoms.
Having Capgras Syndrome can cause a person to struggle with their personal relationships and social interactions, and they may be prone to self-harm or violence. It can also place a strain on the patient’s family due to increased caregiver stress and stigma. Socioeconomic difficulties might arise as well, as the patient may struggle to keep a job. Together, these factors can contribute to a larger burden on the healthcare system and society as a whole.
What else can Capgras Syndrome be?
Capgras syndrome and delusional disorders can often occur alongside other illnesses. The following list presents some common examples of health conditions that have been linked with the development of delusional disorders:
- Vascular diseases such as hardening of the arteries (atherosclerosis), high blood pressure in the brain (hypertensive encephalopathy), and bleeding into the space around the brain (subarachnoid hemorrhage).
- Neurodegenerative disorders including Alzheimer’s disease, advanced Parkinson’s disease, and dementia.
- Other issues affecting the central nervous system, such as epilepsy and fat embolism where fat particles get into the blood vessels.
- Infectious diseases like HIV/AIDS, acute viral encephalitis, and malaria.
- Metabolic disorders like high calcium levels (hypercalcemia) and low sugar levels (hypoglycemia).
- Exposure to toxins like mercury, manganese, and arsenic.
In cases of delirium, there are typically changes in consciousness, hallucinations, and poor cognitive abilities, which you usually won’t find in delusional disorders. On the other hand, substance-related disorders, such as those involving amphetamines, cocaine, hallucinogens, alcohol, and steroids, have been associated with delusions and delusional disorders. In cases of schizophrenia, delusions often appear bizarre and are usually accompanied by hallucinations.
What to expect with Capgras Syndrome
The Capgras syndrome, a condition where a person believes someone they know has been replaced by an imposter, can start at the same time or after another mental illness begins. A study which looked at 20 patients with Capgras syndrome found that the symptoms of the syndrome lessened once their depression eased. However, the symptoms of Capgras syndrome were more persistent in patients who also had schizophrenia along with psychosis, which is a severe mental disorder where thoughts and emotions are impaired.
If Capgras syndrome starts at the same time as psychosis, the return of the psychosis can also cause the symptoms of Capgras syndrome to come back. To simplify, imagine if two illnesses started at the same time, if one gets worse, the other one might get worse too. The same is true if one gets better, the other might get better too.
Possible Complications When Diagnosed with Capgras Syndrome
Capgras syndrome can negatively impact both the individual suffering from the disorder and those around them. Someone with this disorder might end up having problems with their relationships and could even harm themselves or become violent. The strain doesn’t just stop there – the stress and stigma can also affect their family, particularly the person taking care of them.
These implications extend to the person’s socio-economic life as well. They might struggle to keep a job, which can affect everyone in their household, especially caregivers. All these challenges combined make Capgras Syndrome a burden on both the healthcare system and society as a whole.
Symptoms and Implications:
- Conflict in personal and social relationships
- Possible self-harm and violence
- Stress and stigma affecting family, particularly caregivers
- Difficulty retaining a job, impacting household members
- Strain on healthcare system and society
Preventing Capgras Syndrome
Alongside medication, talking with professionals and having therapy sessions are crucial parts of effective treatment for Capgras syndrome—a condition where a person believes that a loved one has been replaced by an imposter. People with this condition have a heightened risk of acting aggressively or violently towards others, including those looking after them. This makes therapy sessions especially important to help manage the condition. Part of helping the patient should be educating them on creating strong emotional bonds and effective communication with their caregivers. Overall, the patient should follow the planned medical and mental health treatment for their condition, as this can help control or even treat any underlying disorders.
Caregivers and family members play a critical role in supporting someone with Capgras syndrome. Due to the risk of the patient lashing out violently at the person they misidentify, it’s crucial to support caregivers. This can be done through communication techniques, counseling, medication, and teaching problem-solving skills. It’s also essential to consider a caregiver’s feelings and provide reassurances. One recommended practice to sidestep the patient’s difficulty in face-to-face interaction is to promote better auditory communication. Caregivers can do this by announcing themselves and communicating clearly while staying out of the patient’s sight. This can help in improving emotional connections. Additionally, caregivers should assess their own strengths and weaknesses in managing the patient’s condition, and seek support from other family members, friends, and relatives.
