The Capgras delusion is a rare psychiatric disorder. Women are affected about twice as often as men. The disease is accompanied by the delusional assumption that familiar people have been replaced by doppelgangers or impostors. The supposed doppelganger is either fought against or the patient thinks he has to protect himself from him.
What is Capgras Syndrome?
Capgras syndrome is a delusional disorder in which the patient believes that someone they trust has been replaced by someone who looks identical. In female patients, the partner is usually the doppelganger. Sometimes one’s own children are also perceived as being exchanged.
Patients claim the originals were abducted decades ago. In some cases they are even aware that they are suffering from a misunderstanding. However, they hold on to it even when it can be proven that they are wrong. Capgras syndrome is named after the French neurologist and psychiatrist Joseph Capgras, who first described it in 1923.
Capgras syndrome is extremely rare. Psychiatrists assume a frequency of 0.1 to 4 percent. In Alzheimer’s patients, the proportion is estimated at 10 to 30 percent. In addition, the syndrome appears to be more common in some cultures than in others. The psychiatric illness usually occurs in connection with certain physical and mental illnesses. Hence, some psychiatrists see them as a symptom of these diseases. If the disease is left untreated, it can have serious consequences for those affected and their social environment.
Causes
Current research assumes that Capgras syndrome can have a variety of causes. It is associated with paranoid schizophrenia, delirium, dementia, and Alzheimer’s disease. It also appears in connection with mood disorders and post-traumatic stress disorder. Delusional depression can also produce the symptoms.
Also possible causes are strokes, cerebral hemorrhages and accidents with brain trauma as a result. In some cases, Capgras syndrome also seems to have psychological causes: Since people with strong positive or negative emotions are usually declared doubles, the sick seem to have a disturbed relationship with them. By turning them into strangers, they can build the emotional distance with them that they desperately need.
In these cases, it is a matter of deliberate denial of the fact that the supposed doppelganger is the real person. Doctors assume that a third to half of the cases have an organic brain cause. In Capgras syndrome, the brain region responsible for the perception of faces (gyrus fusiformis) is separated from that responsible for emotional remembering (amygdala): The doppelgangers are perceived as familiar – face recognition works without problems – but not with the feelings that the person originally had for her.
It has not yet been clarified why the visual information correctly processed in the cerebral cortex is not passed on from there to the limbic system.
Symptoms, ailments & signs
The symptoms of Capgras syndrome can be very different and therefore take on different forms. Typically, those affected think that their friends and relatives have been replaced by doppelgangers. It is therefore a severe mental illness that can severely limit the life of the person affected and reduce the quality of life.
It can also lead to dementia or Alzheimer’s, so that those affected are always dependent on outside help in their lives. Capgras syndrome also often leads to social complaints and loss of contact. There is often also a inner restlessness to insomnia or hallucination.
Those affected have the feeling that they are being controlled from the outside by another person and that they have lost control of their everyday life. In some cases, Capgras syndrome can also lead to aggressive behavior, which is mainly directed against the supposed doppelganger. This can also lead to disputes or injuries.
In women, Capgras syndrome can also lead one mother to think that her child has been replaced by another. This can even lead to actions that could endanger the life of the child.
Diagnosis & course
In Capgras syndrome, the patient takes familiar people to be doppelgangers or confuses them with objects. Sometimes the sick are also not able to consciously control their movements. They recognize the familiar but do not associate them with the feelings they originally felt for them and with memories they have of them.
In severe cases, even several known people are mistaken for doubles by the sick person. Sometimes the patient also considers himself to be spurious. The doppelgangers are often referred to as people without a soul. Since the doppelganger delusion is the only symptom of the rare psychiatric illness, it is also known as a mono-thematic illusion. The doubles are perceived as terrifying. Affected children hide from them or deliberately avoid them.
The strong fears are often associated with insomnia, strong inner restlessness, acoustic hallucinations and the feeling of being controlled from outside. In rare cases there are aggressive acts against the doppelgangers. If Capgras syndrome occurs in connection with dementia, it usually goes away as the dementia worsens.
In the so-called doppelganger madness among mothers, the misunderstanding affects their own baby, which is perceived as being exchanged. It can be perceived as so threatening by the mother that she even wants to kill it.
When should you go to the doctor?
If a family member shows signs of schizophrenia or post-traumatic stress disorder, it is important to speak to them. A visit to the psychologist provides information about the clinical picture and enables appropriate therapy. If the psychiatric disorder is identified and treated at an early stage, the development of Capgras syndrome can be avoided under certain circumstances.
If the syndrome has already set in, it requires immediate treatment by an expert. Since the psychiatric illness can usually not be diagnosed by those affected, the examination must be initiated by friends and family members. This is particularly necessary if further changes in behavior are observed. Affected people often suffer from severe fears associated with insomnia, inner restlessness and acoustic hallucinations.
The following applies to these warning signs: seek professional help immediately. If Alzheimer’s and dementia patients suffer from symptoms of Capgras syndrome, the responsible doctor must be spoken to. A change in medication and therapeutic measures can reduce the delusion and free those affected from their suffering. A complete cure is not yet possible.
Treatment & Therapy
Diagnosing Capgras Syndrome is easy because the disease has clear symptoms. In most cases it is a chronic, non-progressive disease that, if left untreated, can lead to social difficulties for those affected.
The Capgras syndrome is treated according to the underlying disease. The symptoms can also be improved with the help of behavioral and conversational psychotherapy. If the cause is organic, the doctor will also administer neuroleptics to restore the neurotransmitter balance in the brain.
Neuroleptics are also a suitable therapy for paranoid schizophrenia. If the disease is caused by delusional depression, a combination of neuroleptics and antidepressants is used. The problem, however, is that one of the two most effective drugs (risperidone) has very strong side effects. There are no known cases of cure to date.
Outlook & forecast
So far, there are few conservative treatment options for Capgras syndrome. 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 person affected are in demand, as they have to support them emotionally.
This can prevent the person affected from developing further psychological complaints in the course of Capgras syndrome. Behavioral and conversation therapy is also useful. As part of these therapeutic measures, the affected person learns to deal with his illness and to recognize the signs of an acute flare-up.
If the complaints are based on an organic cause, this must first be treated. In addition, neuroleptic therapy is necessary. If Capgras syndrome occurs as part of paranoid schizophrenia, drug treatment is also indicated. This is best supported by those affected by making appropriate lifestyle changes. Affected people should note possible triggers and avoid them in the future.
Stressful situations should generally be avoided, as these can lead to hallucinations and other typical symptoms. In addition to these measures, close medical monitoring is always necessary.
Prevention
Prevention is not possible with Capgras syndrome.
You can do that yourself
Capgras syndrome is an extremely rare psychiatric disorder that affects women much more often than men. The patients are seized with the delusion that close people have either been exchanged for a double or are fraudsters. Sick children often only hide from the supposed doppelgangers, while adult patients take active action against them. The disease therefore not only places a heavy burden on the person affected, but also on their family environment.
The patients are often not aware of their madness and therefore cannot take any measures to help themselves. It is therefore particularly important that people close to you react correctly at the first signs of the disease. In particular, it is important that the person concerned is thoroughly examined by a specialist.
Capgras syndrome often has physical causes. It is therefore crucial for the success of the treatment that the underlying disease is correctly diagnosed and treated. The families of the patients should therefore work to ensure that they are cared for by a specialist who has already gained experience with the disease.
In many cases, in addition to other treatment methods, the symptoms can be improved by behavioral and conversational psychotherapy. Since not only the patients themselves, but also those around them, especially the alleged fraudsters, suffer massively from the disorder, these people should also consider therapy or resort to the support of a self-help group.
