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Capgras syndrome is a relatively rare condition that affects people psychologically. It is also referred to as impostor syndrome, and means that the person affected holds delusional beliefs that a loved one has been replaced with an identical looking impostor. They believe that their loved one is not really them, and somebody else is pretending to be them, and will often ask for the real person in the presence of them.
Even though the Capgras patient can recognise the person’s face, and voice, they believe that it is somebody else disguised as their loved one. However, in reality, the affected person is in fact misidentifying their loved one and experiencing confusion from their delusional belief.
A Capgras patient will often hold identity delusions about somebody that they are the most familiar with, which can be a frustrating aspect of the condition for families and loved ones.
It is common in Capgras syndrome for the affected person to misidentify a family member or other close relation, which is what makes the syndrome particularly difficult for families. As well as a family member, they can also apply their misidentification to an animal, place or object. For example, somebody with Capgras syndrome could misidentify their dog, cat, home, car, spouse, sentimental object, child or sibling.
Joseph Capgras was the name of the French psychiatrist who first identified the condition, hence why it is called Capgras syndrome. It is classed as a form of Delusional Misidentification Syndrome (DMS), and this group of illnesses are often a secondary illness to a primary mental health or neurological condition that a person is already suffering from.
The first diagnosis of Capgras syndrome made by Joseph Capgras was in the 1920s in a female patient, who was repeatedly misidentifying her husband. This patient was in the late stages of Alzheimer’s disease, which is a common risk factor for developing Capgras syndrome.
There are only a small number of studies that focus on Capgras syndrome due to its unidentified occurrence (you can read more about the research into Capgras in the published studies).
However, what has been identified is that it is most commonly found in patients with schizophrenia or dementia, and is more often found in the adult female population. Although Capgras syndrome can affect anybody (male or female), it is always attributed to a functional or organic psychotic disorder.
It can be extremely distressing for both the person affected and the victim of the delusions to cope with Capgras syndrome. This is because the delusions feel completely true to the person, even if there is evidence to show that their delusions are false.
It can create difficulties in family relationships because the person can get extremely distressed in the presence of the supposed impostor; creating tensions, aggression and upset. The remainder of this article will explain the causes and symptoms of Capgras syndrome, before ending with treatment options and support for caring for a Capgras patient.
What are the causes?
Capgras syndrome is a condition that develops from a primary mental health issue, neuro-degenerative disease or brain injury. It is caused by a brain defect where there is miscommunication between the facial recognition, information processing and memory functions of the brain.
There are no reported isolated Capgras syndrome cases without another condition being present, as it is the primary condition that causes the damage to these various brain regions.
In 70% of Capgras syndrome cases, the person primarily suffered from a psychotic disorder which then presented symptoms of Capgras syndrome (most commonly, schizophrenia). With the condition affecting mental health and a true sense of reality, it can present as a symptom of many different disorders of the mind.
The most common associated cause of Capgras syndrome is schizophrenia. Schizophrenia is a mental health condition that causes hallucinations and paranoia most commonly, and it is these symptoms that can develop into Capgras syndrome. It is widely known that schizophrenia can cause a person to live in their own reality which to them is completely realistic, so misidentification can be a common side effect.
Those with schizoaffective disorder (paranoid schizophrenia) can be at even higher risk of the symptoms of Capgras syndrome because the paranoia causes them to mistrust even their closest friends or family. Even if the person recognises their loved one’s face, voice and identity, they may still disbelieve that it is truly them due to the extreme paranoia that they are experiencing.
The second most common illness that Capgras syndrome is an associated disorder of is Alzheimer’s disease or dementia. These diseases both dramatically affect a person’s mind and cause them to have an altered sense of reality; often forgetting recent memories, becoming disorientated or confused with simple tasks and familiar things.
You can read more about the warning signs of dementia developing. An Alzheimer’s or dementia patient can intermittently become confused with a person’s identity, which presents as Capgras syndrome. This can occur acutely or chronically, but not everybody with Alzheimer’s or dementia will necessarily develop Capgras symptoms.
Some other neurological and psychological conditions that can lead to Capgras syndrome include Parkinson’s disease, bipolar disorder, epilepsy, stroke, and acquired brain injuries.
Acquired brain injuries can be the least common causation of the syndrome because it depends on which part of the brain has been damaged from the accident or illness. It is only the facial recognition or memory region of the brain that can cause Capgras syndrome to develop.
What are the symptoms?
The main symptom of Capgras syndrome is for the person to believe that one of their close family members or other significant place, item or relationship, is an impostor. However, as well as this, there are many more symptoms that can stem from it.
The majority of the Capgras syndrome symptoms relate to mental health, because it is a psychological condition, presenting as a secondary illness to a primary mental health or neurological issue. However, it could be argued that Capgras syndrome can cause further mental health difficulties for the patient and their family, due to the difficulty in treating and coping with the condition.
Other common Capgras syndrome symptoms
- Anxiety – Anxiety presents as worry or fear over what is about to happen or what could happen. Anxiety can be a symptom of Capgras syndrome for the person suffering, as they may display worry when they are going to see the supposed impostor, or when they are in the presence of them. Anxiety can also be a symptom experienced by the person being accused. They may become nervous when the sufferer is present or feel worried about the future of their relationship and whether the Capgras syndrome will continue.
- Fear – As an extended effect of anxiety, the person suffering from Capgras syndrome may experience fear of the supposed impostor. A person’s delusions feel completely real to them, and if they do not feel supported through their delusions, it can leave them feeling alone and afraid.
- Sudden change of behaviour – A warning sign of somebody developing Capgras syndrome is their behaviour beginning to change in the presence of a person or thing that they are close to.
- Aggression – Depending on the type of the delusion the affected person is experiencing, they may act aggressively towards the supposed impostor, or act with aggression towards other loved ones for not believing their delusion. This is most likely when the person’s delusion is more developed, or when the person has a history of violence.
- Confusion – Conditions that cause delusions, such as Capgras syndrome, create a false sense of reality. The affected person may appear confused in the presence of the supposed impostor, or confused as to why nobody else understands or believes that they are an impostor.
- Disorientation – This is more common when Capgras syndrome causes somebody to misidentify a place, rather than a person. For example, a person may not recognise that they are in their own bedroom in their own home.
- Paranoia – Paranoia can develop when the person affected becomes mistrusting of their loved one who they have mistakenly misidentified as an impostor. This can be difficult for the supposed impostor because often the more that they try to convince them, the more paranoid the person can become. This can also extend to other loved ones as the affected person’s delusions can isolate them.
- Stress – Stress can be a symptom for the Capgras patient, and their family members. Supporting a Capgras patient is difficult to navigate due to the emotional attachments of the relationships involved. It can cause ambivalence in knowing the right things to do, leading to physical and mental stress.
There is not a specific treatment programme that can be prescribed to Capgras patients to eradicate the condition. This also means that there is no cure to make Capgras syndrome disappear for a patient. However, this does not mean that there is nothing that can be done to alleviate some symptoms of the condition.
Although there is no standard way to reduce the severity of the illness and better manage the delusions, there are a number of options to improve the lives of people with Capgras syndrome, and their families and carers. The main option for treatment is to treat the underlying condition.
As mentioned previously, Capgras syndrome is mostly associated with a primary psychological or neurological illness, so seeking treatment for the underlying condition can help to improve the symptoms of Capgras syndrome. However, the prospect of improving symptoms is heavily reliant on the underlying condition.
For example, if the primary condition is schizophrenia, there are a number of anti-psychotic medications that can reduce psychotic episodes, including the reduction of Capgras delusions.
On the other hand, if the underlying condition is dementia, the prospects of improvement are reduced due to the lack of treatment and recovery options for dementia sufferers. Whilst there are some medications available that aim to support brain function, illnesses such as dementia are degenerative; meaning that over time the condition and associated symptoms will worsen.
As well as treating the underlying condition, there are a number of therapies that aim to help a Capgras patient realise that they are having delusional thoughts that misidentify one of their loved ones. Talking therapies such as Cognitive Behavioural Therapy can help an affected person to navigate their thoughts and introduce coping mechanisms, or alternative thinking patterns, that can help with interacting with the supposed impostor.
Although the therapy will not remove symptoms, it can help the person to react differently when they experience their delusional thought.
As well as this, therapies can also help associated family members in understanding the condition, and learning how to react to delusional episodes. This can help to manage the situation to make interaction and family relationships easier.
If you are a carer or family member that helps a person with Capgras syndrome, there are ways in which you can support the person that will improve their experience when suspecting an impostor. The most important thing is to remain calm around the person, so that it can reduce their feelings of anxiety, fear, aggression or confusion.
This will defuse the situation and help to prevent further agitation or other symptoms. Removing the supposed impostor from the room until the Capgras patient feels calmer can also help to reduce these feelings.
In situations where the affected person is exceptionally distressed, validation therapy can be better than trying to correct their delusional belief. Validation therapy is when you support a person’s delusions, instead of challenge them.
At times it can be healthier to “go along” with the person’s belief so that they feel listened to, which can reduce their anxiety. By not rejecting their thoughts, they can feel more at ease. Caring for a Capgras patient can require a slightly different approach depending on the person, their underlying condition, and the situation, but by maintaining a person centred approach to support them, a high quality of care can be maintained whilst working in the best interests of the affected person.