Verified by 
Capgras Syndrome
Capgras syndrome is a rare disorder in which a person holds the delusional belief that an identical-looking imposter has replaced someone significant in their life. They believe the doppelganger looks and acts exactly like the original person but that they are an imposter nonetheless, and no amount of arguing or reasoning can convince them otherwise.
Individuals with Capgras syndrome believe that an imposter or an identical double is standing in for a loved one. This delusion can be extremely scary for the person suffering from it, as well as deeply painful for the person’s loved ones.
Capgras tends to affect people with mental illnesses or brain damage, such as schizophrenia, dementia, or traumatic brain injury. People with Capgras syndrome can harbor other delusional beliefs as well, including the misidentification of objects.
The term derives from the French psychiatrist Joseph Capgras, who first described the phenomenon in the 1920s.
Capgras is a rare condition. It falls into a class of disorders called delusional misidentification disorders, and it’s not currently listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
Capgras syndrome generally emerges after brain damage, including traumatic brain injury, Alzheimer’s disease and other forms of dementia, schizophrenia, epilepsy, cerebrovascular accident, pituitary tumors, and Parkinson's disease.
Research suggests that damage to the bifrontal, right limbic, and temporal regions can cause Capgras syndrome, which leads to impairments in memory, self-monitoring, and reality perception. This prevents face recognition and emotional information from being integrated and processed together.
The theory behind Capgras syndrome involves impairment of the visual system. When people recognize a familiar face, the brain typically connects that visual input with the rest of the brain, including emotional input from the amygdala. Individuals with Capgras syndrome seem to have lost the capacity to connect visual and emotional input. Thus when they view their spouse’s face, for instance, they recognize it but don’t experience the warm feelings of connection that should accompany that recognition. This can lead to the belief that the person couldn’t be their spouse—just someone who looks like them and acts like them.
Some evidence for this visual-processing theory comes from case studies in which individuals with Capgras syndrome thought someone close to them was an imposter when they saw them, but not when they spoke to them over the phone.
Individuals with Capgras syndrome typically develop their imposter delusion about someone or something close to them; this may be their mother, father, sibling, spouse, friend, pet, or even their house. Sometimes the imposter delusion will begin with the individual closest to them and gradually extend to other members of the family until they believe the entire family is composed of imposters.
Capgras syndrome is rare. Research suggests that the prevalence is around 0.12 percent in the general population and 1.3 percent among people with other mental illnesses, such as schizophrenia. Women experience Capgras syndrome more often than men, with three women having the syndrome for every two men.
Treating Capgras syndrome involves identifying and targeting the underlying psychiatric or neurological problem. For example, this may involve taking an antipsychotic to treat schizophrenia, taking medication to treat dementia, or having surgery or beginning neurorehabilitation to address a traumatic brain injury.
People with Capgras syndrome can also benefit from therapy. Forms of therapy such as reality orientation therapy and behavior therapy can help these individuals manage their delusions and the emotions surrounding them, such as fear, anxiety, and confusion.
For loved ones, Capgras can be a painful condition to witness; it ruptures the relationship and operates outside of a shared reality. For those in the difficult position of caring for a loved one with Capgras syndrome, it can help to first understand their perspective. Recognize that the delusion isn’t intentional or malicious and the person likely feels scared and confused.
Second, it can help to develop some concrete strategies. Don’t try to convince the person that you aren’t an imposter, because that will not likely work and will instead escalate the situation. Listen to what they’re experiencing and ask if there’s anything that would make them feel safe. Take breaks and allow other people to step in. Trying to speak to the person over the phone can be worthwhile because in some cases, the delusion manifests through sight but not through sound.
Witnessing a friend or family member develop Capgras syndrome is upsetting; therapy can be a valuable outlet. Therapy can help loved ones process the shock of the condition, navigate their feelings, and learn coping skills for emotion regulation as well as practical strategies to use when communicating with someone suffering from delusions.
