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Capgras (Delusion) Syndrome

Capgras Syndrome, named for its discoverer, the French psychiatrist Jean Marie Joseph Capgras. The person's primary delusion is that a close relative or friend has been replaced by an impostor, an exact double, despite recognition of familiarity in appearance and behavior. The patient may also see himself as his own double. Also know as Delusional misidentification, illusion of doubles, illusion of negative doubles, misidentification syndrome, nonrecognition syndrome, phantom double syndrome, subjective doubles syndrome.

Delusions are false beliefs, sometimes with bizarre content, that are held with strong conviction even in the presence of contrary evidence. For persons suffering from Capgras Syndrome they typically believe they exist in a world of impersonators. This feeling in a delusional world of doubles can be so alarming that it drives the Capgras sufferer to psychotic behavior. The syndrome typically has the following characteristics:

The person is convinced that one or several persons known by the sufferer have been replaced by a double, an identical looking imposter.

The patient sees true and double persons.

It can may extend to animals and objects.

The person is conscious of the abnormality of these perceptions. There is no hallucination.

The double is usually a key figure for the person at the time of onset of symptoms. If married, always the husband or wife accordingly.

Associated Features:

Cerebral lesions caused by head injury, which are often located in the posterior area of the right hemisphere, where face recognition is performed.

Schizophrenic diseased conditions (paranoid-hallucinatory schizophrenia), but also in affective and organic-psychic disturbances.

Affects both sexes, but prevalent in women.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Alzheimer's Disease
Huntington's Disease
Multiple Sclerosis
Traumatic Brain Injury
Substance-Induced Delusional Disorders - hallucinogens and alcohol
Mood Disorders with Delusions - manic and depressive types


It has been reported that the Capgras Syndrome and related substitution delusions, that 35% have an organic etiology. Some researchers believe that Capgras' syndrome can be blamed on a relatively simple failure of normal recognition processes following brain damage from a stroke, drug overdose, or some other cause. This disorder can also follow after accidents that cause damage to the right side of the brain. Therefore, controversies exist about the etiology of Capgras Syndrome, some researchers explain it with organic factors, others with psychodynamic factors, or a combination of the two,


Individual therapy may be best suited to treat the persons delusions. Persistence is needed in establishing a therapeutic empathy without validating the person’s delusional system or overtly confronting the system. Cognitive techniques that include reality testing and reframing can be used. Antipsychotics and other drugs have been used with some success.

Counseling and Psychotherapy [ See Therapy Section ]:

Cognitive-Behavioural therapy, for treating delusions that is based on persistent gentle discussions about evidence for the belief, might help overcome the problem the person has with believing this substitution al delusion against the available evidence.

Pharmacotherapy [ See Psychopharmacology Section ] :

A reasonable pharmacological treatment approach for the person with delusional disorder is a standard trial of an antipsychotic or SSRI at starting doses commonly used to treat psychotic or mood disorders.

Antipsychotics (typical and atypical)

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2nd September 2003