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No seriously, I’m dead.

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ResearchBlogging.orgI’ve said it before and I’ll probably say it again about other medical conditions but this is my favorite. Having a favourite condition sounds incredibly weird I know but its true. Something about Cotard’s Syndrome (also known as Cotard’s Delusion or Walking Corpse Syndrome) just grips me.

cotard delusion 9

Cotard's Delusion 9 by hunnnterr

Essentially sufferers believe themselves to be dead. Figuratively or literally dead. Slight variations include those that believe they do not exist or have not ever existed, are rotting or have lost all their internal organs.

The first described patient was presented in a lecture in Paris in 1880 by Jules Cotard as Mademoiselle X who presented with significant self-loathing manifested as a denial of the existence of god or the devil and several parts of her body. As she believed herself to be eternally damned and incapable of dying a natural death and so no longer needed to eat. She later died of starvation in what one must assume came as a shock to her at least.

As comical as it appears to be it is obviously a manifestation of some deep-seated emotional issues or brain dysfunction. Another commonly described case involved a motorcycle accident victim who believed he had died as a result of complications during his recovery from the accident. Furthermore his mother had moved to South Africa with him from Edinburgh shortly after the accident, which confirmed to him that he was in hell as it was so hot.

The underlying cause of Cotard’s Syndrome appears to be a misfiring in the fusiform face areas of the brain, which recognises faces, and also in the amygdala, which adds emotions to those recognitions. The result is a lack of emotion when viewing familiar faces and the result disconnection can result in complete detachment. Viewing ones own face in this condition can lead to a lack of association between their reflections or projected self and their own sense of self, leading to a belief that one doesn’t exist.

Gray727 fusiform gyrus

Fusiform coloured yellow. By Gray, vectorised by Mysid, colourd by was_a_bee. (File:Gray727.svg)


Treatment of Cotard’s Syndrome is tricky as it can be very difficult to treat the cause and instead efforts are made to control the symptoms. Anti-depressants and anti-psychotics have been shown to help as has electroconvulsive therapy but we are still very much in the dark on this fascinating and intriguing disease.



Debruyne H, Portzky M, Van den Eynde F, & Audenaert K (2009). Cotard’s syndrome: a review. Current psychiatry reports, 11 (3), 197-202 PMID: 19470281
Ruminjo A, & Mekinulov B (2008). A Case Report of Cotard’s Syndrome. Psychiatry (Edgmont (Pa. : Township)), 5 (6), 28-9 PMID: 19727279
Nejad AG, & Toofani K (2005). Co-existence of lycanthropy and Cotard’s syndrome in a single case. Acta psychiatrica Scandinavica, 111 (3) PMID: 15701110

James Byrne About the Author: Dr James Byrne has a PhD in Microbiology and works as a science communicator at the Royal Institution of Australia (RiAus), Australia's unique national science hub, which showcases the importance of science in everyday life. Follow on Twitter @JB_blogs.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. maxcoltheart 1:48 am 02/1/2012

    This mixes up two quite different delusions: Cotard and Capgras.

    Cotard delusion is the belief that you are dead. It has nothing to do with faces.

    Capgras delusion is the belief that a person whose face you are looking at is a stranger when in fact the person is someone highly familiar to you: typically a spouse. It has nothing to do with believing that you are dead.

    The phrase above – “a lack of emotion when viewing familiar faces and the result disconnection ” – is a well-accepted explanation of the Capgras delusion (not the Cotard delusion. But that phrase completely contradicts another part of the above post – “a misfiring in the fusiform face areas of the brain, which recognises faces, and also in the amygdala, which adds emotions to those recognitions”. That’s not a disconnection. In Capgras delusion, the face recognition area of the brain is intact (no misfiring there) and so are the parts of the brain controlling emotion. These two regions are intact but disconnected. In Capgras delusion.

    Cotard delusion is another story.

    So this was not a very good piece of scientific blogging.

    For an overview of a variety of delusions (including Capgras and Cotard) and a possible explanation for these, see Coltheart, M., Langdon, R. & McKay, R.T. (2011). Delusional belief. Annual Review of Psychology, 62, 271-298.

    Link to this
  2. 2. Jbyrne 4:15 am 02/1/2012

    I am no expert just an interested reader and I know there is a relationship between Cotard’s and Capgras. I believe, based on my reading, that the underlying pathophysiology is very similar resulting in both syndromes exhibiting a disconnection between the recognition centre and an emotional input for that recognition but the development of symptoms can affect the diagnosis.
    My understanding is that when this disconnect is experienced very strongly with others and in particular with people that are otherwise quite familiar it is diagnosed as Capgras. However, when the disconnect occurs internally, for example when viewing your own reflection, this leads to a lack of association between it and the sense of self which often develops into a sensation of not having existed or no longer existing, and as such is diagnosed as Cotard’s.
    I do not have access to the cited journal above at home and will check if I can get it through some other channels but in the mean time I will quote a some of my background reading as,
    Pearn J, Gardner-Thorpe C (2002). Jules Cotard (1840-1889): his life and the unique syndrome which bears his name. Neurology, 14;58(9):1400-3.
    I am very happy to be proven wrong but I did write this piece based on my reading and understanding of a very complex topic with all the expertise a bacteriologist might have about the human brain.

    Link to this
  3. 3. maxcoltheart 3:57 pm 02/1/2012

    The delusion involving failing to recognize yourself in the mirror is a third delusion, unrelated to the other two. It is called mirrored-self misidentification. Also discussed in the paper I referred to.

    Max C

    Link to this

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