Cotard delusion

Visit facepain.org. [upbeat music] This is Christine Cliatt-Brown from the University of Utah.

Today in our series on delusional misidentification syndromes, we're going to explore Cotard syndrome.

Cotard syndrome is a nihilistic delusion in which patients believe that they are dead, dying, rotting, no longer exist, are missing internal organs, or have lost their blood, soul, or body.

This presentation can vary from severe depressive nihilism to bizarre fixed somatic beliefs, but the core feature is this profound denial of self, life, or bodily existence.

The syndrome is named for Jules Cotard, a French neurologist and psychiatrist who described what he called le délire de négation in the late 19th century.

His original patient claimed she had no brain, no nerves, no chest, no stomach, and no need to eat because she was already dead.

Cotard syndrome is often discussed in psychiatry, especially in the setting of severe depression with psychotic features.

But neurologists should know that it also appears in a range of neurologic disorders.

Mm-hmm.

You, you talk about something called the Cotard delusion, which leads patients to believe they are dead, um, and th-- even going to such extremes as burying themselves alive.

Is this a real thing?

Yeah, exceedingly rare psychotic delusion.

I am royalty.

Everyone should bow down to me," things like that.

Um, some of the more rare forms of these delusions, which can happen in schizophrenia or they can happen on their own following some kind of injury, the Cotard delusion, right, where a person believes they are dead, and these are very, very rare cases.

There are instances of people saying, um, "I, I set my alarm Early in the morning, I slept past it and I panicked.

I can't think of many things more horrific than that.

But for this one, we're covering the very rare Cotard's syndrome, also known as the Walking Dead or the Walking Corpse Syndrome, and more broadly, Cotard called it the delusions of negation or nihilistic delusions.

And he described this as a state that is neither life nor death.

He called it being dead alive, which we'll get more into 'cause that sounds contradictory, but it'll make more sense as we dig into this.

He also mentioned that he didn't feel human and that his life felt like a dream, and he had actually died by suicide.

But this is an armchair diagnosis from fans and writers after the fact, so we don't really know if he truly did suffer from Cotard syndrome.

This walking corpse syndrome has also been retroactively connected to disturbing high-profile cases like Richard Chase.

He was never formally diagnosed, but a retrospective analysis of his case suggests that he may have had it.