Have you heard of Capgras Syndrome?
Imagine, one day, a family member you loved accused you of being an imposter. Accused you of not being who you say you are. Accused you of being a person who is replacing the “real you”.
This frightening situation has a name. It is called Capgras Syndrome. It can arise as a result of brain injury or neurological conditions. It can also occur in schizophreniform illness – schizophrenia and schizoaffective disorder. It is the Syndrome caused by schizophreniform illness that interests me here.
This delusion can be upsetting, not only for the person who is described as an imposter, but also for the person experiencing the delusion. Imagine one day you came home and one or more loved ones had been replaced by imposters with no real connection to you. How would it make you feel? How isolating would that be? How frightening?
Interestingly, Capgras Syndrome does not affect the voice. Someone with the Syndrome may recognize their loved one when speaking to them on the phone, but not in face-to-face contact. This suggests that a part of the brain involved in facial recognition may be involved.
However, there is unfortunately currently no broadly current accepted theory about causation of Capgras Syndrome. The brain is involved, but the pathways, the chemistry, remains a mystery. Indeed, mystery about the causes of Capgras Syndrome tie into broader questions about why any one person with a schizophreniform illness develops a particular delusion or hallucination.
How is this Syndrome diagnosed? Normally through patterns of diagnostic practice popular amongst psychiatrists and the medical profession. Because Capgras Syndrome is a rare condition, its diagnostic criteria are not included in the DSM-5, The Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
How is this Syndrome treated? Unfortunately, clinical researchers have not yet developed specific enough interventions to identify and nullify Capgras Syndrome. We must rely, typically, on anti-psychotic medication used to treat schizophreniform illness more broadly. Otherwise some general advice is given1 :
- “Enter their realm of reality when possible. It can help if you try to understand how terrifying it must be.
- Avoid arguing with them or trying to correct them.
- Help them feel safe. If you’re unsure what to do, you can ask the person what they need or talk with a healthcare professional.
- Acknowledge their feelings.
- If possible, have the “imposter” leave the room. If this is you and you’re the caregiver, let someone else take over until the episode is over.
- Rely on sound. If you know someone is prone to CS, you can make sure the first way they register your appearance is with sound. Greet them out loud before you see them when possible.”
Please note that I am not a medical professional, so any information given here is for general interest only. If you or a loved one appears to be experiencing Capgras Syndrome please consult your GP or psychiatrist.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health richard.schweizer@onedoor.org.au.
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Dr Richard Schweizer
[1] https://www.healthline.com/health/capgras-syndrome#caring-for-someone-with-cs