Understanding Cotard Delusion: The Walking Corpse Syndrome

If a person dies, will they continue to eat, sleep or take medicines? Will they brush their teeth or take a bath? No, right? Well, that is what people diagnosed with Cotard delusions argue. Cotard Delusion is a rare neuropsychiatric disorder. People with Cotard Syndrome think they are not alive. They say they do not exist. Some people have a belief that some parts of their body are dead or rotten away. So, they feel they do not have to do self-care or get nourished. Cotard delusions are seen to be a manifestation of other underlying disorders.

Cotard syndrome is marked by deep feelings of anxiety and sadness, and beliefs of being rejected. It is accompanied by a lack of pain sensitivity and delusions about one’s own body or existence. Cotard syndrome can show up in various ways, from beliefs about sudden and total loss of the body and soul to outright refraining from one’s existence. 

What are the symptoms?

It typically arises alongside severe depression and certain psychotic disorders. It may also be found in conjunction with other mental health issues and neurological conditions. The major symptoms of walking corpse syndrome are discussed here.

Delusional believes

1. They may believe they do not exist.
2. They may believe some parts of their body are missing.
3. They may say they have already died and are now living the next life.
4. They might sense that they are no longer alive or are approaching death.

Other symptoms

1. Hypochondria
2. Self Mutilation
3. Social Isolation
4. Depression and anxiety
5. Auditory hallucinations and delusions
6. Nihilism (Thought that life is meaningless)
7. Few neurological symptoms like seizures, migraine, etc.

What are the causes and risk factors?

The correct cause of Cotard Delusions is still not known. As already mentioned this nihilism syndrome has strong associations with pre-existing neurological conditions. This is seen as a symptom of a brain-related illness. A few of these disorders that act as risk factors or causes include:

• Migraine 
• Epilepsy 
• Schizophrenia 
• Encephalopathy 
• Parkinson’s disease 
• Depression and anxiety
• Brain damage (tumour, injury, stroke or blood clots

Dehydration and substance use are also included as potential causes of this syndrome.

What are its stages?

The intensity of the symptoms is used to differentiate between the 3 stages of Cotard Delusions.

• Cotard Syndrome Germination Stage: This is the initial stage of the syndrome where the prominent symptoms include fear, anxiety and being hypochondriac (constantly worrying about having serious illnesses despite having no or only minor symptoms.)
• Cotard Syndrome Blooming Stage: This is the stage where the delusions of denial and non-existence manifest. At this stage, people become socially withdrawn.
• Cotard Syndrome Chronic Stage: This is the stage where severe depressive symptoms become prominent. People are very disturbed by the hallucinations and paranoia.

How is it diagnosed?

Since there is no direct test or evaluation method to diagnose this condition, the rule-out method is used. Alongside, patients’ medical history and personal observation are taken into consideration to analyze the symptoms. Since this syndrome is mostly comorbid with other disorders, dual diagnosis is possible. According to research, neuroimaging is found useful in the diagnosis of Cotard Syndrome. Neuro images of people with Cotard Delusions have shown significant variations in their brain structure. 

How is it treated?

Though this is a very rare yet serious neurological condition, treatment options have had remarkable effects. One noteworthy therapy for this syndrome is ECT (Electroconvulsive Therapy). It is utilized for managing critical mental health issues including severe depression. Here, small electric currents are passed through the brain. This can ease symptoms when other therapies have failed. However, this treatment option has its pitfalls of having side effects (like memory loss). 

Therefore other safer options are considered. Medications that include mood stabilizers, antidepressants and antipsychotics can help reduce the symptoms of Cotard Syndrome. Therapeutic interventions like CBT and talk therapy can also be considered along with medications for this syndrome.

When does it get complicated?

• Undernourished: Since they are delusional about their existence they fail to eat, drink or take medicines. This in turn makes them undernourished.
• Stopping self-care: The people living with this disorder believe they are dead, therefore they refuse to take basic self-care like brushing their teeth or taking baths. This can get them into serious skin diseases or teeth-related problems.
• Self-harming: Self-injuring behaviour is very commonly prevalent in Cotard Syndrome. Some try it during their depressive episodes as a way of escape. A few others use self-harming behaviour to prove they cannot die again. 

Cotard delusion is an uncommon but severe mental disorder that can be difficult to diagnose and treat. A blend of therapy and medication helps with reducing the symptoms. Like any other mental disorder, it is important to get external help and manage the symptoms for better well-being.

FAQs

How is Cotard’s Delusion defined?

• Cotard Delusion is a rare neuropsychiatric disorder. People with this syndrome believe they are dead.

What are the other names for this disorder?

• Cotard Delusions, Cotard Syndrome, Nihilism Syndrome, Walking Corpse Syndrome 

What are some symptoms of Cotard Syndrome?

• Migraine 
• Epilepsy 
• Schizophrenia 
• Encephalopathy 
• Parkinson’s disease 
• Depression and anxiety
• Brain damage due to tumour, injury, stroke or blood clots 

Which treatment option is very effective?

• Electroconvulsive Therapy