“A suspicious mind will see evidence of poison wherever it looks”
7:30 pm. I’ve just finished my homework and I head downstairs for dinner. Where’s my mom? Let’s check the kitchen.
Wait…who’s that?
“Um, sorry but where is my mother?”
The strange person looked at me confused. “Are you okay? Do we need to get your eyes checked or something?”
“What…excuse me WHO ARE YOU AND WHERE IS MY MOTHER?”
“WHAT ARE YOU SAYING? I’M YOUR MOTHER!”
…
What?
Understanding Capgras Delusion
Capgras syndrome or Capgras Delusion, a disorder that causes the faces of our loved ones to contort and transform into impostors. It deludes us into thinking that a friend, parent, or even a pet has been replaced by an identical impostor.
Capgras delusion is typically classified as a "delusional misidentification syndrome," a group of rare psychiatric disorders characterised by the misperception of familiar people, places, or objects. A person may recognize their loved ones' physical appearance, but the emotional connection has been severed, leading to a strange sense of estrangement. An important thing to note about this disorder is that it involves a "loss" of familiarity, not a "lack" of it.
Referring back to the situation we began with, the individual comes downstairs to find their mother but stumbles upon someone they do not seem to recognise. But, as it turns out, that ‘stranger’ was in fact their mother. They were unable to form that internal emotional connection between this person and their mother.
Symptoms and Diagnosis
The hallmark symptom of Capgras syndrome is the delusional belief that a significant person in the individual's life has been replaced by an imposter. An unease, anxiety, or fear often accompany this conviction. It is not uncommon for individuals suffering from Capgras delusion to weave intricate narratives to rationalise their unsettling experiences.
In addition to misidentification, individuals may display heightened vigilance, suspicion, persistent doubt and distrust towards loved ones, emotional detachment and a reluctance to engage with the suspected impostors. Typically, the person affected by the delusion does not extend the misidentification to all individuals they see, and it is instead restricted to a smaller group of individuals.
Diagnosing Capgras delusion can be challenging due to its rarity and association with other mental health disorders and psychiatric conditions, such as schizophrenia, Alzheimer's disease, or traumatic brain injuries. Understanding these associations and conducting careful assessments, including interviews with the patient and their family is crucial for clinicians to tailor treatment approaches effectively.
Potential Causes
There are a variety of theories and hypotheses proposed by researchers as to the precise causes of Capgras delusion. A general agreement, however, is that the origins of this disorder can be found in structural damage to organs. More specifically, brain damage in the bifrontal, right limbic, and temporal regions can cause Capgras Syndrome. This type of damage could lead to an adverse effect to memory and perception of reality. Alternatively, damage to both the frontal lobe and right hemisphere might cause problems with familiarity and visual recognition respectively.
Treatment Approaches
Managing Capgras delusion is something that poses a challenge to professionals due to the lack of an evidence-based approach, inspired by treatment not being well studied. Treatment strategies often involve a combination of psychotherapy and medication. Cognitive-behavioural therapy (CBT) can assist individuals with modifying their disordered thought patterns caused by the delusion. Antipsychotic medications, commonly used to treat schizophrenia and related disorders, may be prescribed to alleviate the intensity of delusional beliefs. While treatment may not completely eradicate the delusion, it can help individuals cope with their symptoms and enhance their overall quality of life.
Conclusion
Capgras delusion stands as a captivating and perplexing example of how the human mind can distort reality, creating a stark disconnect between what is seen and what is felt. As researchers continue to unravel the complexities surrounding this condition, a deeper understanding of its nature could be revealed. But, for now, the enigma of Capgras delusion stands to serve as a reminder of the intricate interplay between cognition, emotion, and perception in shaping our perception of reality.
PS:
Here are 2 case studies to better understand the nature of Capgras Syndrome
1: Mary, aged 40 years, was referred for psychiatric evaluation out of concern that a mental health diagnosis was interfering with her ability to appropriately and safely care for her child. The patient had stated on numerous occasions that her 9-year-old daughter, Sarah, had been placed in the custody of Child Protective Services and replaced by an imposter. Mary also reported that she had given birth to twins but that the hospital record only documented the birth of Sarah. On occasion, she had shown up at her daughter’s school, refusing to pick her up, screaming, “Give me my real daughter; I know what you’ve done.”
2: Mrs. D, a 74-year-old married housewife, recently discharged from a local hospital after her first psychiatric admission, presented to our facility for a second opinion. At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another unrelated man. She refused to sleep with the impostor, locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalise her. At times she believed her husband was her long deceased father. She easily recognised other family members and would misidentify her husband only.