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Cotards Syndrome: The living dead

Cotard Syndrome: The living dead blog | Bham Pharma

What is Cotards syndrome?

Cotards syndrome (also known as Walking Corpse Syndrome or Cotards delusion) causes people to believe they are dead. Either metaphorically or literally dead.

Some people think they do not exist or have never existed, that their bodies are decaying, or that they have lost all their internal organs. A statistical analysis of 100 patients revealed that denial of self-existence occurs in 45% of cases of Cotards syndrome, with the remaining 55% presenting with delusions of immortality.

The first patient, Mademoiselle X, was described by Jules Cotard in 1880. She showed signs of self-loathing which manifested as a denial of the existence of God or the devil and several parts of her body. She believed herself to be eternally damned and, therefore, could not die a natural death. She later died of starvation, which may have come as a shock to her.

Although it may seem amusing, Cotards syndrome is a rare condition that shows signs of emotional instability or brain dysfunction. Another commonly mentioned case involved a motorcycle accident victim who thought he had died due to complications with his recovery. His mother also relocated to South Africa from Edinburgh shortly after the accident, confirming that he was in hell because of the heat.

The underlying cause of Cotards syndrome appears to be misfiring in the fusiform face areas of the brain, which recognise faces, and in the amygdala, which adds emotions to those recognitions. The result is a lack of emotion when seeing familiar faces, and disconnection can lead to complete detachment. Viewing one's face in this state can result in a lack of association between their reflections or projected self and their sense of self, leading to the belief that one does not exist.

Signs and symptoms of Cotards syndrome

The main symptom of Cotards syndrome is delusions of negation. The patient usually denies their existence and the existence of a specific body part or a portion of their body. Cotards syndrome can be classified into three stages:

  • 1st Stage: Germination stage: symptoms of psychotic depression and hypochondria appear
  • 2nd Stage: Blooming stage: complete development of the syndrome and delusions of negation
  • 3rd Stage: Chronic stage: persistent severe delusions along with chronic psychiatric depression

Signs and symptoms of Cotards syndrome

Cotards delusion is often challenging to diagnose because most organisations do not recognise it as a disease. It is usually diagnosed only after all other potential causes have been ruled out. Currently, is not included as a specific disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).

How is Cotards syndrome treated?

Treating the underlying cause of Cotards syndrome can be challenging, so efforts are instead focused on managing the symptoms. Behavioural therapy, mood stabilisers, anti-psychotic medications, and anti-depressants have been successful. Similarly, electroconvulsive therapy (ECT) has proven to be more successful than pharmacotherapy for patients who are depressed. However, there is still a lot about this fascinating disease that we do not know yet.

Living with Cotards syndrome

Several complications can arise when you believe your death has already occurred. It may occasionally cause complications with hygiene, especially with the skin and teeth. For instance, some people may stop caring for themselves and bathing, and this can cause those around them to start distancing themselves. Additionally, it may trigger depressive and isolating thoughts.

Some people stop eating and drinking because they think their bodies do not require it. In extreme circumstances, starvation and malnutrition may occur.

People with Cotards syndrome frequently attempt suicide. Some see it as a means of proving their death by demonstrating their incapacity to die once more. Some individuals may feel trapped in a life and body that do not seem real.
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Aarti Chauhan
Medical Writer II & Social Media Lead