Negative twin syndrome: treatment, symptoms

Psychopathological syndromes are very diverse. Some of these disorders are quite harmless and easily treatable, while others pose a threat to the patient and his environment.

Capgras syndrome is a rather rare pathology in which a sick person’s perception of his own personality or of people from his close environment is disrupted. Naturally, many patients, as well as their relatives, are interested in questions about this disease. What are the reasons for its occurrence? What symptoms should you pay attention to? Does modern medicine provide a complete cure?

What is the disease?

As already mentioned, Capgras syndrome is relatively rare in modern psychiatric practice. If you have such a disease, a person is sure that someone from his environment (spouse, one of his children or parents) has been replaced by a double.

In some cases, the patient is confident in the presence of his own double, and it is this fictitious personality that is responsible for the actions performed by the patient. It is worth noting that the patient can see the double or consider him invisible. Sometimes, in complete strangers, a person with this pathology recognizes relatives, acquaintances, people with whom he has known for a long time.

You are a stranger here: why people with Capgras syndrome do not recognize their loved ones and themselves

Photo: Nikolay Kostyushin, MTRK "Mir"
We are talking about a rare and unusual mental disorder - Capgras syndrome, or the “illusion of doubles”.

Imagine that one morning you woke up and stopped recognizing your loved ones. The environment seems unfamiliar to you, and the family members seem like complete strangers who also want to harm you. It sounds crazy and scary, but there are people in the world who experience these emotions every day. Some, on the contrary, suddenly begin to recognize strangers as friends and relatives, and some even believe in the existence of their own double. All these unfortunate people have one thing in common - they suffer from Capgras syndrome. Read about what this rare disorder is and whether it can be cured in the material “MIR 24”. Absolutely anyone, even the healthiest person, can become a victim of mental illness. The topic of mental illness has long been a source of inspiration for writers and filmmakers. Thus, the main character of the series “Dangerous Delusion” Alina Kuznetsova lives an ordinary life until she gets into a terrible accident. Waking up in the hospital, the girl discovers that she doesn’t remember anything and, worst of all, she doesn’t recognize her own husband and children. Another problem arises from Alina’s work: before the accident, she was developing a vaccine against a rare deadly virus. Just before the tragedy, the girl managed to deduce the formula for the medicine, but it disappeared from her head along with the rest of the memories of her past life. Not trusting doctors, Alina begins her own investigation.

Will the heroine be able to piece together the picture of events? To find out, watch the series “Dangerous Delusion” on Saturday, October 12, at 22.15 on the MIR TV channel.

Capgras delusion, misrecognition syndrome, delusion of false recognition - this disease has many names. The unusual disorder was first described in 1923 by the French psychiatrist Joseph Capgras. He called the disease “the illusion of doubles.” Here is a typical description of the symptoms of this disease: “Mrs. D., a 74-year-old married housewife... believed that her husband had been replaced by a stranger. She refused to sleep with the impostor, locked her bedroom, asked her son for a gun and fought with the police who came to hospitalize her. Sometimes she believed that her husband was her long-dead father. She easily recognized the rest of the family.” The woman's case, described by psychiatrists Passor and Warnock, clearly demonstrates the presence of Capgras syndrome. It is interesting that in this example we see selective recognition in the patient. However, often patients with this disease cannot recognize any of their loved ones: it seems to them that they have been replaced by doubles. There is even a known case where a patient considered his own cat to be an impostor. Moreover, the man claimed that the cat double was in conspiracy with the FBI and was spying on him. Another famous case: an elderly Frenchman complained for several days that a stranger was in his house. According to him, the uninvited guest was hiding in the mirror and looked exactly like himself.

In addition to the symptoms of a negative twin, there is another type of Capgras syndrome - the so-called positive twin symptom. It is diagnosed in patients who begin to recognize strangers as their acquaintances or family members.

This also includes Fregoli syndrome, named after the famous Italian comedian, known for his ability to instantly change his appearance during a performance. A person with Fregoli syndrome suffers from persecution delusions. He is convinced that someone he knows is constantly following him, constantly changing his appearance beyond recognition. The imaginary stalker can appear in the guise of a man, woman, child, or even an animal or inanimate object.

Capgras syndrome is quite rare. Most often, symptoms appear after 30 years of age. Although there are cases where the disease affected people at a younger age. So, one day a 15-year-old girl came to psychiatrists, claiming that her father and brother tried to put drugs in her food. When the girl’s mother came to visit her at the clinic, she declared her an impostor. But the unfortunate woman suddenly mistook one of the orderlies for her father, declaring that he wanted to injure her.

The causes of this disease are still not fully understood. Capgras syndrome has been diagnosed both in people who have suffered severe head injuries and in patients with other disorders (for example, schizophrenia). The most popular hypothesis is that the disease is still associated with physiological pathology.

The fact is that the visual information that we receive first enters the fusiform gyrus (fusiform). This is where objects, including people's faces, are distinguished. After processing, this data from the fusiform gyrus enters the amygdala, which is responsible for the emotional verification of objects and produces an appropriate emotional reaction. The fusiformis and amygdala are connected by fibers, and if these fibers are damaged, a person's connection between what he sees and what he feels is disrupted. Simply put, people with Capgras syndrome can experience the same emotions as normal people, but because the connection between visual perception and feelings is severed, loved ones no longer evoke any emotional response in them. Imagine seeing your mother, spouse, or child but not feeling anything for them, or suddenly no longer identifying with your reflection. It is not surprising that against this background, the thought of substitution comes to many people’s minds. Because Capgras syndrome often behaves differently, it is not easy to diagnose. Many doctors define it as schizophrenia. Why this happens, explains psychiatrist, general director of the Scientific Center for Personalized Psychiatry, Nadezhda Solovyova. “There are different schools of psychiatry, and the views of psychiatrists in different schools are similar regarding certain most severe disorders, but for many borderline conditions, opinions may differ. And in order to avoid very serious discrepancies among specialists and discrimination of patients, there is an international classification. It changes every decade. The classification of the 10th revision is currently in effect; from 2022, the classification of the 11th revision, already adopted by the World Health Organization, will be mandatory. And depending on what classification we use today, the concept of “schizophrenia” may differ, and radically,” explains Nadezhda Solovyova. In the International Classification of Diseases, 10th revision (ICD-10), Capgras syndrome is not classified as a separate category, the doctor notes. A separate code for this disease will be assigned only in 2022.

“Today, as a rule, they are diagnosed with chronic delusional disorder, since the current classification has such a code. In any case, this is a range of schizophrenia spectrum disorders, if not schizophrenia itself,” says Solovyova.

In her psychiatric practice, she also encountered patients with Capgras syndrome. The doctor noted that this disorder, fortunately, does not always require treatment in a hospital.

“If we are talking about Capgras syndrome, then in outpatient practice this disease occurs more often than in inpatient practice. For example, Cotard's syndrome (a disease in which a person believes himself to be dead - editor's note) is a very severe delusional disorder, and this is just an inpatient case. Such cases, thank God, do not occur so often, because there are drugs that do not allow a person to reach such a state,” says the doctor.

She consoles: despite the severity of the disease, Capgras syndrome is treatable. As a rule, doctors prescribe antidepressants and antipsychotics to a patient with such a disorder, which help bring the condition back to normal.

“We can reverse any delusion if a drug is selected and if it is not a resistant condition,” the psychiatrist emphasizes. – This is when a person, due to the characteristics of his brain receptors, is not sensitive to the effects of drugs. There are not many such cases, but they do happen. It's hard. And generally people respond very well to medications. The main thing here is not to “heal” the patient to such an extent that there are side effects of the drugs, and, having treated delirium, we get some additional diseases.”

It is also noteworthy that, unlike people suffering from, say, an anxiety disorder or various types of phobias, who are most often aware of the illusory nature of their fears and obsessive thoughts, a patient with Capgras syndrome seriously believes that his relatives or himself have been replaced by doubles.

“However, unlike schizophrenia, it is believed that in the treatment of Capgras syndrome it is possible, in parallel with the use of antipsychotics, to engage in cognitive psychotherapy, that is, to work with the patient’s ideas. Which, for example, is meaningless in a purely schizophrenic process. If this is schizophrenic delirium, then psychotherapeutic work is structured differently, not with the goal of dissuading the person,” explains Nadezhda Solovyova. Thus, Capgras syndrome has both some similarities with other mental illnesses and significant differences. In any case, remember the main thing: if you notice symptoms similar to those described in this article in one of your relatives or friends, be sure to ensure that this person receives qualified medical care. Convincing him that he is sick can be very difficult, but the participation of a psychiatrist in such a situation is simply necessary. Don't forget: without proper treatment, any mental disorder can have disastrous consequences.

Ekaterina Solovyova

Brief historical background

The first case of such a disease was described in 1923. The article was published in a popular medical journal and talked about a patient who was sure that doubles had already taken the place of her husband and close friends. The author of the research publication was the French psychiatrist Joseph Capgras, after whom, in fact, similar psychopathological syndromes were named.

At that time, this disease was considered delusional, one of the symptoms of schizophrenia, and it was generally believed that only women were susceptible to it. Pathology began to be more actively studied only in the 1980s. Today it is already known that Capgras syndrome is a neurological disorder that is primarily associated with brain lesions.

general information

Capgras syndrome is also called negative twin syndrome. According to medical encyclopedias, this is a mental disorder in which the patient mistakes strangers for his family and friends. It also happens the other way around - he considers strangers to be relatives. In some cases, a person thinks that he himself has also been replaced by a double.

For clarity, here are examples from life:

A certain Mrs. D, a 74-year-old housewife, believed that her husband had been replaced by a completely stranger. She did not want to sleep in the same room with him, closed the doors to herself and even asked her son to bring her a pistol to protect her from the stranger. The woman also started a fight with a policeman who wanted to take her to the hospital. This only happened to my husband. Mrs. D. perceived other family members adequately.
One of the patients with Capgras syndrome convinced others that it was not he who was committing illegal actions, but his twin brother. He lived abroad and then came. And now he is trying to recruit the patient. Outwardly, he is no different. The only difference is in behavior. The man gave the example of a broken window. According to him, he himself was in a completely different place at that moment.
For 10 years Madame M. believed that everyone around her, including her husband, daughter, and neighbors, had been replaced by doubles. And that is not all. She said they were changing. For example, in the place of the spouse during this period of time there were at least 80 doubles. He himself, as Madame M. believed, had been killed long ago. By the way, in the divorce document she indicated the replacement of her husband as the reason.

The main causes of the disease

Of course, first of all it is worth considering the reasons for the development of pathology. Similar syndromes in psychiatry began to be studied not so long ago. Scientists do not yet have a consensus on the origin of the disorder.

There is a hypothesis that this condition is not an independent pathology and develops against the background of schizophrenia. Nevertheless, there is reason to believe that Capgras syndrome appears after organic or traumatic damage to that part of the cerebral cortex that is responsible for recognizing faces and causing a corresponding emotional response.

Therefore, risk factors include a previous stroke, as well as cracks or ruptures of cerebral aneurysms. Causes also include deep chronic alcoholism, which also affects nerve cells. In some patients, the disorder appears after neurosurgery or after a trauma that caused the formation of a hematoma in the cerebral area. In addition, the symptoms of the disease appear against the background of senile dementia and schizophrenia with paranoid and manic components.

How does Capgras syndrome occur?

Researchers and practitioners have not yet come to a consensus on the syndrome. There are several theories about its origin:

Freudian concept. The syndrome is seen as the repression into the unconscious of “unacceptable” feelings and emotions towards a loved one (for example, a feeling of sexual interest in oneself on the part of the family member who has been “replaced”). Thus, the patient “splits” the relative’s personality into “good” and “bad” - that is, the relative himself and the stranger who pretends to be him. The latter bears “responsibility” for the emotional discomfort that causes such a deep intrapersonal conflict in the patient.
The neuropsychological concept states that Capgras syndrome is often accompanied by pathological changes in the brain (namely, the frontal and temporal lobes of the right hemisphere), which can be caused by head injuries, diseases - dementia, schizophrenia, cerebrovascular disease.
Vileyanur Ramachandran's concept is one of the most famous and cited theories of the origin of this group of syndromes. The syndrome appears here as a disruption of communication between two key areas of the brain - the fusiform gyrus (face recognition) and the amygdala, which is responsible for the emotional response to faces. Normally, these two areas, interacting with each other, give, for example, the following picture of the world: “This is my husband and I love him.” In patients with Capgras syndrome, according to the researcher, facial recognition does not entail a corresponding emotional response: “This man looks like my husband, but this is not my husband - the face does not evoke in me the feelings that were there before. He must have been replaced by a double" [2].

Ramachandran derived this theory from observations of his own patient, David, who, after suffering a serious head injury, woke up from a five-week coma to believe that his parents had been replaced by doubles. An interesting detail - David believed that the “doubles” were in some ways more skillful than the “real” parents - his father drove a car more skillfully, his mother cooked much more deliciously. This is exactly how, according to him, he determined the fact of substitution [6].

One of the newest concepts in this area is the concept of psychiatrists Nicola Edelstein and Femi Oyebode. It is an addition to Ramachandran’s theory and consists in detecting pathological changes in patients in the prefrontal cortex of the brain, which is responsible for setting goals, designating behavioral strategies, and making decisions. Edelstein and Oyebode suggested that it is precisely because of the disruption in these processes that the above-described conclusion “This man looks like my husband, but is not him” does not seem strange and unusual to the patient, and there is no criticism of his condition [2].

Agree, even after a detailed analysis, it is not easy to believe in the existence of the syndrome. It is even more difficult to imagine the variety of patterns of its development and symptoms in different people. An example of an even more unusual development of the syndrome is the story of a 71-year-old American man with bipolar affective disorder. After refusing drug treatment, the patient began to have delusional ideas - he believed that the FBI was watching his house. The apotheosis (and at the same time the manifestation of Capgras syndrome) was the moment when the man became convinced that his cat had been replaced. According to him, the “New” cat, in collusion with the FBI, followed him and his family, passing on the information he received. Psychiatrists Darby and Kaplan, of whom the patient was a patient, gave the syndrome a new name “Katgra”.

However, despite the many variations and complexities of the disorder, Professor of Psychiatry N. Edelstein believes that with the passage of time and the advent of more and more scientific research, the picture is becoming clearer, and the syndrome “ceases to be part of the neurological “X-Files” [2]. The syndrome is also interesting in how clearly it manifests the fear of the very phenomenon of duality, the fact of being replaced by a double - another person who exactly copies the “original”. We will talk more about the doppelganger and the unconscious fear of the double in the next article.

The first signs of the disease

Like many syndromes in psychiatry, this pathology develops gradually. At first, only short-term problems arise with visual identification of people - they last no more than a few minutes. As the disease progresses, attacks occur more frequently and their duration increases.

In the early stages, the patient may make assumptions that his relatives and even himself have been replaced. Such delusional ideas are often combined with excessive suspicion with which a sick person communicates with loved ones. One may also notice the patient's inability to identify people, whether they are familiar or unfamiliar.

Reasons for appearance

The clinical picture is described in detail by world-famous psychiatrists. They professionally studied Capgras syndrome: photos of difficult patients, videos of the most delusional monologues were analyzed in detail by them, and the correct conclusions were drawn. Instead, the causes of the disease still remain vague and not fully understood. They say that the main impetus is damage to the back of the right hemisphere of the brain, which controls the recognition and recognition of people's faces and the appearance of objects. This can result from a severe head injury or unsuccessful surgery.

Another hypothesis states that the appearance of the syndrome has a psychological rather than a physical basis. That is, very severe stress experienced by the patient can lead to this. Often the disease begins to progress much later than the tragedy has occurred. That is, several months, years, even decades may pass after the accident before the syndrome begins to develop. Some psychiatrists admit that the tendency to illness is inherent in the womb of the mother. Others argue: it becomes a consequence of a difficult childhood or authoritarian upbringing.

Classification: forms and varieties of the syndrome

Before considering the main symptoms, it is worth familiarizing yourself with the possible forms of pathology. For example, quite often a patient is diagnosed with delusions of a negative double. The patient is sure that his acquaintances, friends and relatives have been replaced by their exact copies, doubles.

Sometimes you can observe a completely different picture - delusional recognition of positive doubles. With this form of pathology, the patient recognizes friends and relatives in complete strangers.

There is another classification scheme. In the first - autoscopic - type of disorder, a person can see and feel a double, while for patients with the second type of pathology, the double is invisible (although this does not make it any less real in the patient’s mind).

It is worth saying that in most cases a person retains the ability to identify people’s faces, although it is poorly developed.

The essence of the disease

The mental disorder is named after the famous French doctor. It was Jean Marie Joseph Capgras who first noticed this deviation in his patients, identified and described it. The psychiatrist observed how a particular individual accused his friend of being an impostor. Very often, he recorded such cases among notorious workaholics who, due to chronic fatigue and continuous stress, accused their business partners or colleagues of being unreal and fake.

Capgras syndrome is otherwise called delusional identification. It is also known in scientific literature as the negative twin illusion. Experienced experts say that the bizarre behavior of a sick person is sometimes accompanied by the belief that a close relative, such as a spouse, has been stolen by aliens and replaced with an exact copy. Comments about the fact that a woman still has the same appearance, habits, character, manner of behavior and speech patterns do not impress him and do not affect his perception. On the contrary, they can worsen symptoms. A person begins to think that he lives in a whole world of doubles, and the doctor is no exception.

Capgras syndrome: symptoms

As already mentioned, depending on the form of the disease, the patient can see and feel his double or consider him invisible. The perception of doubles can be both negative and positive, and in most cases there is a perverted perception of not one, but an entire group of people.

If we are talking about a negative perception, then patients, as a rule, are sure that their relatives and close people have been replaced by someone who looks absolutely identical, for example, aliens, robots, etc. For the patient, the similarity of people is only external . That is why the patient is constantly trying to find accurate confirmation of his hypothesis, trying to check whether there is makeup on the face of a friend, wife or other person. The patient sees some difference in eye color, gait, behavior pattern, etc.

Of course, such confidence in substitution makes a person suspicious. Moreover, he believes that the double threatens him or the life of his loved ones. In many cases, the patient decides that the duplicates need to be eliminated. If we are talking about the positive perception of doubles, then the patient suddenly begins to recognize old friends, relatives, parents, etc. in the faces of strangers.

There is another form of the disease in which a person loses the ability to identify himself. He is sure that there is a very real double. All actions and unseemly deeds in the patient’s mind are performed by his understudy - a person of whom he is outwardly a complete copy. It is this version that he will prove to everyone around him. Due to constant fear, tension, doubt and mistrust, the patient gradually becomes hot-tempered and aggressive.

Diagnosis and treatment

An experienced psychiatrist will always notice alarming symptoms; diagnosing a deviation includes observing the patient and collecting complaints. The doctor notes which ideas prevail in the patient and also interviews his relatives. An X-ray of the brain shows the presence of an organic substance in the human body that affects the functioning of the nervous system.

Any image enters the fusiform gyrus, where recognition of living and nonliving objects occurs. The finished result goes to the amygdala, which is responsible for emotions. If there is damage to the organ, then the connection between perception and mental reactions is broken.

Fregoli delirium is difficult to treat. Not only drug therapy for the disease is important, but also a friendly environment in the patient’s family. A common mistake made by relatives is to try to explain to the patient that he is wrong and that the persecutor does not exist in reality.

Such actions will worsen a person’s well-being, since the delusions of a positive double are accompanied by the ward’s confidence in his own rightness. Psychiatrists associate this illness with delusions of grandeur.

Treatment of Fregoli delirium takes many years. The prognosis of the disease depends on the following factors:

Modern diagnostic methods

A person with such symptoms requires hospitalization - only in an inpatient setting, with constant monitoring, a psychiatrist can make the correct diagnosis. A distinctive feature of this syndrome is that the patient accurately identifies people’s faces (the results, naturally, do not coincide with reality), names them, but cannot tell by what criteria he recognized this or that person.

Of course, some examinations are also carried out that help supplement the collected anamnesis and determine the possible cause of the development of the disorder. For example, tests are needed to determine the content of alcohol and drugs in the body. Tomography, encephalography and other studies may be performed to help determine the presence of organic lesions in the brain.

Treatment of negative twin syndrome

The Salvation Clinic provides treatment for mental disorders using modern techniques and proven pharmacotherapy. Medicines are prescribed for severe conditions. Treatment primarily consists of individual psychotherapeutic training. Clinic specialists provide on-site consultations at home. We ensure confidentiality. Other arguments for contacting our center:

assistance with hospitalization;
competent specialists;
high quality of psychotherapeutic assistance;
reasonable prices for services;
convenient location.

The clinic is located away from the bustle of the metropolis, near a park area. We organize not only treatment, but also leisure. Patients are under supervision 24 hours a day and do not need anything. They do not pose a threat to themselves or to the environment, they can collect their thoughts and improve their mental health. We offer a real solution to the problem when a relative has mental disabilities. Contact us, we will help!

Possible complications

The further development of the disease largely depends on its causes and the presence of concomitant diseases. For example, in schizophrenia, Capgras syndrome can progress rapidly, and other mental disorders often appear.

The feeling of fear and threat makes the patient aggressive. Anger and violence in this case are a defense mechanism. If left untreated, people with this pathology can undoubtedly be dangerous to others, because they easily become angry and can pursue or even attack imaginary doubles. In some cases, the disease leads to the desire to commit suicide.

Symptoms of pathology

The main sign is the belief in the presence of doubles. But in psychiatry there are a number of accompanying symptoms:

slow mental activity;
frequent repetition of the same thought (perseveration);
fragmented thinking;
absurd conclusions against the background of complex logical reasoning;
incoherence of speech.

Interestingly, in some cases, a patient with Capgras syndrome clearly sees his double next to him. But most often he talks about the results of his behavior. And at the same time he is trying to prove that he has nothing to do with everything that happened.

Like other mental disorders, Capgras syndrome develops gradually. First, short-term problems with self-identification appear, for about a couple of minutes. Over time, this period grows.

Capgras syndrome: treatment

Quite often this disorder is treatable. Nevertheless, therapy should be aimed at eliminating the cause of such a syndrome. For example, in some cases antipsychotic medications provide good results, although there are many patients who did not experience any positive changes.

The doctor’s actions are aimed at completely normalizing the functioning of the central nervous system. In some cases, antiepileptic drugs and third-generation antidepressants are indicated to help relieve anxiety and depression.

Capgras syndrome often occurs in waves, so after an attack and treatment there often follows a period of relative well-being: the patient behaves quite adequately, recognizes faces, identifies himself and those around him. At this time, it is extremely important to create a calm environment for the person and try to avoid stressful situations that could provoke a new attack. Doctors also advise monitoring your diet and proper daily routine, and completely abstaining from alcohol.

Treatment

The diagnosis is Capgras syndrome, based on the clinical picture. The doctor must be able to differentiate the syndrome from other mental disorders:

Alzheimer's disease;
schizophrenia;
multiple sclerosis;
manic-depressive psychosis;
Huntington's disease.

Treatment of the disease depends on the cause of the syndrome. With the help of strong psychotropic drugs, it is possible to restore the cognitive functions of the brain and restore the functioning of damaged areas of the central nervous system . To get rid of illusory-delusional forms of recognition, antiepileptic drugs are used (therapy can be carried out from one month to several years). Antidepressants are prescribed for the treatment of depressive, manic, and anxiety states.

Reframing is an effective cognitive treatment method. The procedure is aimed at rethinking reality, restructuring thinking in order to eliminate incorrect mental patterns. Reality testing showed good results in treatment. It makes a distinction between borderline personality and serious psychotic syndromes. During testing, the patient's behavior, thoughts and affects are assessed.

How to treat

There is currently no specific treatment plan for Capgras syndrome. As a rule, correction is aimed at the root cause of the disease. For example, a person may have schizophrenia, and a syndrome has arisen against it. Treatment for schizophrenia can correct the disorder and relieve symptoms. But when Capgras syndrome occurs in the context of Alzheimer's, treatment options are limited.

The most effective approach is to create a comfortable environment for the patient, where he will feel safe. For example, some institutions use validation therapy, where the patient's misconceptions are supported rather than refuted. This reduces his anxiety and panic in a delirious state. Hence the conclusion follows: under no circumstances should you convince a person of the falsity of his illusions. The consequences are unpredictable, especially if you are a double whom he does not recognize. In this case, you should give the person for examination to specialists, and leave him alone until the symptoms subside. In fact, the doctors’ recommendations in this case apply to any communication. You need to understand the person, not argue with him when this is not necessary, and acknowledge his feelings.