Cotard's Delusion
Also known as walking corpse syndrome or Cotard's syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, is purifying, or have lost their blood or internal organs.
Cotard delusion is a rare condition marked by the false belief that you or your body parts are dead, dying, or don't exist. It usually occurs with severe depression and some psychotic disorders. It can accompany other mental illness and neurological conditions. You might also hear it referred to as walking corpse syndrome, Cotard's syndrome, or nihilistic delusion.
In 1880, the Neurologist Jules Cotard described the condition as Le delire negations(The Delirium of Negation), a psychiatric syndrome of varied severity.
Sings & Symptoms:
The delusion of negation is the central symptom in Cotard's syndrome. The patient usually desires their own existence, the existence of a certain body part, or the existence of a portion of their body. Cotard's syndrome exists in three stages:
Stage 1:
Germination stage: symptoms of psychotic depression and of hypochondria appear
Stage 2:
Blooming stage: full development of the syndrome and delusions of negation
Stage 3:
Chronic stage: continued severe delusions along with chronic psychiatric depression.
Cotard's syndrome withdraws the afflicted person form, other people, due to neglect of their personal hygiene and physical health. Delusions of negation of self prevent the patient from making sense of external reality, which then produces a distorted view of the external world.
One of the main symptoms of Cotard delusion is Nihilism. Nihilism is the belief that nothing has any value or meaning. It can also include the belief that nothing really exists. People with Cotard delusion feel as if they're dead or rotting away. In some cases, they might feel like they've never existed.
While some people feel this way about their entire body, others only feel it in regard to specific organs, limbs, or even their souls.
Depression is also closely related to Cotard delusion. Existing research about Cotard delusion notes that 89% of documented cases include depression as a symptom.
. Anxiety
. Hallucinations
. Hypochondria
. Guilt
. Hurting yourself or death
Pathophysiology:
The underlying neurophysiology, and psychopathology, of Cotard syndrome, might be related to problems of delusions misidentification. Neurologically, Cotard's delusion is thought to be related to Capgras delusion, each type of delusion is thought to result from neural misfiring in the fusiform face area of the brain, which recognizes faces, and in the amygdala, which associate emotions to a recognized face.
The neural disconnection creates in the patient a sense that the face they are observing is not the face of the person to whom it belongs, therefore that face lacks the familiarity normally associated with it.
Cotard delusion seems to occur more often in people who think their personal characteristics, rather than their environment, cause their behavior. People who believe that their environment causes their behavior are more likely to have a related condition called Capgras syndrome. This syndrome causes people to think their family and friends have been replaced by imposters. Cotard delusion and Capgras syndrome can also appear together.
Mental health conditions that might increase someone's risk developing Cotard delusion include:
. Bipolar disorder
. Postpartum depression
. Catatonia
. Depersonalization
. Dissociative disorder
. Psychotic depression
. Schizophrenia
Cotard delusion also seems to be associated with certain neurological conditions, including:
. Brain infections
. Brain tumors
. Dementia
. Epilepsy
. Migraines
. Multiple sclerosis
. Parkinson's disease
. Stroke
. Traumatic brain injuries.
Diagnosed:
Diagnosing Cotard delusion is often difficult because most organizations don't recognize it as a disease. This means there's no standardized list of criteria used to make a diagnosis. In most cases, it's only diagnosed after other possible conditions have been ruled out.
According to the DSM-5: Cotard's delusion falls under the category of Somatic delusions, those that involve bodily functions or sensations. There are no further diagnostic criteria for Cotards syndrome within the DSM-5, and identification of the syndrome relies heavily on clinical interpretation.
Complications:
Feeling like you've already died can lead to several complications. For example, some people stop bathing or taking care of themselves, which can cause those around them to start distancing themselves. This can then lead to additional feelings of Depression and isolation. In some cases, it can also lead to skin and teeth problems. Suicide attempts are also common in people with Cotard delusion. Some see it as a way to prove they're already dead bu showing they can't die again. Others feel trapped in a body and life that doesn't seem real. They hope that their life will get better or stop if they die again.
Cotard delusion is a rare but serious mental illness. While it can be hard to get the right diagnosis and treatment, it usually responds well to a mix of therapy and medication. Many people need to try several medications, or a combination of them before they find something that works. If nothing seems to work, ECT is often an effective treatment. If you think you have Cotard delusion, try to find a doctor who seems open to listening to your symptoms and working with you to diagnose or address any other conditions you might have.
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