Cotard's Syndrome - The Real Walking Dead

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Cotard’s syndrome, also known as Cotard’s delusion or walking corpse syndrome, is a rare, but severe mental affliction characterized by the belief that one is dead, does not exist or has lost their blood or internal organs. As a consequence, many patients stop grooming themselves or even eating (which eventually leads to starvation if not properly treated).

Technically speaking, this syndrome is not included as a standalone disorder either in the DSM-5 or the ICD-10 (these are the two reference manuals for mental disorders used within the United States and outside of it, respectively). Instead, Cotard’s delusion is usually considered to be part of an underlying condition, such as schizophrenia, depression with psychotic elements, bipolar disorder, dementia, brain tumours, temporal lobe epilepsy and many others.

Although the conditions in which it appears are so heterogeneous, the underlying mechanism seems to be the same. Scientists believe that Cotard’s patients suffer from disconnection mainly between two areas important for face processing (although others could also be involved to a smaller extent):

the fusiform face area, which helps us recognize faces
and the amygdala, which helps us associate faces with emotions

This neural disconnection then translates into a disconnection from the environment, or, better said, between the sense of self and one’s own face. Basically, the face which these patients observe in the mirror is not seen as belonging to their own self anymore. Researchers also hypothesize that personality characteristics also play a role in this. If one has more of an internal attributional style (they attribute causes of events and behaviours more to themselves), they are more likely to develop Cotard’s delusion. In contrast, people with more of an external attributional style tend to develop another rare syndrome called the Capgras delusion.

In terms of treatment, treating the underlying disorder is usually the best option. Antipsychotics and antidepressants also tend to be useful. In some cases, the delusion can spontaneously disappear. Finally, electroconvulsive therapy has also been successfully used in treating this syndrome.

Although it has been described more that a century ago, given that it’s such a rare disorder, to this day Cotard’s is still not fully understood. But it remains a powerful reminder that every aspect of our reality, including the sense of being alive, is shaped by our brains.

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