What is Cotard delusion?
Cotard delusion is a rare condition marked by the false belief that you or your body parts are dead, dying, or don’t exist. It usually occurs with severe depression and some psychotic disorders. It can accompany other mental illnesses and neurological conditions. You might also hear it referred to as walking corpse syndrome, Cotard’s syndrome, or nihilistic delusion.
What are the symptoms?
One of the main symptoms of Cotard delusion is nihilism. Nihilism is the belief that nothing has any value or meaning. It can also include the belief that nothing really exists. People with Cotard delusion feel as if they’re dead or rotting away. In some cases, they might feel like they’ve never existed.
While some people feel this way about their entire body, others only feel it in regard to specific organs, limbs, or even their soul.
Depression is also closely related to Cotard delusion. A 2011 review of existing research about Cotard delusion notes that 89% of documented cases include depression as a symptom.
Other symptoms include:
- preoccupation with hurting yourself or death
Who gets it?
Researchers aren’t sure what causes Cotard delusion, but there are a few possible risk factors. Several studies indicate that the average age of people with Cotard delusion is about 50. It can also occur in children and teenagers. People under the age of 25 with Cotard delusion tend to also have bipolar depression. Women also seem to be more likely to develop Cotard delusion.
In addition, Cotard delusion seems to occur more often in people who think their personal characteristics, rather than their environment, cause their behavior. People who believe that their environment causes their behavior are more likely to have a related condition called Capgras syndrome. This syndrome causes people to think their family and friends have been replaced by imposters. Cotard delusion and Capgras syndrome can also appear together.
Other mental health conditions that might increase someone’s risk of developing Cotard delusion include:
- bipolar disorder
- postpartum depression
- depersonalization disorder
- dissociative disorder
- psychotic depression
Cotard delusion also seems to be associated with certain neurological conditions, including:
- brain infections
- brain tumors
- multiple sclerosis
- Parkinson’s disease
- traumatic brain injuries
How is it diagnosed?
Diagnosing Cotard delusion is often difficult because most organizations don’t recognize it as a disease. This means there’s no standardized list of criteria used to make a diagnosis. In most cases, it’s only diagnosed after other possible conditions have been ruled out.
If you think you might have Cotard delusion, try to keep a journal of your symptoms, noting when they occur and how long they last. This information can help your doctor narrow down the possible causes, including Cotard delusion. Keep in mind that Cotard delusion usually occurs alongside other mental illnesses, so you might receive more than one diagnosis.
How is it treated?
Cotard delusion usually occurs with other conditions, so treatment options can vary widely. However, a 2009 review found that electroconvulsive therapy (ECT) was the most commonly used treatment. It’s also a common treatment for severe depression. ECT involves passing small electric currents through your brain to create small seizures while you’re under general anesthesia.
However, ECT does carry some potential risks, including memory loss, confusion, nausea, and muscle aches. This is partly why it’s usually only considered after other trying other treatment options, including:
- mood stabilizers
- behavioral therapy
Can it cause complications?
Feeling like you’ve already died can lead to several complications. For example, some people stop bathing or taking care of themselves, which can cause those around them to start distancing themselves. This can then lead to additional feelings of depression and isolation. In some cases, it can also lead to skin and teeth problems.
Others stop eating and drinking because they believe their body doesn’t need it. In severe cases, this can lead to malnutrition and starvation.
Suicide attempts are also common in people with Cotard delusion. Some see it as a way to prove they’re already dead by showing they can’t die again. Others feel trapped in a body and life that doesn’t seem real. They hope that their life will get better or stop if they die again.
Living with Cotard delusion
Cotard delusion is a rare but serious mental illness. While it can be hard to get the right diagnosis and treatment, it usually responds well to a mix of therapy and medication. Many people need to try several medications, or a combination of them, before they find something that works. If nothing seems to work, ECT is often an effective treatment. If you think you have Cotard delusion, try to find a doctor who seems open to listening to your symptoms and working with you to diagnose or address any other conditions you might have.