Capgras syndrome

Overview

Capgras syndrome, also known as Capgras delusion, is a rare psychiatric disorder in which a person believes that someone they know—usually a close family member, spouse, or friend—has been replaced by an identical-looking impostor. It is classified as a delusional misidentification syndrome and is typically associated with underlying neurological or psychiatric conditions. While Capgras syndrome is uncommon, it can be emotionally distressing and may lead to significant social disruption and relationship strain.

Causes

The exact cause of Capgras syndrome is not fully understood, but it is believed to result from a disconnection between the brain regions responsible for visual recognition and emotional processing. This disconnection causes individuals to recognize a person’s face but lack the expected emotional familiarity, leading them to conclude the person is an impostor. Contributing factors include:

• Neurodegenerative diseases – such as Alzheimer's disease, dementia with Lewy bodies, or Parkinson’s disease

• Schizophrenia – especially the paranoid subtype

• Traumatic brain injury – particularly affecting the right hemisphere or frontal-temporal lobes

• Stroke or brain tumors – disrupting facial recognition or emotional pathways

• Epilepsy – particularly temporal lobe epilepsy

Symptoms

The hallmark symptom of Capgras syndrome is the persistent belief that a familiar person has been replaced by an identical-looking impostor. Other associated symptoms may include:

• Accusations or confrontations directed at the “impostor”

• Emotional detachment or paranoia toward loved ones

• Confusion, anxiety, or fear around people they formerly trusted

• Possible extension of the delusion to pets, objects, or even places

• Other signs of underlying psychiatric or neurological illness, such as hallucinations or cognitive decline

Diagnosis

Diagnosis of Capgras syndrome is based on clinical evaluation, including the patient’s behavior, delusional content, and associated neurological or psychiatric signs. Diagnostic steps may include:

• Psychiatric assessment – evaluating the presence and nature of the delusion and any coexisting mental health conditions

• Neurological examination – to assess for signs of cognitive impairment or focal neurological deficits

• Neuroimaging (MRI or CT) – to identify any structural abnormalities or lesions in the brain

• Cognitive testing – to evaluate memory, reasoning, and facial recognition skills

• EEG – if seizures or epilepsy are suspected

Treatment

Treatment for Capgras syndrome focuses on managing the underlying cause and alleviating the delusional belief. Common treatment approaches include:

• Antipsychotic medications – such as risperidone, olanzapine, or aripiprazole, particularly effective in psychiatric-related cases like schizophrenia

• Cognitive-behavioral therapy (CBT) – to help patients develop coping strategies and challenge distorted beliefs

• Cholinesterase inhibitors – for dementia-related cases to slow cognitive decline

• Family support and education – to help caregivers manage interactions and reduce distress

• Environmental consistency – maintaining routine and minimizing sensory confusion may help reduce delusional episodes in dementia

Prognosis

The prognosis for Capgras syndrome varies depending on the underlying cause. In psychiatric conditions such as schizophrenia, symptoms may improve with medication and therapy, although recurrence is possible. In neurodegenerative diseases like Alzheimer’s, the delusion may persist or worsen over time as cognitive decline progresses. Early diagnosis, appropriate treatment, and strong social support can improve outcomes and quality of life. While Capgras syndrome can be chronic, some individuals experience partial or full resolution of symptoms with appropriate intervention.