Causes and Symptoms of Cotard Delusion

Did You Know? 

Cotard delusion is a rare mental illness that is named after a French neurologist Jules Cotard (1840 – 89). He described this condition in 1880, after he came across a female patient who believed that her organs didn’t exist, and that her skin and bones were decomposing.

Jules Cotard described the condition as délire des négations, which translates to nihilistic delusion. This is a rare, bizarre mental illness, with the characteristic symptom being the delusion of non-existence. Cotard’s patient didn’t believe in God or devil; she believed that she didn’t have a soul, and that she couldn’t die a natural death. She also believed that she didn’t need to eat to survive.

Though this condition is also referred to as the walking corpse syndrome, the presence of the delusion of being dead is not necessary. At times, the patients might have the delusion of being non-existent or immortal. The incidence of the delusion of non-existence or self-negation is higher than the delusion of immortality. It must be noted that the Cotard delusion doesn’t find a mention in the Diagnostic and Statistical Manual of Mental Disorders (DSM), IV-TR published by the American Psychiatric Association.

Contributing Factors and Symptoms of Cotard Delusion

This syndrome comprises three stages. The first stage is referred to as the germination stage. In this stage, symptoms are associated with hypochondria and psychotic depression. In the second stage, the patient develops the delusion of non-existence or self-negation. In the third stage, psychiatric depression and the delusions become more severe.

It is believed that this condition might be caused due to problems in the amygdala and fusiform gyrus in the brain. Amygdala acts as an emotional center, whereas the fusiform gyrus helps us recognize faces. The ability to perceive the social, emotional, and expressive cues can get adversely affected, if there is misfiring of neurons in the fusiform gyrus. As a result, the affected individual might not feel connected with reality.

The affected individuals might experience any of the following symptoms or signs of Cotard delusion:

✦ Anxious melancholy
✦ Depression
✦ Convinced of being dead
✦ Convinced that one is immortal or cannot die
✦ Ideas of damnation or possession
✦ Belief that one doesn’t exist
✦ Belief that one’s organs are missing
✦ A tendency for self-mutilation or suicide

In a study, 100 cases of Cotard delusion were analyzed. It was found that both men and women could get affected by this syndrome. Depression was reported in 89% of subjects. Anxiety was reported in 65% of the cases, whereas guilt was reported in 63% of the cases. Hypochondriacal delusions and delusions of immortality were observed in 58% and 55% of the cases, respectively. Delusions associated with the body were observed in about 86% of the cases, whereas delusions concerning one’s existence were reported in 69% of the cases.

It was observed that some of the affected individuals had a few delusions about non-existence, melancholia, and psychotic depression, whereas some of them were mainly delusional. There have been cases where the patients experienced auditory hallucinations, anxiety, depression, etc. Thus, it is important to analyze the symptoms properly before ascertaining the treatment.

It has been observed that this syndrome could exist in individuals who have been diagnosed with any of the following conditions:

✦ Psychosis
✦ Neurological conditions
✦ Mental illness
✦ Derealization
✦ Clinical depression


✦ While this condition was identified and named after Jules Cotard in 1880, the symptoms were reported by Charles Bonnet in 1788. This was a case of an elderly woman who developed this condition, after she became paralyzed. She believed that she was dead, and forced her daughters into placing her in a coffin. She even asked her family to mourn her, as she believed that she was dead.

✦ There’s another case of a Scottish man who started believing that he was dead after he suffered from head trauma during a motorcycle accident in 1996. After recovering from the accident, he and his mother moved from Edinburgh to South Africa. He believed that he was burning in hell, as he compared the heat of South Africa to hell.

✦ In a case that was reported by Greek psychiatrists in 2003, the patient had committed suicide before, as he felt that he was retarded and didn’t have a brain. He didn’t undergo treatment, but was admitted again. His condition improved after treatment.

✦ In 2008, a 53-year-old patient, Ms. Lee was admitted to a psychiatric unit in New York, when she complained of being dead and told her family members that she smelled like rotting flesh. She even accused the paramedics of trying to burn down her house.

✦ In 2009, Belgian psychiatrists reported the case of an 88-year-old man who believed that he was dead. The patient exhibited symptoms of depression. He expressed his concerns regarding the fact that he had not been buried.

In most of these cases, the condition of the patients improved after they received proper treatment. The treatment of Cotard delusion involves the use of antidepressants, however, electroconvulsive therapy has proven to be beneficial in several cases. In case of electroconvulsive therapy, a seizure in a certain area of the brain is induced, which causes the patient to lose consciousness and convulse for 15 seconds. This therapy has also proven to be effective in the treatment of mental illnesses such as depression, bipolar disorder, and schizophrenia.

DisclaimerThe information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a mental health expert.