A New Phenomenological Approach of Delusional Misidentification Syndromes
Maria Margariti Lecturer of Psychiatry University of Athens
Delusional Misidentification Syndromes
•Capgras syndrome: Delusional belief that a familiar person has been replaced by a double (Capgras, Reboul-Lachaux, 1923) •Fregoli syndrome: Delusional belief that a familiar person has replaced an unfamiliar person (Courbon, Fail, 1927) •Intermetamorphosis: Delusional belief that a person has been physically and psychologically transformed into another (Courbon, Tusques, 1932) •Subjective doubles: Delusional belief that another person has acquired the physical characteristics and identity of self (Christodoulou, 1978) •Reduplicative paramnesia: Belief that a place familiar to the patient exists simultaneously in various places (Pick, 1903)
Cases of multiple doubles
• “On her admission she claimed that her son had been replaced by two impostors, which over the next week became four” (Young et al,1993) • “Eleven days after the patient’s admission, the patient expressed her conviction to Dr T's registrar that there were four Dr T's, and while their voice was the same, three of them were wearing a mask” (Todd et al, 1981) • “She stated that men resembling and dressed like her husband had come to their home pretending to be him” (Todd et al, 1981) • “She claimed that every day another “son” came home, and she was able to distinguish them by slight differences in their appearance” (Christodoulou et al,1995)
• “Each of his brothers and sisters was actually five different people” (Murai et al,1998)
• Reduplicative paramnesia: “ the patient reported that he had been treated at five different Audie Murfy VA hospitals, ranging in location from Central Mexico to Key West, Florida” (Holliday et al, 1995)
Who can be misidentified?
Unknown
Known
Known
Unknown
Known Unknown
Capgras delusion
Fregoli delusion Patient
Uniqueness
• Pauli’s exclusion principle: “Two identical particles having the same properties cannot coexist in the same space”. Each one is unique. • Uniqueness is a fundamental property of the material world • Uniqueness permits matter to be distributed in space Pauli, 1925
Explanatory hypothesis for the DMS
•Derealization feelings, strangeness, perceptual abnormalities, etc.
Capgras delusion
Fregoli delusion Subjective doubles
Disordered sense of uniqueness
•False feelings of familiarity, ideas of reference, etc.
•Depersonalization feelings, ideas of passivity control, etc.
•Disorientations due to memory deficiencies, etc.
Reduplicative paramnesia
A proposal for a model of face recognition and delusional misidentifications
Structural encoding
Expression analysis
Speech codes
Visual codes
Arousal orienting response
Face recognition units
Name production Skin conductance response
Name retrieval
Personal information
Affective response to familiar stimuli
Semantic information units
Integrative device
Identitificatio n
Fig.1 Model of face recognition and delusional misidentification of Ellis and Lewis (revised). According to our proposal, actual identification takes place in the Integrative Device. Integration of perceptual, personal, and affective information is implemented on the ground of uniqueness, the role of which is to compensate for a certain degree of discrepancy between recent and stored information, serving identification constantly and successfully. A disorder at that level results in a breakdown of the identification process by allowing even a slight discrepant input to misdirect identification through a denial of the true identity and reidentification as a "double".
Thank you for your attention