ICD-9-CM 297.1The Cotard delusion (also Cotard’s syndrome and walking corpse syndrome) is a rare mental illness in which an afflicted person holds the delusion that they are dead, either figuratively or literally; yet said delusion of negation is not a symptom essential to the syndrome.
In 1880, the neurologist Jules Cotard described the condition as Le délire des négations (“The Delirium of Negation”), a psychiatric syndrome of varied severity. A mild case is characterized by despair and self-loathing, and a severe case is characterized by intense delusions of negation and chronic psychiatric depression.
The case of Mademoiselle X describes a woman who denied the existence of parts of her body and of her need to eat, and said that she was condemned to eternal damnation and therefore could not die a natural death. In the course of suffering “The Delirium of Negation”, Mademoiselle X died of starvation.
As a mental illness, Cotard’s syndrome also includes the patient’s delusion that they do not exist as a person, are putrefying, and have lost blood, internal organs, or both.
The delusion of negation is the central symptom in Cotard’s syndrome. The patient afflicted with this mental illness usually denies their existence, or the existence of a certain body part, or the existence of a portion of their body. Cotard’s syndrome exists in three stages: (i) Germination stage—the symptoms of psychotic depression and of hypochondria appear; (ii) Blooming stage—the full development of the syndrome and the delusions of negation; and (iii) Chronic stage—continued, severe delusions and chronic psychiatric depression.
The Cotard syndrome withdraws the afflicted person from other people, which includes neglecting their personal hygiene and physical health. The delusion of negation of self prevents the patient from making sense of external reality, producing a distorted view of the external world. Such a delusion of negation is usually found in the psychotic patient who also presents with schizophrenia. Although a diagnosis of Cotard’s syndrome does not require the patient’s having had hallucinations, the strong delusions of negation are comparable to those found in schizophrenia patients.