Medically known as Cotard delusion, this baffling mental disorder causes a person to believe they are dead.
The most common mental disorders—like anxiety, depression, and bulimia—are often under the spotlight. But many other equally complex and troubling conditions don’t get the same attention, largely because they’re very rare and more mysterious. One of these is called Cotard delusion.
What is Cotard delusion, and what are the symptoms?
Cotard delusion, also known as walking corpse syndrome, Cotard’s syndrome, or nihilistic delusion, was first described by the French neurologist and psychiatrist Dr. Jules Cotard in 1882. It covers a series of psychotic delusions, ranging from a person’s belief that they have lost all their internal organs, to their certainty that they are actually dead.
“Psychosis is when a person departs with reality in some way—Cotard’s syndrome is an example of this,” New York City psychiatrist Margaret Seide, MD, tells Health. “When a person has Cotard’s syndrome, they have an extreme sense of nihilism—the belief that life is meaningless.”
It’s important to differentiate between a hallucination and a delusion, says Dr. Seide. “A hallucination is when you experience something in one of your five senses (touch, sight, hearing, smell, and taste) that is not real, such as hearing voices,” she explains. “However, a delusion is when you believe something that is not real. It is a fixed, false belief not in keeping with social norms.”
People can have a delusion of any kind, but with Cotard delusion, there is a common theme: a firm belief that part of or all of your body is dead or decaying. It's not clear how many people suffer from this baffling disorder, but it definitely is not common. “It’s rare to develop such a deep, firm delusion,” California-based psychiatrist and author Gayani DeSilva, MD, tells Health.
Other delusions reported by Cotard delusion patients include denial of pregnancy, denial of their own name or age, denial of their capacity to walk or eat, and/or denial of the existence of their parents, partners, children, or even the world at large.
What causes Cotard delusion?
While the exact cause of Cotard delusion is unknown, Dr. DeSilva says it can be a symptom of severe depression. “When people experience a severe, major depression, they can often develop psychotic symptoms, like auditory or visual hallucinations, vague paranoid thoughts, or delusions,” she says.
“The main cause is thought to be genetic, with no known external precipitating factors,” adds Dr. Seide. “It may also be a precursor to schizophrenia.” Cotard delusion is also associated with some neurological health conditions, such as migraines, dementia, and epilepsy.
According to an article published in the Journal of Neurosciences in Rural Practice in 2014, Cotard delusion is thought to be less common than it used to be, possibly because people with severe depression who display psychotic symptoms get the treatment they need at an earlier stage.
How is Cotard delusion diagnosed?
Because a person with Cotard delusion has a fixed belief, they won’t respond to reasoning—you can’t talk them out of it. “Someone struggling with this condition will experience extreme distress. It is important to emphasize that the person really and truly understands this to be their reality,” says Dr. Seide.
However, Cotard delusion is relatively easy to diagnose. “The first step is to take a thorough history,” explains Dr. Seide. “Questioning should be designed to bring to light the delusions associated with the condition. For the patient, this is their truth, so they typically will openly share their story of feeling that they are deceased even while talking to you. At that point, the diagnosis may be conclusively made.”
In some cases, the delusion may have some underlying truth to it. “I once cared for an elderly man with the delusion that his neighbor was stabbing his chest wall and poisoning him,” recalls Dr. DeSilva. “As it turned out, he had a cancerous mass in his chest wall that caused him pain and made him nauseous. He incorporated his real physical illness into his delusional beliefs.”
While Dr. DeSilva hasn’t had any patients with the full delusion that they are dead, she has cared for many people who believed that parts of their body were not alive or decaying. “It is very distressing to these people,” she says. “I take all delusions seriously, understanding that though it is a delusion, the story may have some factual basis. The patient may not know how to describe their physical concerns in a realistic way due to their mental illness. It’s crucial that medical providers listen beyond the initial story to find the underlying issues and give the proper care.”
How is Cotard delusion treated?
Cotard delusion usually occurs in tandem with other conditions, which can influence treatment options. A 2012 article published in Case Reports in Psychiatry suggests that electroconvulsive therapy (ECT) can help. People who undergo ECT are put under general anesthesia, after which doctors pass electric currents through the brain to create seizures. It's a known treatment for depression that may help Cotard delusion patients as well.
ECT can be risky, though, potentially triggering memory problems, confusion, nausea, and body or muscle aches. So other treatment options may be considered first, such as prescription meds like antidepressants, antipsychotics, and mood stabilizers. Behavioral therapy and psychotherapy are also treatment options.
While Cotard delusion can be treated successfully, it may take time to find the right method—and it doesn't mean every person who has it will end up free from the grip of their delusion.
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