Delusional Misidentification Syndromes

29 Oct

Whenever I’m doing research on the Internet it seems that I constantly get sidetracked into hidden corners and nooks and crannies and stumble across some really unusual stuff. A case in point would be the Delusional Misidentification Syndromes, an odd and thankfully rare group of psychiatric problems. The term Delusional Misidentification Syndrome is a catch all for a number of psychiatric problems that share a delusional belief that some person, object, or place has been changed or altered in some unusual way. There appears to be four main variants of this syndrome along with a few other minor types that may be related. They are each wild and unusual in their own right.

I should point out that in the field of psychiatry there is always arguments over what things should be called and which patients fit into which categories. That’s simply due to the subjective and inexact nature of psychiatry. It’s not like math and chemistry but rather is very interpretive. So much is in the eye of the beholder. Many of these syndromes overlap or contain similar features. For this reason there will always be arguments as to which ones are real and distinct and which ones are simply unusual manifestations of another.

The Capgras Syndrome: In this disorder the victim believes that a spouse, relative, or friend has been replaced by an identical appearing imposter. Uncle Joe is not Uncle Joe but rather is some stand in that has been inserted into Uncle Joe’s place.

This syndrome was first described by French psychiatrist Joseph Capgras in 1923 after he treated a woman who complained that many of the people she knew had been replaced by identical doubles. It seems to occur most often in those with schizophrenia or some previous brain injury.

The Fregoli Syndrome: This is the belief by the victim that many of the people he meets during his daily life are actually the same person over and over again just wearing a different disguise. So the teller at his bank, the young lady that steams up his cappuccino at his local Starbucks, the person sitting next to him for three wasteful hours at the DMV, and the guy behind him in line at the ZZ Top concert are all the same person. The fact that they are each different in size, age, sex, and ethnicity doesn’t seem to click. The belief that they are really all the same person holds firm.

The syndrome is named after the Italian actor Leopoldo Fregoli who was famous quick change artist. It was first documented in 1927 in a report that dealt with a young woman who believed she was being stalked by two actors she often saw at the theater. She felt that many of the people she knew were actually these actors in disguise. Who knows, maybe she was right.

Intermetamorphosis: The victim of this syndrome believes that the people around them, though their appearance remains unaltered, have swapped identities with each other. Sort of like Bob is Bill and Bill is Bob yet Bob still looks like Bob and Bill still looks like Bill. This could get confusing. How can you keep everyone straight without a scorecard?

I’m not sure how common this syndrome is but I have many times in my career seen victims of Alzheimer’s disease and other forms of dementia misidentify family and friends. An elderly man might think his daughter is his deceased wife or his third-grade schoolteacher or almost anyone else. This is simply a manifestation of the dementia and probably not a true case of Intermetamorphosis. Many of you may have seen this in your own families. It can be a difficult problem.

Subjective Doubles: (Also called the Subjective Capgras Syndrome) Here the victim believes that he has been duplicated and that his duplicate is going about another life independently. The old doppelgänger deal. I remember reading a case many years ago where a guy stated that he did not commit the robbery but rather his duplicate did. Though this would be a lame alibi, if I remember correctly, this guy turned out to have schizophrenia and did not remember the robbery but was absolutely certain that his doppelgänger had pulled it off.

There are a few other syndromes that many believe should not be included in the Delusional Misidentification family of syndromes but they share some common characteristics that are worth mentioning because they are very interesting entities.

Mirrored Self-Misidentification Syndrome: This one is just what you would expect from its name. The sufferer believes that his own reflection in a mirror is actually someone else. You mean that guy in the mirror when I shaved this morning wasn’t me? Who the hell is that guy? How did he get into my house? You see, this can be a fairly distressing syndrome.

Reduplicative Paramnesia: This is the erroneous belief that a familiar person, place, or object has been duplicated. A spouse is not the true spouse but rather an identical copy. Or the hospital where the patient finds himself is not the same one he was originally admitted to, but rather an identical hospital in an entirely different location.

Syndrome of Delusional Companions: This is the belief that an object is actually a living, breathing entity. Your car can think and talk, your golf clubs have personalities, or the stuffed cat sitting on the sofa is a real cat.

Clonal Pluralization of Self: In this situation the victim believes that he has been copied multiple times and that these identical beings are all going about their lives without his control. Don’t you often wish this was true? Maybe get one of these guys to run your errands or even go to work for you? I think this one is a keeper.

Cotard’s Syndrome: This is the belief that some of the victim’s organs or body parts are missing. They might believe that their heart no longer exists, or that their internal organs have somehow melted or evaporated. Some victims also believe that they no longer exist and are unable to feel anything. This syndrome is often associated with schizophrenia and/or bipolar disorder.

The brain is a wonderful organ and it does so many incredible things. It is also capable of the oddest constructions and we understand its workings not even a little bit.


13 responses to “Delusional Misidentification Syndromes

  1. Bill Sewell

    October 29, 2009 at 12:31 pm


    Every time I think I’ve heard or seen everything, you always come through. 🙂



    • D.P. Lyle, MD

      October 29, 2009 at 12:37 pm

      Thanks. There are many odd things in this world and these syndromes qualify.


  2. GMiki

    October 29, 2009 at 1:30 pm

    Why are you writing this column today and calling yourself Doug?


    • D.P. Lyle, MD

      October 29, 2009 at 2:26 pm

      Doug? Doug who? I’m just a simple doppelgänger.


  3. Kate

    October 29, 2009 at 1:30 pm

    I wonder if the Capgras Syndrome inspired Invasion of the Body Snatchers?


    • D.P. Lyle, MD

      October 29, 2009 at 2:27 pm

      I’m sure it was and I think one of them took over one my cats. Can’t find the pod but he’s acting weird.


      • Kate

        October 29, 2009 at 2:30 pm

        Wheneve my boss says “please” or “thank you” I want to look under his desk and see if there’s a pod under there, but I haven’t done it yet. Maybe I don’t need to know…

        Cats act weird? No.


  4. Gayle Carline

    October 29, 2009 at 1:44 pm

    So… the disembodied voices giving me directions via the GPS navigation system in my cell phone are NOT really Wanda the Wonder Navigator and her drunken sister, Justine? Damn.



  5. Doug

    October 29, 2009 at 3:34 pm

    The New Yorker had a pretty great article (“Brain Games”) in the May 11, 2009, issue about behavioral neurologist Vilayanur S. Ramachandran. Most of the article is about apotemnophilia, “the compulsion to have a perfectly healthy limb amputated.” There is some discussion of other disorders, including (I think) Capgras Syndrome. The main point in this article is that many of these conditions (or at least Capgras and apotemnophelia) are physiological, not psychological. I can’t quite remember the conclusion exactly, but basically Capgras is caused (or sometimes caused?) by some sort of broken neural connection between sight, memory, and emotion. You see a person you recognize, but you do not receive the appropriate emotional impulse from that recognition, and so you view the person is an imposter. Seems like good fodder for a story.


    • D.P. Lyle, MD

      October 30, 2009 at 8:45 am

      Thanks for your post. Yes many of these syndromes are associated with brain injuries–strokes, trauma, infections, etc.–so that there is a physical component in some patients. In others it is more psychiatric due to schizophrenia or some similar disorder. Often both a psychiatrist and a neurologist are involved in the diagnosis and care of these folks.


  6. Carola Dunn

    October 30, 2009 at 10:24 am

    Hi, Doug, there’s similar sort of story in one of Oliver Sacks’ books, where he describes his experiences after a severe injury to his leg .IIRC He was unable for some time to recognize his leg as part of his own body.


    • D.P. Lyle, MD

      October 30, 2009 at 10:38 am

      There is even an odd syndrome where a person wants to have an extremity amputated, saying it’s not theirs but belongs to someone else, and have attempted the removal themselves when doctors have refused. The brain is a strange organ.


  7. Cherley

    November 24, 2009 at 7:48 am

    This is so interesting. Fascinating. The brain is so powerful. My husband is in the hospital today for gall bladder surgery and I’m entertaining him with your blogs.

    Thank you.



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