What Is Cotard's Syndrome (Walking Corpse Syndrome)?

People with Cotard's syndrome (also called walking corpse syndrome or Cotard's delusion) believe that parts of their body are missing, or that they are dying, dead, or don’t exist. They may think nothing exists.

Cotard's syndrome is rare, with about 200 known cases worldwide.

Though the symptoms are extreme, most people get better with treatment.

Symptoms

People with this syndrome often become much less social. Sometimes, they may stop speaking at all. Some hear voices that tell them they're dead or dying.

Others may refuse to eat (because, among other reasons, they see no point since they're "dead"). Some may try to harm themselves.

In one well-documented case of Cotard's syndrome reported in 2008, a 53-year-old woman was admitted to the hospital after her family called 911. They said the woman believed that she was dead and smelled like rotting fish. She also asked to be taken to a morgue because she wanted to be with dead people.

Causes

It's not clear what causes Cotard's syndrome. We do know that it's often a symptom of a deeper medical problem that affects the brain, such as:

Some experts think Cotard's syndrome results from two types of brain damage. The first changes the way people view themselves. The second makes them continue to believe this false view, even when they’re shown it’s not true. Not everyone agrees with this idea, though.

Who Gets It?

Cotard's syndrome can happen at almost any age, though it strikes many people in their early 50s. Many people who have it also have a history of mental health problems, especially:

Most have some kind of brain damage that shows up on imaging tests. The harm may come from:

Additionally, Cotard's syndrome may cause bipolar disorder in teens and young adults.

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Diagnosis

It should be easy to spot. The problem is that it’s a symptom of another condition, not a disease. And it’s not listed in the DSM. That's the handbook used to diagnose mental health problems. The fact it's not in there means there are no firm rules to guide doctors.

It's usually diagnosed after doctors rule out other conditions that look like it. One such disorder is Capgras syndrome, when a person believes a friend or family member has been replaced by an identical fake. It's also called "imposter syndrome."

Treatment

Doctors have many ways to treat Cotard's syndrome. The usual approach is to treat the medical problem that's causing it.

Most people do best with a combination of medication and a form of talk therapy, like cognitive behavioral therapy (CBT) or psychotherapy. Both of these provide a safe place for people to talk about how they feel and help them find healthier ways to think and act.

Medicines used to treat Cotard's syndrome include:

Most people need more than one type.

If medicines and talk therapy don't help, electroconvulsive therapy (ECT) is an option. It sends small electric currents through the brain. This changes the brain’s chemistry and may clear some mental health symptoms.

ECT can cause side effects like memory loss and confusion. So it’s often a last resort.

WebMD Medical Reference Reviewed by Jennifer Casarella on January 21, 2020

Sources

SOURCES:

International Journal of Psychiatry in Clinical Practice: “‘I am dead’: Cotard syndrome and dementia.”

The Primary Care Companion for CNS Disorders: “‘I’m dead, so why do I need to eat?’” “Cotard Syndrome Resulting from  Valacyclovir Toxicity.”

The Journal of Neuropsychiatry and Clinical Neurosciences: “A Neuropsychiatric Analysis of the Cotard Delusion.”

Cognitive Neuropsychiatry: “Factor one, familiarity and frontal cortex: a challenge to the two-factor theory of delusions.”

Bipolar Disorder: “Cotard’s syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder.”

National Institutes of Health: "I'm Dead, So Why Do I Need to Eat?"

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