I’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.

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.

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.

References

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