Capgras syndrome is a rare condition in which someone believes that their loved ones or others they know have been replaced with doubles or imposters. The belief is so real that nothing can correct this illusion.
Capgras syndrome, or Capgras delusion, is named for the doctor who treated a patient with it nearly 100 years ago. You may also hear it called imposter syndrome, but it is different from the more common “imposter syndrome” that you may have heard about.
What Is Capgras Syndrome?
Experts describe Capgras syndrome as a delusion of doubles. Delusions are an intense belief in something untrue. People with this syndrome think an identical duplicate (or double) replaced someone or something they love — including animals. They recognize the face but don’t feel emotionally attached; so, they assume that the person (or animal) is an imposter. They usually think the imposter has bad motives, which can cause someone with Capgras syndrome to get angry or even violent.
Who Can Get Capgras Syndrome?
Since Capgras syndrome is rare, it’s hard to study. Most of what we know comes from doctors’ reports of individual patients. Some research shows that it’s more common among people with neurodegenerative conditions such as dementia; up to 16% of those with Lewy body dementia or Alzheimer’s also have Capgras syndrome.
It’s also more likely in people with other brain conditions, such as Parkinson’s or epilepsy, in people who’ve had a stroke or a traumatic brain injury, or those with schizophrenia or bipolar disorder. One research estimates that people with schizophrenia and dementia make up 81% of all cases.
One study about Capgras syndrome used a health database of 250,000 people in the U.K. It found just 84 cases in that large pool. One common thread was that many people with Capgras syndrome also had other types of delusions.
People with the condition also tend to be middle-aged, have had other mental health issues in the past, and are twice as likely to be women.
Capgras Syndrome Causes and Risk Factors
There are two systems at work in your brain when you see a familiar face. The central nervous system scans the features of the face. Then, the extended nervous system relays emotional information related to that face. Doctors still don’t know exactly how Capgras syndrome develops, but they think a broken connection between those two systems prevents normal face recognition.
A scientific review of 255 published cases of Capgras syndrome shows that researchers find it challenging to pinpoint the exact cause, which varies among cases. More research is needed to better understand Capgras syndrome, but scientists know that certain conditions may increase the risk of having this delusional syndrome.
Brain lesions
Many people with Capgras syndrome have one or more lesions or areas of damage on the brain. This includes those with dementia or Parkinson’s, which are degenerative brain conditions that can damage your brain. These lesions don’t have to be on the exact parts of the brain responsible for recognition. They can simply be on areas connected to them.
Substance abuse
Some people develop Capgras syndrome after using large amounts of recreational drugs, such as cocaine or cannabis, or heavily drinking alcohol.
Metabolic conditions
One study linked hypothyroidism (low thyroid levels in your blood) to Capgras syndrome.
Nutrient deficiencies
Another study showed that being short on vitamin B12 may also be a risk factor for Capgras syndrome.
Capgras Syndrome Symptoms
The most telling symptom is the belief that the person’s loved ones are imposters. No amount of reasoning can change their mind.
Sometimes, the delusion is about more distant people, pets, or even objects. Delusions may come and go, especially among people with dementia. There may also be the symptoms of an underlying illness, such as Alzheimer’s or a brain injury.
People used to think that Capgras syndrome made people violent, but experts now know this is rare and more likely to stem from another condition.
Capgras Syndrome Diagnosis
To make a diagnosis, doctors will do physical and mental health exams. They might order mental skills tests to check for dementia or other conditions, and brain imaging tests such as MRI or EEG that look for lesions or other brain changes. Talking to family members or caregivers is important to learn when the delusions started and other details.
Capgras Syndrome Treatment
The right treatment depends on your situation. It may start with treating any physical or mental condition that could be causing Capgras syndrome. While this condition can be difficult to manage, proper treatment and good communication can lead to better outcomes.
Dementia drugs
Cholinesterase inhibitors, a type of drug used to treat dementia and Parkinson’s disease, ensure that there is enough of the hormone acetylcholine in the brain. This hormone is a chemical messenger that supports memory, language, and judgment. Donepezil (Aricept), galantamine (Razadyne), and rivastigmine (Exelon) are cholinesterase inhibitors that may reduce Capgras syndrome symptoms. Look out for side effects such as nausea, diarrhea, inability to hold your pee, muscle cramps or twitching, and weight loss. Starting at a low dose and working up may reduce some of these side effects.
Antipsychotics
Your doctor may recommend typical or atypical antipsychotics to treat Capgras syndrome delusions. Both work by blocking neurotransmitters, or chemical messengers, in your brain.
Typical, or first-generation, antipsychotics such as chlorpromazine, fluphenazine, haloperidol, and thiothixene block dopamine receptors. Atypical, or second-generation, antipsychotics such as aripiprazole (Abilify), olanzapine (Zyprexa), lumateperone (Latuda), quetiapine (Seroquel), and risperidone (Risperdal) block dopamine and serotonin receptors.
These medications may ease delusions and agitation. There are some possible disadvantages including movement disorders (especially if you’re being treated for Parkinson’s disease), heart and circulatory problems, dizziness, and sleepiness. Let your doctor know right away if you have any of these side effects while taking an antipsychotic.
Antidepressants
People with delusional disorders such as Capgras syndrome sometimes have depression, too. Antidepressants called selective serotonin reuptake inhibitors (SSRIs) can help. SSRIs are commonly prescribed and work by ensuring that enough serotonin is active in your brain. Examples are citalopram (Celexa), escitalopram (Lexapro), and fluoxetine (Prozac). Side effects may include headache, sexual problems, sleep disruption, weight changes, dizziness, nausea, and vomiting.
Therapy
Your doctor may suggest therapy first to help you and your loved ones to manage this illness. With habilitation therapy, the loved ones of a patient with the condition will try to put themselves in the patient's place to better understand what they're feeling. This therapy is often used in dementia care and helps maintain emotional connections, despite fear that one's loved ones are imposters.
Validation therapy gives you a sense of safety if you’re scared that an imposter is there to hurt you. This type of therapy accepts and validates your experiences and feelings without forcing you to accept reality.
Family counseling might also help. Trying to persuade someone who has Capgras syndrome that they’re mistaken doesn’t work and can cause more distress for everyone. Family counseling helps you and your caregiver establish emotional ties and effective, compassionate communication. It may help if your caregiver uses techniques such as distraction, a soothing voice, and soft touch.
Capgras Syndrome vs. Imposter Syndrome
Some experts refer to Capgras syndrome as imposter syndrome. This is different from the more common "imposter syndrome," which refers to when someone doesn’t believe they’re as capable as they are.
Capgras syndrome may be called imposter syndrome because those with the condition believe that imposters have replaced their loved ones. This symptom of Capgras is an actual delusion, while the other imposter syndrome refers to an internal belief about oneself.
Capgras Syndrome vs. Fregoli syndrome
Capgras and Fregoli syndromes are rare delusional disorders.
If you have Capgras syndrome, you believe your loved ones are replaced by imposters. Fregoli delusion is similar in that loved ones are involved. Except with Fregoli delusion, you believe people around you are familiar even though they’re actually strangers.
People with Fregoli syndrome may feel as though they are watching a play because strangers around them seem to change their appearance or wear disguises to appear like someone they know or love. Similar to Capgras syndrome, you may feel as though the familiar person in disguise is trying to harm you. You may also feel like they’re trying to trick you. Because of this, you may feel anxious, agitated, or paranoid.
Takeaways
Capgras syndrome is a delusional disorder where individuals believe that their loved ones have been replaced by imposters, often leading to anger or fear. The syndrome may be linked to brain lesions (such as those found in dementia and Parkinson’s disease), substance abuse, metabolic conditions, or nutrient deficiencies. These factors disrupt your ability to feel an emotional connection to a face you know and love. Treatment typically involves medications such as dementia drugs, antipsychotics, and antidepressants, along with different types of therapies. Talk with your doctor if you think you may have Capgras syndrome or if you or a loved one need support managing this condition.
Capgras Syndrome FAQs
What is Capgras imposter syndrome?
Capgras syndrome is sometimes called imposter syndrome. While imposter syndrome is a belief that you aren’t as capable of something as you actually are, Capgras syndrome is a delusional disorder where you believe your loved ones are replaced by imposters.
How can I talk to someone with Capgras?
If someone with Capgras syndrome thinks you’re an imposter, use a calm voice and try to maintain an emotional connection, even though they may be afraid of you. Don’t try to convince them that they’re mistaken. This may upset them and lead to aggression.
Can children have Capgras syndrome?
Although rare, Capgras syndrome can occur in children and adolescents, often in connection with schizophrenia or other psychotic disorders.
How common is Capgras syndrome?
Capgras syndrome is extremely rare, making it difficult for scientists to study this complex condition because there are so few diagnosed cases.
