History and Description of Cotard’s Syndrome

Cotard’s syndrome, also known as Cotard’s delusion or Walking Corpse Syndrome,  is named after Parisian neurologist Dr. Jules Cotard (1840-1889). According to Dr. G.E. Berrios and Dr. R. Lugue of the University of Cambridge, Cotard described what he believed to be a clinical state of “agitated melancholia”. He called it délire des négations. Patients with Cotard’s delusion firmly believe they are actually dead, are missing one or more body parts, are missing most or all of their blood, are missing one or more vital internal organs, are missing parts of their skeleton or have lost their souls. Some patients with Cotard’s syndrome deny their very existence.    

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He described the syndrome during a lecture given in 1880. He claimed the syndrome ranged from mild (self-loathing and feelings of despair) to severe. To illustrate the severe end of the syndrome, he related the story of one of his patients. The woman denied the existence of the Devil and God, but this belief eventually transformed into the belief that she was damned and could not die. The patient also claimed that several parts of her body did not exist. She denied having the need to eat and as a result, eventually died from starvation. Self-starvation continues to be an aspect of Cotard’s syndrome that is frequently reported. Over the years, other patients have reported smelling their own putrefying flesh or reported feeling the movement of worms inside their bodies.  Although, it should be pointed out that patients who feel worms crawling on, or through them, usually suffer from sleep deprivation or amphetamine induced (most notably cocaine) psychosis. Other patients suffering from Walking Corpse syndrome report that they believe they are immortal. On the mild end, delusions include reports of losing all earthly possessions. Cotard’s syndrome is the only delusional psychosis syndrome that is self-certifiable, meaning it is the only one the patient can authoritatively confirm or deny that certain criteria have been met.

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Causes and Prevalence of Cotard’s Delusion

Walking Corpse syndrome is found primarily in patients suffering from schizophrenia, and disorders that can have psychotic features such as bipolar disorders, derealization disorders or severe depression. Neurological culprits include nondominant temporoparietal cortex lesions and organic brain disorders. There are even cases of some patients suffering from migraines who report symptoms of Cotard’s delusion .

Cotard’s syndrome can’t be neatly categorized under the current psychiatric classifications because the criteria for diagnosis is based primarily on self-reporting and case studies. A syndrome is a group of symptoms and not a disorder in and of itself. There is very little scientific data to support the pathogenesis, prevalence or treatment of Cotard’s delusion.

Dr. G.E. Berrios and Dr. R. Lugue of the University of Cambridge performed a statistical analysis on 100 cases. They report no significant difference of occurrence between men and women. However, age appears to increase the risk of developing  Walking Corpse syndrome. They report that 89% of the subjects suffered from depression, 65% reported anxiety and 63% reported feelings of guilt. They report 86% of the subjects  reported delusions concerning their body, 69% reported delusions regarding their existence, 55% had delusions of immortality, 58% suffered hypochondriacal delusions.

Berrios and Lugue go on to describe three different types of the syndrome; psychotic depression with melencholia, Cotard’s syndrome type 1 and Cotard’s syndrome type 2. Patients with psychotic depression with melancholia report few nihilistic delusions (the belief that something doesn’t exist). Patients with Cotard’s delusion type 1 don’t meet criteria for mood disorders or organic disease and may only be delusional. The patients with Cotard’s delusion type 2 suffered from depression and anxiety and had auditory hallucinations.

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Course and Treatment of Walking Corpse Syndrome

Because self-starvation qualifies as dangerous behavior to self, patients can be committed, and treated, against their will. Treatment of Walking Corpse syndrome varies by patient and the underlying disorders they suffer from. Electroconvulsive therapy (ECT) appears to be effective in most patients. ECT is more effective when used in combination with medications such as antidepressants, antipsychotics or mood stabilizing medications. Cotard’s delusion is not a chronic syndrome, rather it appears to occur intermittently throughout life span of the individual. So far, there is no data to indicate whether the syndrome worsens with each occurrence or if the patient reaches the same level of delusion each time.

An Interesting Side Note to Consider

It is interesting to note that, Cotard’s syndrome is thought to be neurologically related to Capgras’s syndrome. Both syndromes are thought to result from a disconnection between areas of the brain that control facial recognition and areas of the brain that attach emotions to recognition. So, if the person doesn’t have an expected emotional reaction to a face, they believe the other person has been replaced by a stranger (Capgras’s Syndrome)or an alien. With Cotard’s delusion, if a person does not recognizing their own face it can theoretically lead to feelings of nonexistence.