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The '''Capgras delusion''' (or '''Capgras syndrome''') is a disorder in which a person holds a [[delusion]] that a friend, spouse, parent or other close family member has been replaced by an identical-looking [[impostor]]. The Capgras delusion is classed as a [[delusional misidentification syndrome]], a class of delusional beliefs that involves the misidentification of people, places, or objects. It can occur in [[Acute (medical)|acute]], transient, or [[Chronic (medicine)|chronic]] forms.
The '''Capgras delusion''' (or '''Capgras syndrome''') is a disorder in which a person holds a [[delusion]] that a friend, spouse, parent, some jerk you know from work, or other close family member has been replaced by an identical-looking [[impostor]]. The Capgras delusion is classed as a [[delusional misidentification syndrome]], a class of delusional beliefs that involves the misidentification of people, places, or objects. It can occur in [[Acute (medical)|acute]], transient, or [[Chronic (medicine)|chronic]] forms.


The delusion is most common in patients diagnosed with [[schizophrenia]], although it can occur in connection with a number of conditions, including [[Acquired brain injury|brain injury]] and [[dementia]].<ref name="forstl">Forstl, H.; Almeida, O.P.; Owen, A.M.; Burns, A.; & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. ''Psychological Medicine'' '''21''' (4) 905&ndash;910.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1780403&dopt=Abstract]</ref> It occurs more frequently in females, with a female:male ratio of 3:2.<ref> AJ Giannini, HR Black. The Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. Garden City, NY. Meddical Examination Publishing Co, pp. 97-98. ISBN 0-87488-596-5. </ref> Although the Capgras delusion is commonly called a [[syndrome]], because it can occur as part of, or alongside, various other disorders and conditions, some researchers have argued that it should be considered a symptom, rather than a syndrome or classification in its own right{{Citation needed|date=June 2008}}.
The delusion is most common in patients diagnosed with [[schizophrenia]], although it can occur in connection with a number of conditions, including [[Acquired brain injury|brain injury]] and [[dementia]].<ref name="forstl">Forstl, H.; Almeida, O.P.; Owen, A.M.; Burns, A.; & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. ''Psychological Medicine'' '''21''' (4) 905&ndash;910.[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1780403&dopt=Abstract]</ref> It occurs more frequently in females, with a female:male ratio of 3:2.<ref> AJ Giannini, HR Black. The Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. Garden City, NY. Meddical Examination Publishing Co, pp. 97-98. ISBN 0-87488-596-5. </ref> Although the Capgras delusion is commonly called a [[syndrome]], because it can occur as part of, or alongside, various other disorders and conditions, some researchers have argued that it should be considered a symptom, rather than a syndrome or classification in its own right{{Citation needed|date=June 2008}}.

Revision as of 04:41, 14 July 2010

Capgras delusion
SpecialtyPsychiatry, clinical psychology Edit this on Wikidata

The Capgras delusion (or Capgras syndrome) is a disorder in which a person holds a delusion that a friend, spouse, parent, some jerk you know from work, or other close family member has been replaced by an identical-looking impostor. The Capgras delusion is classed as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places, or objects. It can occur in acute, transient, or chronic forms.

The delusion is most common in patients diagnosed with schizophrenia, although it can occur in connection with a number of conditions, including brain injury and dementia.[1] It occurs more frequently in females, with a female:male ratio of 3:2.[2] Although the Capgras delusion is commonly called a syndrome, because it can occur as part of, or alongside, various other disorders and conditions, some researchers have argued that it should be considered a symptom, rather than a syndrome or classification in its own right[citation needed].

History

The Capgras delusion is named after Joseph Capgras (1873-1950), a French psychiatrist who first described the disorder in 1923 in his paper co-authored by Reboul-Lachaux,[3] on the case of a French woman who complained that corresponding "doubles" had taken the places of her husband and other people she knew.

Their term l'illusion des « sosies »... -- which can be literally translated as "the illusion of 'doubles'..." -- finds some[4] modern professional use in French (e.g. "L’illusion des sosies de Capgras est...", which however its authors render in English as "Capgras’[5] syndrome is ...").[6] But the distinction between illusion and delusion is important in modern technical English, and the Capgras syndrome is clearly a delusional condition.

Presentation

This case is taken from a 1991 report by Passer and Warnock:[7]

Mrs. D, a 74-year old married housewife, recently discharged from a local hospital after her first psychiatric admission, presented to our facility for a second opinion. At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another unrelated man. She refused to sleep with the imposter, locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalise her. At times she believed her husband was her long deceased father. She easily recognised other family members and would misidentify her husband only.

Causes

Some of the first clues to the possible causes of the Capgras delusion were suggested by the study of brain-injured patients who had developed prosopagnosia. In this condition, patients are unable to recognize faces consciously, despite being able to recognize other types of visual objects. However, a 1984 study by Bauer showed that even though conscious face recognition was impaired, patients with the condition showed autonomic arousal (measured by a galvanic skin response measure) to familiar faces,[8] suggesting that there are two pathways to face recognition—one conscious and one unconscious.

In a 1990 paper published in the British Journal of Psychiatry, psychologists Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system that produces the automatic emotional arousal to familiar faces.[9] This might lead to the experience of recognizing someone while feeling something was not "quite right" about them.

In 1997, Hadyn Ellis and his colleagues published a study of five patients with Capgras delusion (all diagnosed with schizophrenia) and confirmed that although they could consciously recognize the faces, they did not show the normal automatic emotional arousal response.[10]

In that same year, William Hirstein and Vilayanur S. Ramachandran reported similar findings in a paper published on a single case of a patient with Capgras delusion after brain injury.[11] Ramachandran also portrays this case in his book Phantoms in the Brain.[12] Since the patient was capable of feeling emotions and recognizing faces but could not feel emotions when recognizing familiar faces, Ramachandran hypothesizes that the origin of Capgras syndrome is a disconnection between the temporal cortex, where faces are usually recognized (see temporal lobe), and the limbic system, involved in emotions. Because the patient could not put together memories and feelings, he believed objects in a photograph were new on every viewing, even though they normally should have evoked feelings (e.g., a person close to him, a familiar object, or even himself). Ramachandran therefore believed there was a relationship between Capgras syndrome and a more general difficulty in linking successive episodic memories, since it is believed that emotion is critical for creating memories.

Most likely, more than an impairment of the automatic emotional arousal response is necessary to form Capgras delusion, as the same pattern has been reported in patients showing no signs of delusions.[13] Ellis and colleagues suggested that a second factor explains why this unusual experience is transformed into a delusional belief; this second factor is thought to be an impairment in reasoning, although no definitive impairment has been found to explain all cases.[14]

In popular culture

  • The Capgras delusion plays an important part in Richard Powers's 2006 novel The Echo Maker, winner of the National Book Award.
  • In Shirley Jackson's short story "The Beautiful Stranger", the protagonist begins with the delusion that her husband has been replaced and is ultimately unable to recognize her own house.
  • An explanation of the Capgras delusion serves as an important plot turn in Neil Gaiman's short story "Foreign Parts", found in the Smoke and Mirrors collection.
  • The character of Debbie in Kate Atkinson's novel Human Croquet may suffer from this, and the syndrome is mentioned about halfway through the book.
  • An example of the Capgras delusion occurs in John Wyndham's 1959 science fiction novel The Outward Urge, where an astronaut develops the delusion that his colleague is a Martian.
  • In the 2002 film Spider, the protagonist develops the belief (eventually revealed to be delusional) that his father has killed his mother to replace her with his mistress.
  • A Capgras delusion was used as the reason for a murder in the plot of the episode, "Heart of Glass" on the American television crime drama CSI: NY.
  • In the 8th season of the television series Scrubs in the episode titled "My Full Moon", one of the patients was diagnosed with Capgras syndrome.
  • In episode 11 of the Lifetime TV series Side Order of Life, Jenny interviews a woman who believes her husband is an imposter due to Capgras Disorder.
  • Capgras disorder is mentioned as a possible explanation of the main character's perceptions in the 2008 horror movie The Broken.

See also

Notes

  1. ^ Forstl, H.; Almeida, O.P.; Owen, A.M.; Burns, A.; & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. Psychological Medicine 21 (4) 905–910.[1]
  2. ^ AJ Giannini, HR Black. The Psychiatric, Psychogenic and Somatopsychic Disorders Handbook. Garden City, NY. Meddical Examination Publishing Co, pp. 97-98. ISBN 0-87488-596-5.
  3. ^ Capgras, J. & Reboul-Lachaux, J. (1923), "Illusion des « sosies » dans un délire systématisé chronique". Bulletin de la Société Clinique de Médicine Mentale 2 6–16.
  4. ^ "Approche clinique du syndrome de Capgras ou « illusion des sosies » illustrée par un cas", Gaël Le Vacon, 2006; rough translation: "Clinical approach to Capgras sydrome or 'illusion of doubles' illustrated by a case"
  5. ^ Sic on linked Web page, though Dorland's Illustrated Medical Dictionary, 27th edition, spells it without any apostrophe. It also specifies that the final S is silent, which implies that the possessive form would be "Capgras's", pronounced "KAP-grahz".
  6. ^ L’illusion des sosies de Capgras : une interprétation délirante..., K. Henriet, S. Haouzir, and M. Petit, Annales Médico-psychologiques, revue psychiatrique, Volume 166, Issue 2, March 2008, Pages 147-156
  7. ^ Passer, K.M. & Warnock, J.K. (1991). Pimozide in the treatment of Capgras' syndrome. A case report. Psychosomatics 32 (4) 446–448.[2]
  8. ^ Bauer, R.M. (1984) Autonomic recognition of names and faces in prosopagnosia: a neuropsychological application of the guilty knowledge test. Neuropsychologia 22, 457–469.
  9. ^ Ellis, H. D., & Young, A. W. (1990) Accounting for delusional misidentifications. Br J Psychiatry, 157, 239-248.
  10. ^ Ellis, H. D., Young, A. W., Quayle, A. H., & De Pauw, K. W. (1997) Reduced autonomic responses to faces in Capgras delusion. Proc R Soc Lond B Biol Sci, 264, 1085-1092.
  11. ^ Hirstein, W., & Ramachandran, V. S. (1997) Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proc R Soc Lond B Biol Sci, 264, 437-444."
  12. ^ Ramachandran, V. S (1998). Phantoms in the Brain. Great Britain: Harper Perennial. ISBN 10-1-85702-895-3. {{cite book}}: Check |isbn= value: length (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  13. ^ Tranel D, Damasio H, Damasio A (1995) Double dissociation between overt and covert face recognition. Journal of Cognitive Neuroscience, 7, 425-432.
  14. ^ Davies, M., Coltheart, M., Langdon, R., & Breen, N. (2001) Monothematic delusions: Towards a two-factor account. Philosophy, Psychiatry, and Psychology, 8, 133-158.

External links

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