Capgras Syndrome: What is this Imposter Syndrome?What Can You Do?

Posted by Marya Kain, MS, CMC on Jan 16th 2020

Are you or someone you know experiencing delusional thinking? A lot of times delusional thinking are dopamine imbalances, but with Capgras is a recognition issue of someone you know. Ex:

“You’re not my husband. You look like my husband, but you aren’t my husband. What did you do with my husband?!”“I want to go home! I know this place looks like my home, but it’s not my home. Let me go home!” “The lady who cooked my breakfast was my wife. I wish she was here to cook my dinner because she’s a better cook than you are.”

History of Capgras Syndrome

Capgras Syndrome is named for the French Psychiatrist, Joseph Capgras, who described the condition in 1923, when he had a female patient who declared that her husband was someone in disguise, posing as her husband. Capgras Syndrome is listed in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as one of the many delusional misidentification syndromes.Capgras syndrome is usually secondary to other conditions such as Traumatic Brain Injury, Schizophrenia, Huntington’s, Alzheimer’s, Multiple Sclerosis, Epilepsy, Hypothyroidism and many others; and it is more common in women than in men.

Experiencing Delusional Thinking

A person with Capgras syndrome irrationally believes that someone or something they know has been replaced by an identical imposter. The connection between the visual center of the brain, in the temporal lobe, and the emotional center in the amygdala is somehow damaged. The exact mechanism(s) for this disconnect is unknown.The expected emotional reaction when seeing the person or thing doesn’t occur. This can be measured with polygraph equipment; the normal sweating response doesn’t occur in people experiencing Capgras when they view a picture of the person or thing. The result is that the front part of the brain, responsible for logical thinking, compensates for the disconnect by concluding that the person or thing is an imposter. This conclusion is so strong that no amount of reasoning helps them change their mind. Reasoning cannot override the brain’s lack of emotional response that the brain expects to receive. Interestingly, the connection is still intact with auditory input.

As one would imagine, this experience is very upsetting to both the person experiencing interacting with an imposter, and to the person being accused of being an imposter. If you have a loved who may be experiencing Capgras syndrome, here are some things you can do:

  1. Notify the person’s physician right away. While there is no one medical treatment that reverses this condition, any of the following may bring some relief: antipsychotics, memory and recognition medications, therapy, and surgery.
  2. Because the emotional connection is still intact with auditory input, talking on the phone is a very effective way to communicate. The person will recognize the caller for who they really are.
  3. Focus on the goal of helping the person feel safe, more than on convincing them of the reality as you experience it.
  4. Validate the person’s emotions.“It must feel scary to see me as someone other than your husband.”
  5. It is okay to help the person look for you.Sometimes it is helpful to say something like “I’ll stay with you until they come back, okay?” or “We have permission to stay here tonight, and we can look for the real house tomorrow in the daylight.”You may even go outside and call them, and ask them to let the person who looks like you help them.
  6. Try leaving and coming back, verbally announcing yourself before they see you, such as calling out “Honey, I’m home!”
  7. Distract with pleasant events.Use pleasurable sights, music, foods etc.
  8. To help the person stay calm, use inclusive and strength-based communication:

a.Make sure that your words, tone of voice and body language send the same message.

b.Palms up, smiling, nodding, and on-your-side body language all help the brain know that the person is safe.

9.Be aware that these moments trigger grieving in you, because they confront you with the knowledge that your loved one is changing from the person you’ve known.This loss is significant.

10.Be loving and encouraging with yourself.Acknowledge that supporting someone who is experiencing these changes is difficult. Pat yourself on the back for doing the very best you can with the reserves of energy, knowledge and patience you have available in that moment.

Consider using Behavior Consultant to support you and your loved one.Marya Kain, MS, CMC, is a Behavior Consultant and an Aging Life care Manager. You are not alone.