April 29th, 2016
The world is full of of embarrassing conditions you wouldn’t wish on your worst enemy. Every week, Carian discusses one. This week: Cotard Delusion.
Imagine how horrific life would be when you are convinced to be dead, while you are still alive. This delusional belief of non-existence characterizes sufferers of the rare mental disorder Cotard Delusion. Slight variations include those that believe they are rotting or have lost their blood or internal organs.
The first described patient was presented in a lecture in Paris in 1880 by neurologist Jules Cotard as Mademoiselle X, who denied the existence of god and the devil as well as several parts of her body and her need to eat. Furthermore she believed herself to be eternally damned and incapable of dying a natural death. She later died of starvation in what one must assume came as a shock to her at least.
Jules Cotard classified the condition into three different groups: hypochondriac delusions of negation, where the patient denies the existence of certain organs; negation of their own psyche, where thoughts and ideas don’t exist; and negation of the external world, where neither people or anything else exists, including themselves.
The underlying cause is thought to be a disconnection between the brain areas responsible for recognizing faces and the areas that add emotions to those recognitions. This disconnection is associated with a lack of emotion when viewing familiar faces, including their own face. An absence of familiarity results in patients experiencing derealization and depersonalisation, which causes delusions. These delusions make it impossible for patients to make sense of reality and as a consequence they have an extremely distorted view of the world.
Treatment of Cotard Delusion often involve the use of anti-depressants and anti-psychotics drugs. However, the most common treatment is electroshock therapy. This therapy usually takes place several times a week until the patient’s delusions end, usually leaving them rather confused about their delusional experience.
Depersonalization, by Mauricio Sierra
Photo via horror-movies
Debruyne H, Portzky M, Van den Eynde F, & Audenaert K (2009). Cotard’s syndrome: a review. Current psychiatry reports, 11 (3), 197-202 PMID: 19470281