Capgras Syndrome: How to Cope with a Loved One's Delusions

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Capgras is a type of delusional misidentification syndrome (DMS) that may present due to any number of neurological diseases or psychiatric disorders. Although the exact prevalence of this disorder is unknown, a 1999 study estimates that it is present in between two and 30 percent of individuals with Alzheimer’s disease. This disorder can seriously complicate a dementia patient’s quality of life and their caregivers’ efforts, so it is crucial to spread awareness of this little-known condition.

What is Capgras Syndrome?

“Capgras is a misidentification syn­drome characterized by the transient, recurrent, or permanent belief that someone known to a patient has been replaced by an impostor with a strong physical resemblance,” explains Erin Shvetzoff Hennessey, MA, NHA, CPG, and Vice President of Health Dimensions Group. “These delusions are suggested to stem from impairment of the brain’s facial recognition system and are also associated with brain lesions.” There is limited research available on this condition, but it affects those with a variety of neurological and psychological diagnoses, including schizophrenia, Alzheimer’s and other forms of dementia.

Capgras can be extremely stressful for the person with the syndrome, but it is also very disturbing for those around them. “While dementia caregivers usually anticipate a loved one’s forgetfulness and inability to remember close family members and friends, it can be very painful and confusing when this syndrome causes a different kind of loss of recognition,” laments Shvetzoff Hennessey. A loved one may remember their caregiver, spouse, or other relative—and may even ask for them by name—but they believe that this person is an impostor. Such delusions can make caregiving, family time, and other social experiences extremely painful and confusing.

Reality Orientation Techniques

When interacting with a person who is experiencing Capgras, it is common for caregivers and family members to attempt to correct or explain their delusions. A research article in the Frontiers in Human Neuroscience journal states that, “A defining characteristic of delusions also present in Capgras syndrome is that patients will firmly hold on to their delusional beliefs [even] in the presence of mounting contradictory evidence.”

While some caregivers may continue to correct sufferers and try to convince them that they are merely experiencing delusions, the use of reality orientation techniques for sufferers of memory loss has declined in recent years. “This strategy includes frequent reminders of present time, location and facts based in reality, including deaths, moves or other major life events,” Shvetzoff Hennessey explains. Reality orientation may be logical and appealing for those without Capgras but is often frustrating and upsetting for individuals who are experiencing delusions.

Validation Therapy

Shvetzoff Hennessey says that reality orientation has largely been replaced by validation therapy, which supports the patient’s delusions rather than correcting or contradicting these very real ideas, thoughts and feelings. Validation techniques have been found to reduce stress and anxiety in both dementia patients and their loved ones.

For some sufferers, neither reality orientation nor validation techniques are successful, leaving both the patient and their loved ones frustrated, lonely and anxious. For these situations, a mixture of several techniques may be needed in order for both parties to enjoy spending time together. “By working with the patient’s care team, including direct care providers, physicians, social work professionals, pharmacists and therapists, techniques and strategies can be developed to relieve the symptoms in the patient, as well as reduce the stress and frustration of loved ones,” advises Shvetzoff Hennessey. “This can include communication techniques, medications, and creative problem-solving methods.”

Interactions and Caregiving

Research shows that time and interactions with loved ones who have Alzheimer’s or other types of dementia is valuable for both the patients and their caregivers. However, this delusional condition can make it difficult, if not impossible, for the patient and the believed impostor to interact. Some patients may blatantly refuse to speak or cooperate with the “impostor.” Changing the format, timing and length of visits may help in some cases.

“If the patient does not live with those they do not recognize, these loved ones may have to visit during certain times of the day when the patient is more relaxed,” Shvetzoff Hennessey recommends. “Impostors” may need to visit along with other people that the patient recognizes, or even visit as a stranger, but these options may still allow for interaction.

Shvetzoff Hennessy emphasizes that safety and wellbeing are paramount. “If the patient’s delusions make caregiving, living together and safety challenging, housing changes may be needed to ensure the emotional and physical health of everyone involved.” In such cases, placement in a specialized memory care unit might be the best option.

Care for Yourself, Too

Alzheimer’s and dementia caregivers already experience serious emotional and physical strain, and this is only compounded by the development of Capgras syndrome. “It is important for family members and caregivers of sufferers to care for themselves in order to better care for their loved ones,” Shvetzoff Hennessey urges. This self-care can include increased time away from the patient, self-acceptance of limitations and reliance on other support systems including friends, family, and community and healthcare resources.

Interacting with Someone Who Is Suffering from Delusions

Shvetzoff Hennessey offers family caregivers the following tips for interacting with a person who is experiencing Capgras syndrome.

  • Validate their feelings and concerns. Rather than challenging their perspective, make it clear that you understand how they are feeling and that it is perfectly acceptable for them to feel this way. Try to identify with their reality rather than correct it.
  • Make a safe, emotional connection. Dementia alone can be extremely confusing and disorienting for a patient. Adding delusions that someone they trust has been replaced with an identical fraud can be very frightening for them. Remind the patient of how much you love them and how much the “impostor” loves them. If the patient has additional misconceptions that this fake is trying to harm them or steal from them, gently reassure them that they are safe and you will not allow anything of the sort to happen.
  • Rely on auditory interactions. Since this disorder makes it difficult or impossible for sufferers to visually connect with loved ones, sound is the next best way to communicate. Rather than visiting face-to-face, try conversing over the telephone or just outside of their line of sight. If a patient has difficulty interacting in person, it can help for the impostor to announce themselves while still out of sight. This helps to establish an emotional connection and begin a conversation that continues while they come into sight. This may assist the patient in positively identifying their loved one.

Carol Bradley Bursack

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Over the span of two decades, author, columnist, consultant and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Her experiences inspired her to pen, "Minding Our Elders: Caregivers Share Their Personal Stories," a portable support group book for caregivers.

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8 Comments

even if a demented elder cant make a hit on your facial features , they can recognize you by your body language , actions and your nature .
consistency is important if you want the elder to trust you .
ive been face blind most of my life . i recognize shapes , voice and posture .
This is a great article and was very helpful to. Me. Thank you 😊
Thank you for sharing this. My Dad had times when he would think I was one of my sisters or sometimes a stranger. He made my brother show him his drivers license when he came to care for him one day. I am not sure if it was Capgras but it was still so difficult and happened literally overnight. One day fine the next day he fell and broke his hip and never came back to himself after surgery.