Rare disorder sometimes associated with severe depression, manifested by the presence of nihilistic delusions of extensive absurd content (loss of organs, body decay, the conviction of own death). It is also observed psychomotor agitation, extreme anxiety, and reduction of pain sensation and suicidal tendencies. The syndrome occurs most often in involutional depression.
The name of the disease comes from the name of Jules Cotard (1840-1889), a French neurologist who first described this condition as le délire de negation (from fr. Delusion of negation).
In this publication, Cotard described the case of Miss X, who initially denied the existence of God and Satan, and some parts of her body, and ordered to be called Mademoiselle X. Later claimed that she is dead and doomed to eternal damnation and can no longer die a natural death.
Cotard delusion - symptomsEdit
The patient with the Cotard syndrome is convicted that he's dead and perceives himself as "dead man walking". The person with CD may also believe that there is nothing - himself, the world and people around.
Moreover, the patients report:
- reduced perception of their own body (for example, does not feel. own heartbeat);
- believe that their body is under post-mortem process of decay - rotting and also is infested with worms that eat the body slowly on the outside and the inside. That causes a sense gradual organ failure, and ultimately it's absence. Although patient does not know, how is it possible that he can talk and move around without a brain, heart and other organs, is absolutely convinced that he do not possess them;
- feeling energized - moves in very specific manner, which may resemble the movements of the "living dead" that can be seen in movies;
- feeling kind of bond with the dead and often walk through the cemeteries, which seemed to him the most appropriate place to be
- lower pain threshold, which increases the risk of self-aggressive behavior. The patient can mutilate himself, to convince the environment that he's dead (if he is dead, then his wounds will not bleed). A person with CD may even attempt suicide in order to prove the validity of his claims (if he is dead, he can not die again). Suicide is also a way to get rid of a dead body, with which the patient is supposedly doomed;
- does not bathe, does not eat or drink (food and drink do not make sense if he's dead). Hunger and exhaustion are the second after the suicide reasons of patient's death;
These symptoms are accompanied by extreme anxiety and guilt. The patient seeks to explain why he's still on earth if he's already dead. In the end, he comes to the conclusion that death is a punishment for his sins and disobedience. He is a stray soul, doomed to an eternity of being in a dead body.
Cotard delusion may coincide with Capgras syndrome (the patient is convinced that his friends were replaced by the doppelgangers). It is assumed that both the Cotard and Capgras syndrome arises from neuronal connections damage that connects the face recognition with the limbic system, responsible for the association of recognized objects with emotional states.
Affected with Cotard syndrome interestingly refer to different logical implications of what they experience. A well-known case is the delusion of a 26-year-old, whose parents had been dead for six years. Very soon after their death, he began to blame himself for what happened. He became reclusive and stopped to care about anything. When he finally was persuaded to seek a help in a psychiatrist, he confessed to the doctor that feels nothing. He does not eat, not drink, not defecate - his body is not physical. When the psychiatrist asked why he dresses, since he does not have limbs, he refused to answer the question. During therapy, at the request of the doctor, he drank a glass of water. Asked what happened to the water, he said that it evaporated. He refused to answer similar questions, saying he did not know. Inconsistencies did not wonder him and do not cause any embarrassment.
There was a similar case reported with 32-year-old Iranian, whose family reported him to therapy. He was convinced that no one pays attention to him because he's dead. Initially, he felt a sort of electrical discharges at different parts of his body. Then, as claimed organs got transformed. He saw no contradiction in his words. He claimed that he says, breathes and eats, but he's dead.