Capgras syndrome is a very rare psychiatric disorder. Women are affected about twice as often as men. The disorder is associated with the delusional belief that familiar people have been replaced by doubles or impostors. The supposed doppelganger is either fought or the patient believes he or she must protect himself or herself from it.
What is Capgras syndrome?
Capgras syndrome is a delusional disorder in which the patient believes that a person familiar to him, has been replaced by a person with an identical appearance. In female sufferers, it is usually the partner who is the doppelganger. Sometimes the patient’s own children are also perceived as having been replaced. Patients claim that the originals were abducted decades ago. In some cases they are even aware that they are suffering from a misrecognition. However, they hold on to it even when they can be proven to be mistaken. Capgras syndrome is named after the French neurologist and psychiatrist Joseph Capgras, who first described it in 1923. Capgras syndrome is exceedingly rare. Psychiatrists assume a frequency of 0.1 to 4 percent. Among Alzheimer’s patients, it is estimated to occur in 10 to 30 percent. In addition, the syndrome appears to be more common in some cultures than in others. The psychiatric disorder usually occurs in association with certain physical and mental illnesses. Therefore, some psychiatrists consider it a symptom of these diseases. If the disorder is not treated, it can have serious consequences for those affected and their social environment.
Causes
Current research suggests that Capgras syndrome may have several causes. It occurs in association with paranoid schizophrenia, delirium, dementia, and Alzheimer’s disease. It also appears in association with affective disorders and post-traumatic stress disorder. Depression with delusional features can also cause the symptoms. Causes may also include cerebral apoplexy, cerebral hemorrhage, and accidents resulting in traumatic brain injury. In some cases, Capgras syndrome also appears to have psychological causes: Since people who are usually emotionally strongly positive or negative are declared doubles, the sufferers seem to have a disturbed relationship with them. By turning them into strangers, they are able to create the emotional distance to them that they desperately need. In these cases, it is a conscious denial of the fact that the supposed double is the real person. Medical experts assume that one third to one half of the cases have a brain-organic cause. In Capgras syndrome, the brain region responsible for perceiving faces (fusiform gyrus) is separated from the one responsible for remembering them emotionally (amygdala): the doppelgangers are perceived as familiar – face recognition works without problems – but not linked to the feelings the person originally had for them. Why visual information properly processed in the cerebral cortex is not transmitted from there to the limbic system has not yet been clarified.
Symptoms, complaints, and signs
The symptoms of Capgras syndrome can vary widely in severity and thus take different forms. As a rule, those affected think that their friends and relatives have been replaced by doubles. It is thus a severe mental illness that can severely limit the life of the affected person and reduce the quality of life. It can also lead to dementia or Alzheimer’s disease, so that the affected person is always dependent on outside help in their life. Similarly, Capgras syndrome often leads to social discomfort and contact breakdowns. There is also often an inner restlessness, insomnia or hallucination. Sufferers have the feeling of being controlled from the outside by another person and of having lost control over their daily lives. In some cases, Capgras syndrome can also lead to aggressive behavior, which is mainly directed against the supposed doubles. This can also lead to arguments or injuries. In women, Capgras syndrome can also lead to a mother thinking that her child has been replaced by another. This may even lead to actions that could endanger the child’s life.
Diagnosis and course
In Capgras syndrome, the patient mistakes familiar people for doubles or confuses them with objects. Sometimes the sufferers are also unable to consciously control their movements. They recognize the familiar person but do not associate them with the feelings they originally had for them and with memories they have of them. In severe cases, even several familiar people are mistaken for doubles by the sufferer. Sometimes the patient also believes himself to be a fake. The doubles are often referred to as people without souls. Since the doppelganger delusion is the only symptom of the rare psychiatric disorder, it is also called mono-thematic illusion. The doubles are perceived as frightening. Affected children hide from them or deliberately avoid them. The strong fears are often associated with insomnia, strong inner restlessness, auditory hallucinations and the feeling of being controlled from the outside. In rare cases, aggressive acts against the doubles occur. If Capgras syndrome occurs in the context of dementia, it usually disappears when the dementia worsens. In the so-called doppelganger delusion in mothers, the misrecognition concerns the mother’s own baby, which is perceived as replaced. It may be perceived by the mother as so threatening that she even wants to kill it.
When should you go to the doctor?
If a family member is showing signs of schizophrenia or post-traumatic stress disorder, it is important to address this. A visit to a psychologist will provide information about the clinical picture and enable appropriate therapy. If the psychiatric disorder is recognized and treated early, the development of Capgras syndrome may be avoided. If the syndrome has already developed, this requires immediate treatment by an expert. Since the psychiatric disorder usually cannot be detected by the affected person himself, the investigation must be initiated by friends and family members. This is especially necessary if further changes in behavior are observed. Affected individuals often suffer from severe anxiety associated with insomnia, inner restlessness, and auditory hallucinations. The rule for these warning signs is to seek professional help immediately. If Alzheimer’s and dementia patients suffer from symptoms of Capgras syndrome, it is necessary to talk to the responsible physician. A change in medication as well as therapeutic measures can reduce the delusion and relieve those affected of their suffering. However, a complete cure is not possible to date.
Treatment and therapy
Diagnosis of Capgras syndrome is straightforward because the disorder has a clear symptomatology. In most cases, it is a chronic, nonprogressive disorder that, if left untreated, can lead to social difficulties for affected individuals. Capgras syndrome is treated according to the underlying disease. The symptoms can also be improved with the help of behavioral and conversational psychotherapy. In the case of an organic cause, the doctor also administers neuroleptics to restore the neurotransmitter balance in the brain. In paranoid schizophrenia, neuroleptics are also the appropriate therapy. If the illness is due to delusional depression, a combination of neuroleptics and antidepressants is used. However, it is problematic that one of the two most effective drugs (risperidone) has very strong side effects. Cases of recovery have not been reported to date.
Outlook and prognosis
Few conservative treatment options exist for Capgras syndrome to date. In addition to drug therapy, which is particularly useful for less severe symptoms, a number of self-help measures are used. Above all, the relatives and friends of the affected person are called upon to provide emotional support. This can prevent the affected person from developing further psychological complaints in the course of Capgras syndrome. Behavioral and talk therapy is also useful. Within the framework of these therapeutic measures, the affected person learns to deal with his or her illness and to recognize the signs of an acute episode of the disease. If the symptoms are due to an organic cause, this must first be treated. Neuroleptic therapy is also necessary.If Capgras syndrome occurs in the context of paranoid schizophrenia, drug treatment is also indicated. This is best supported by the affected person through appropriate lifestyle changes. Affected individuals should note possible triggers and avoid them in the future. Stressful situations should generally be avoided, as these may cause hallucinations and other typical symptoms. Accompanying these measures, close medical monitoring is always necessary.
Prevention
Prevention is not possible with Capgras syndrome.
What you can do yourself
Capgras syndrome is an extremely rare psychiatric disorder that affects women significantly more often than men. Patients are seized by the delusion that close people have either been exchanged for a double or are impostors. Sick children often only hide from the supposed doubles, whereas adult patients actively act against them. Therefore, the disease puts a great strain not only on the affected person, but also on his or her family environment. Patients are often not aware of their madness and therefore cannot take any measures to help themselves. It is therefore particularly important that close persons react correctly at the first signs of the disease. In particular, it is important that the affected person is thoroughly examined by a specialist. Capgras syndrome often has physical causes. It is therefore crucial for the success of treatment that the underlying disease is correctly diagnosed and treated. Patients’ families should therefore work to ensure that they are seen by a specialist who has had previous experience with the condition. In many cases, the symptoms can be improved by behavioral and conversational psychotherapy, in addition to other treatment methods. Since not only the patients themselves, but also their environment, especially the alleged cheaters, suffer massively from the disorder, these individuals should also consider therapy or resort to the support of a self-help group.
