What is Capgras Syndrome? How does it effect you?

Tracy Smith, LPC, NCC, ACS
September 25, 2018

Capgras Syndrome, also known as “imposter syndrome” or “Capgras delusion” is a psychiatric condition where individuals experience delusions, causing them to believe that people in their lives are actually identical imposters.  People with this condition believe that the body of a spouse, parent, sibling, friend, or pet has been taken over and inhabited by an identical fraud.  Capgras Syndrome can cause significant distress for the afflicted and for the accused imposter.


Capgras syndrome is named after its founder, French psychiatrist, Joseph Capgras, who was the first to identify and illustrate details of the disorder.  Capgras co-authored a case study on “Madame M.”, who believed that her husband and several others had been discarded for analogous “doubles.”

Capgras syndrome is uncommon and representative of an inadequately and poorly understood phenomenon.  Research has been conducted in attempts to determine the cause of the illness, but there have been no conclusive findings to date.  Several theories suggest that the syndrome is caused by dysfunction in the brain, in the form of atrophy or brain lesions.  Other theories propose that delusions are precipitated by inaccuracies in perception and processing mechanisms corresponding to damaged memories.  Others believe that the syndrome is linked to both physical and cognitive forces that culminate to produce disconnect.

Despite various theories, it is generally agreed upon that Capgras syndrome is some type of neurological malady that results from organic brain lesions or degeneration.  Due to the disorder’s rarity, there is no formal diagnostic criterion to assist practitioners with diagnosis.  Diagnosis most commonly occurs when an individual is brought in for a psychiatric evaluation, usually by a loved one that is targeted as an imposter.

The syndrome most often occurs in those diagnosed with paranoid schizophrenia, brain injury, dementia, Alzheimer’s disease, and other neurodegenerative diseases.  Alzheimer’s and dementia are two conditions that greatly impact memory and reality.  Paranoid schizophrenia can precipitate instances of the syndrome by impacting reality and by prompting delusions.  In some cases, lesions in the brain where facial recognition is processed can also trigger Capgras syndrome.  It is a rarity, but individuals with epilepsy may also experience Capgras delusions.   The disorder is most commonly diagnosed in females and older individuals, but can also be found in males and in children.

In addition to lack of research and limited diagnostic criteria, there is no overall treatment regimen employed for people with Capgras syndrome.  Despite this, a limited number of treatment options are available that primarily target the cause and symptoms of the syndrome.  Treatment is more favorable for a paranoid schizophrenic rather than an Alzheimer’s patient, where degeneration is consistently and progressively occurring.

Individuals with Capgras syndrome are usually referred for individual therapy to assist them in dispelling delusions via reality testing and reframing cognition.  Reality testing helps the afflicted individual by consistently re-orienting them to place and time.  Other treatment options include validation therapy, where delusions are substantiated instead of undermined so as to treat the overall symptoms of anxiety and panic.

Pharmacological interventions have been employed with some success.  Antipsychotic medications have been utilized to treat those with paranoid schizophrenia.  Cholinesterase inhibitors seek to improve memory and judgment and are utilized in dementia and in Alzheimer’s patients.  Finally, some individuals with lesions and head trauma might be identified as candidates for surgery to repair problematic areas of the brain.

Overall, treatment for Capgras syndrome seeks to make the individual feel safe and calm.  Caring for one with these delusions can be extremely challenging if you are the one perceived to be the imposter.  If you find yourself a caretaker for one who experiences Capgras delusions, it is important to acknowledge their feelings, maintain empathy for their intense fear and discomfort, and be mindful to avoid arguing or constantly re-directing their claims.

Tracy Smith, LPC, NCC, ACS

Tracy is a Licensed Professional Counselor and is a clinical supervisor for the Community YMCA, Counseling & Social Services branch. Tracy has over 12 years of experience working in many settings including partial care hospitalization and intensive outpatient programs, community agencies, group practice, and school-based programs. Tracy works with clients of all ages, but especially enjoys working with the adolescents. Tracy  facilitates groups using art therapy, sand play and psychodrama.