Capgras Syndrome: The Delusion of Doppelganger

Capgras Syndrome is a rare condition in which a person is perceived as the duplicate of a family member or loved one. This delusion can hamper daily functioning and affect both the patient and the person disillusioned as a doppelganger.

What are its symptoms?

The symptoms of Capgras syndrome include a delusion that a close or loved one has been replaced by someone identical or doppelganger of the person. The symptoms then follow up with unpleasant or even aggressive behaviour towards the person accused of being the doppelganger. Some cases of Capgras Syndrome have even involved homicide. Researchers often link Capgras Syndrome with other conditions, such as neurological disorders or schizophrenia. These associated conditions then manifest themselves with their comorbidity.

What causes this syndrome?

There are various theories for this, but no empirical-based factors. One of the major causes is alterations in the structure of the brain. These include injury, lesions, atrophy or dysfunction. Neurological damage or brain perception can be the risk factors for Capgras syndrome. We also witness comorbidity with both physical and cognitive changes.

• Brain injury: TBI (traumatic brain injury) can affect the functioning of how the brain works. Brain injury can impact the processes and mechanics regulated by Braun, including memory retention, balancing, and mood. This impact can be either temporary or sometimes even permanent. The potential for recognizing facial features lies in the temporal cortex of the brain. If something impacts this area, a person might lose the capacity to identify and recognize familiar faces. Traumatic brain injury and its concussion can disconnect the junction between the limbic mechanism and the temporal cortex. This contributes to the cause of it.

• Screening and Diagnosis: Capgras syndrome, its rare occurrence makes it difficult to identify and diagnose it since its criteria are not mentioned even in the renowned DSM-5. A psychological or psychiatric evaluation is necessary to diagnose it. This encompasses the health history of other disorders (especially dementia) along with the ongoing medications. Capgras Syndrome is more common in women or females assigned at birth. The risk factors for such conditions include conditions like schizophrenia, paranoid personality or other neurological disorders.

• Facial Blindness: It is a condition known as prosopagnosia. According to some experts, the cause of Capgras syndrome can be associated with this since recognition of familiar faces is not possible. While this cause remains controversial with other experts because the inability for recognition does not necessarily align with thinking of someone as a duplicate or doppelganger of their loved one.
• Neurological conditions: With such conditions that are degenerative like Alzheimer’s, memory retention is critically reduced. This is the leading cause of Capgras syndrome since the sense of reality gets distorted. Other conditions like Parkinson’s disease, stroke, epilepsy, tumour schizophrenia and related disorders.

How to manage it?

Currently, no specific treatment plan exists for managing Capgras Syndrome, and researchers need to conduct much more research in this area. Doctors practice treating the underlying disorders that often accompany it. For example, treating a schizophrenic person for schizophrenia and other psychotic symptoms can help alleviate Capgras Syndrome symptoms as well. Physicians use medications for memory retention along with treatments for improving perception and judgment skills.

1. Behaviour Therapy

Behavioural therapists and other mental health care professionals use techniques like CBT- Cognitive Behavioural Therapy to eventually bring the patient back to reality without making it a hugely stressful event. Therapists utilize models like ABC (Antecedents, Behavior, and Consequences). They challenge delusional thoughts, and the patient’s responses to these challenges determine the course of the therapy.

2. Reality Orientation Therapy

This therapy is useful for dementia patients. As the name suggests, the therapy revolves around bringing back the person to reality. Instead of arguing or labelling as delusion, the therapist gradually brings the person back to reality by describing the beautiful and positive things in reality. This makes the reality easy to accept and come back to it. The reality is the environment of place, time and the people in it.

Dementia patients feel less anxious when they feel aware of the reality with this therapy because it helps them comprehend reality in a much better way. The therapist and associated professionals also guide the caregivers and other family members of the patient to help deal with delusion episodes efficiently.

Few studies have signified the significance of reality orientation therapy showcasing the benefits in the behaviours and cognitive aspects of patients dealing with dementia. Therapists consider this therapy efficient for dealing with the condition.

Dealing with it

For people with Capgras syndrome, the patient and their loved ones can experience a significant impairment in their quality of life. This is especially true for the caregiver or loved one whom the person perceives as an imposter. Getting aggression and violent responses can also impact the mental health of the person being called as a duplicate or fake. Small steps like connecting the patient to reality in micro terms whenever the situation allows can be a good strategy. Experts always advise against arguing with or correcting a delusional person, as this approach does not yield positive responses and can negatively impact the individual’s mental health.

The patients struggling with Capgras Syndrome, a feeling of being unsafe and insecurity sets in since according to them, they are living with a doppelganger who has ill intentions for them and their loved ones. Here it holds great importance to let them leave a sense of security and belongingness within their home or the rehabilitation centre they are in. Avoiding contact with the person misjudged as the imposter can be one of the ways to avoid triggers.

In conclusion, it is one of the rare conditions that is difficult to diagnose without standard criteria. Understanding the symptoms can help elevate the treatment plan. Professional guidance like therapeutic support can be magnificently beneficial for cases of Capgras Syndrome. Understanding the patient empathetically and patiently can help the person overcome the symptoms more quickly when they can accept the reality.