History and Description of Capgras’s Delusional Theory

Capgras’s delusion is named after French psychiatrist Jean Marie Joseph Capgras (1873-1950). In a 1923 paper co-written by Jean Reboul-Lachaux, Capgras’s intern, they report the case of a woman (Madame M.) who claimed her husband, family and eventually evolved to the belief that other people she knew had been switched out and replaced by an impostor. She also believed each of the impostors were eventually switched out and yet another impostor took their place. Since then, Capgras delusion includes the belief that any person, animal, object, place and even time have been substituted. The delusion usually centers around one sense, vision, but there have been cases where it centered around hearing. Oddly enough, patients with Capgras syndrome typically don’t feel like someone is “out to get them”, they just want to know why the person, place or thing was replaced.

DuplicatesCredit: commons.wikimedia: public domain

Examples of What Capgras’s Syndrome Patients See

There have been people who suffered from Capgras’s delusion who didn’t recognize their own faces in a mirror. In one case, a man didn’t recognize his own reflection in a mirror and pinched his own arm. He is reported to have said he wondered if he and the man in the mirror were the same person. In another case, a woman reportedly flew into violent rages when she saw herself in any reflective surface. She believed the reflection was another woman who was trying to steal her husband.

One patient believed his dog had been switched out for a duplicate, another patient was certain his gym shoes (and other belongings) had been replaced. Yet another patient, a man, recognized his wife’s voice while they spoke on the phone but when he saw her face-to-face he believed she was an exact duplicate sent to replace his wife. In the cases of blind patients, they believe the voices of family and friends are coming from an impostor.

Classification, Forms and Prevalence of Capgras’s Delusion

Capgras’s syndrome obviously falls under delusional beliefs surrounding misidentifying people, places and things. Therefore, it fits under the classification of delusional misidentification syndrome. It can take on an acute, chronic or transient form. Acute Capgras delusion comes on suddenly and is severe, but patients respond quickly to treatment. Chronic Capgras syndrome does not appear or progress quickly. It persists over a long period of time and often recurs. Transient Capgras’s delusion is not as sever as the acute form, but it also comes on rapidly and patients respond to treatment very quickly.

Dr. Todd Feinberg from the Albert Einstein College of Medicine, claims thousands of people in the United States may be suffering from Capgras’s syndrome on a daily basis.

Case Studies and Theoretical Causes of Capgras’s Syndrome

British psychologists, Hadyn Ellis and Andy Young, publish a paper hypothesizing that patients suffering from Capgras’s delusion may be able to consciously recognize faces but their ability to attach emotion to the face is somehow impaired. They theorize that this leaves the patient feeling as if something isn’t right about the other person.

Ellis, et al., publish a study involving five patients diagnosed with Capgras’s syndrome. Each of the patients were also diagnosed as schizophrenic. The patients were able to recognize faces but did not have normal emotional reactions to the faces.

William Hirstein, PhD. and Vilayanur Ramachandran, MD., publish a paper outlining the case of an individual diagnosed with Capgras’s delusion who had suffered a brain injury. They report findings similar to what Ellis. et al reported.

Ramachandran believes Capgras’s syndrome involves a disruption between the areas of the brain that recognize faces and the area that attaches emotions to the face. Ellis, et al., believe that there is an impairment in the ability to reason along with the lack of emotional response to a face.

While schizophrenia has been reported in a large number of patients suffering from Capgras delusion, not all of the patients are diagnosed as having a psychological disorder. There are also reports of its occurrance in patients suffering from traumatic injuries to the temporal lobe, suffering from brain lesions, epilepsy, dementia, migraines, diabetes and hypothyroidism. The clinical director of the Pittsburgh Center for the Neuroscience of Mental Disorders, Matcheri Keshavan MD., says close to â…“ of the patients either have temporal lobe epilepsy or their temporal lobes are malformed.  

Treatment of Capgras’s Delusion

Capgras syndrome does not have a specific treatment. Treatment is approached based on the individual and the suspected cause. Antipsychotics and cognitive therapy have been successful in some cases.

An Interesting Side Note to Consider

It is interesting to note that, Capgras syndrome is thought to be neurologically related to Cotard’s syndrome. Both are believed to result from a disconnection between brain areas that control facial recognition and emotions. Where patients suffering from Capgras delusion believe something or someone has been replaced, patients with Cotard’s delusion don’t believe something even exists.