INTRODUCTION: CAPGRAS DELUSION
In the Capgras delusion, the person misidentifies a person. It is a psychological disorder where the person experiencing the delusion believes that someone they know or they themselves have been replaced by an impostor. They might assume their friend is no longer them, but a double has been placed instead.
They recognize the person but claim that “they can see through the disguise”. This accusation can cause excessive strains on the person experiencing it as well the person being blamed. It is not limited to only people, but can be stretched to objects and animals as well.
It is a delusional disorder, which is coded in ICD-10, as 297.8. It was named after the first scientist who described such a case, Joseph Capgras in 1923.
The misidentified people are usually ones they’re very close with, a spouse if they’re married, or close relatives. Sometimes, they might also misidentify healthcare staff.
The affected person behaves completely normal except for this part of their life, and this specific symptom doesn’t affect any other sphere of their lives.
It is more common in women and is rarely present in children.
ONSET: CAPGRAS DELUSION
Capgras syndrome usually appears as a symptom as compared to being present in its pure form. It often accompanies psychosis. The person is probably suffering from schizophrenia, especially paranoid hallucinatory schizophrenia, or other affective disorders. Schizophrenia might alter one’s sense of reality, and this can cause delusions.
It also occurs in people suffering from organic conditions, such as brain injury, infection, drug intoxication, etc. Central lesions, especially in the back of the right hemisphere, where facial recognition is located, might lead to Capgras syndrome as well.
Epilepsy increases the chances as well. It might signify the beginning of dementia. It’s also related to Alzheimer’s disease, cerebrovascular diseases, and pituitary tumour.
It could be due to a combination of atrophy, lesions, or cerebral dysfunction, physical and cognitive changes. It’s an outcome of a problem with the processing of information and an error in perception. Memory lapses further complicate the process.
It can also be triggered by the development of negative feelings to the person being blamed, after which they cannot accept it, and hence, gets into the delusion that it couldn’t have been them, and that someone else took their place. This arises from a love-hate conflict in the mind.
TREATMENT: CAPGRAS DELUSION
Treatment is very essential for this, as the presence of this disorder can pose a threat to both the person having it as well as the person being blamed. The person might lash out, act aggressive and display violence.
This is only in very severe cases. However, suspiciousness and hostility of the person directly correlates to this danger. In other cases, the patient might be anxious and afraid. They might become obsessed with the idea of wanting to locate the actual person, and this further worsens the situation.
Though it isn’t possible to cure the disorder as such, the symptoms can be reduced using the help of treatments. Treating the underlying issue, ex: Schizophrenia, might help to reduce the effect of the syndrome. However, if the parent disorder is difficult to treat, like with Alzheimer’s, it might not be that successful.
Other treatments that can be used are antipsychotics and therapy for people with people experiencing psychosis or has schizophrenia, surgery for people who have had brain lesions, accidents, head trauma, etc.
Therapy and medications are given for memory and recognition problems. Medications can be given for people suffering from Alzheimer’s or dementia in order to increase the number of neurotransmitters.
Creating a positive and pleasant atmosphere might help the patient feel more safe, and less afraid. Another method that is used is called ‘validation therapy’, which validates the person’s delusion present, and this can help inculcate trust in the patient, make them open up and also reduce anxiety and stress. They feel less ‘crazy’, and this can help in creating a welcoming environment.
There is also another type of therapy that is the exact opposite of this that is frequently used, which includes the rooting of the patient into reality, by constantly reminding them of the time and place they are in, increasing their temporal and spatial awareness. This can be done by caregivers, the health care workers, or therapists. These are called reality orientation techniques. This also includes frequent reminders of major life events, and changes.
CARING: CAPGRAS DELUSION
It is important to not argue with the person undergoing the delusion, so as to not make them feel antagonistic. It is important to recognize that it is their truth, and it is what they believe in. While it is unwise to confirm their suspicions, validating their delusions helps hugely. Trying to minimize contact with the misidentified person helps as well. This is in order to be sensitive to the needs of the affected person. Having the person speak before they enter the visual field might help as they might recognize the voice. A simple greeting can do this job.
The caregiver must be patient and not get frustrated with the patient, considering the Capgras syndrome brings with a lot of confusion, fear and anxiety. Try to empathize with them and understand what they’re going through. Talking to them, and listening to what they have to say, rather than argue with them provides an insight about how they’re feeling, which can help the caregiver to decide how to give appropriate responses.
Acknowledging what the patient is undergoing, and the feelings they are having is important. It is okay to talk to them about the identity confusion they are facing and how they feel it is affecting them. Make them feel safe, and ask them questions if you’re not sure what to do at any point of time.
OUTLOOK: CAPGRAS DELUSION
While the effects might fade over time, it is of utmost need to approach a doctor as soon as possible in order to prevent any mishaps and have the best chance at treatment. They might never fully recover, but the anxiety and fear they face can definitely be managed.
Legg, T.J., (2017) What is Capgras syndrome? Medical News Today. https://www.medicalnewstoday.com/articles/320042
Bhandari, S., (2012) Unusual psychiatric syndromes. Core Psychiatry (Third Edition)
Josephs, K.A. (2007). Capgras syndrome and its relationship to neurodegenerative disease. Archives of neurology.
Ana Gotter (2017) What is Capgras Syndrome? Healthline.