The 12 rarest and most unknown delusions and syndromes

Hello friends!

Since its inception, psychiatry has had a strong tendency to create classification lists of mental disorders. Some of these classifications are rare, in the sense that they are little used by professionals and/or because they are rarely diagnosed. Many of them are even unknown to psychiatrists and health professionals such as clinical psychologists, psychoanalysts (who use another classification method) and psychotherapists.

The list below has been reproduced on several websites. I found two versions in Spanish and then the version that I believe to be the original, written by psychologist Dr Jeremy Dean. However, the text below is not a literal translation of Dean’s text. I used it as a base and wrote it in my own words.

First, it is helpful to describe what a delusion is. Delirium comes from the Latin delirium, which literally means “going off the rails”. In general, the best way to explain a delusion is to compare it with reality. However, this definition of opposition to what is real is not always effective, since a delusion can be shared with another person, as in folie à deux (“madness for two”).

However, simplifying, we can say that a person in delirium has thoughts and feelings that do not match reality, for example, they say they are historical characters like Napoleon or they say they are being persecuted, observed, watched. In some delusions, bizarre figures appear, such as monsters, aliens, animals, etc.

The definition of delirium as what separates the person from reality is also used with a special criterion: the person in delirium cannot differentiate between reality and delusion, that is, it is not a fantasy, an artistic creation, an escape of ideas. the person really believe that the delusion is real.

1. Othello Syndrome

The Othello Syndrome comes, of course, from Shakespeare’s famous character. In the play Othello, the Moor of Venice, the main character has the obsessive thought that his wife is cheating on him.

Thus, in Othello Syndrome, the person thinks that his or her partner is having an affair, despite all evidence to the contrary.

According to experts, this is not a simple case of jealousy, although jealousy is the main feeling of the Syndrome. As jealousy becomes an obsessive thought that does not cease, the person with it starts to carry out all kinds of behavior to find the supposed proof of betrayal: check the cell phone, invade emails, chase in the street and, in extreme cases, reach physical violence .

To read later (in English):

2. Cotard’s Delusion (The Living Dead Syndrome)

The name of delirium comes from the neurologist Jules Cotard (1840–1989) who described the symptoms of this extremely rare mental illness, in which the person thinks he is dead, does not exist or does not have the internal organs of his body. Cotard also named it as delusion of denial, land delire des negations.

In principle, this type of hallucination would be present in diagnosed cases of schizophrenia and, for specialists, it should be considered as a hallucination of this disorder and not as a separate disorder.

References (in English):

3. Capgras delusions

Joseph Capgras was the French physician who described this type of delusion and, as in the case of Cotard, his name became synonymous with the type of delusion he analyzed. In the Capgras delusion, the sufferer has the delusion that a close person has been replaced by an imposter who, although physically identical, is not the same person.

For example, a man thinks that his wife has been replaced by another identical person. But despite being identical, she is not the same person. She is an imposter pretending to be his spouse.

In general, Capgras delusion is caused by schizophrenia, dementia, or brain damage.

Some studies (in English):

4. Folie à deux

The term Folie à deux, in French, means madness for two. As it is used in the original language, we will not translate it here. Technically, experts use the terminology Shared Psychotic Disorder. In summary, we can understand this disorder as when two or more people share delusions and hallucinations. In DSM-IV, the diagnostic criteria are:

Diagnostic Criteria for F24 – 297.3 Shared Psychotic Disorder

A. A delusion develops in an individual in the context of a close relationship with another person(s) with an already established delusion.
B. The delusion is similar in content to the person with the already established delusion.
C. The disturbance is not better accounted for by another Psychotic Disorder (eg, Schizophrenia) or a Mood Disorder With Psychotic Features, nor is it due to the direct physiological effects of a substance (eg, a drug of abuse, a medication ) or a general medical condition.

5. Insertion of thought

This type of delirium happens when the person considers that someone has put, inserted, stuck, added thoughts in his head. In other words, thoughts are not considered own. In general, in cases of psychosis, it is relatively common for the internal thought to be considered external or coming from another person, close or distant, known or unknown.

Investigations:

6. Paris Syndrome

Paris Syndrome appears in people who are visiting the capital of France, Paris, and begin to describe symptoms such as hallucinations, delusions of persecution, anxiety and other physical or psychosomatic symptoms. Although it may be laughable, it is a Syndrome frequently diagnosed in the City of Lights.

According to Dr. Dean, about twenty Japanese tourists are diagnosed and hospitalized each year. The reason for eliciting the Syndrome would be the high expectations projected in the city. Treatment is often simple: return to your hometown.

7. Jerusalem Syndrome

As with the Paris Syndrome, the city of Jerusalem is also a place that can awaken certain symptoms in its predisposed visitors, causing symptoms described in the literature as anxiety, obsessive behavior, delusions of being a preacher (the person starts giving sermons in public – which he did not do before visiting the city).

Other symptoms are: starting to wear a toga, singing hymns and singing Bible verses at the top of your lungs.

The epidemiology is estimated at 40 cases per year, which require hospitalization and treatment, which also means returning home.

The British Journal of Psychiatry published research on Jerusalem Syndrome

8. Alice in Wonderland Syndrome

I think everyone knows the book Alice in Wonderland. If you, by chance, have never read it or never heard of it, I highly recommend that you read it. It is a fantastic and even very funny book, in addition to having several levels of reading. The so-called Alice in Wonderland Syndrome describes the case in which there is confusion in the perception of time and space. For example, the size of objects is seen as smaller or larger than it actually is and the passage of time is often confused, hours become minutes and minutes become hours.

The Doctor. Dean warns that in childhood and adults, some similar sensations may occur before going to sleep, which, in turn, would not be a cause for concern. This symptomatology can also be caused by migraine. The author of the books Alice in Wonderland and Alice Through the Looking Glass, Lewis Carrol suffered from migraines and this may have influenced his stories.

Some references (in English):

9. Ekbom Syndrome

Ekbom Syndrome, (not to be confused with Restless Legs Syndrome), is characterized by the belief that the body has been infected by parasites, germs or other harmful biological agents. It was described in 1930 by Karl Axel Ekbom, hence the name.

In cases of Ekbom Syndrome, it is common for the bearer to initially seek specialized doctors such as dermatologists or infectologists so that they can provide the appropriate treatment for their supposed infection.

To read:

10. Clinical Lycanthropy

Despite the complicated name, it is simple to understand what it is about. Lýkos comes from Greek and means wolf. Therefore, lycanthropy is the belief of the person who thinks he has become or is in the process of becoming a wolf.

In clinical cases in which lycanthropy was recognized, specialists reported that patients also described other possibilities of transformation: into frogs, cats, horses, birds, hyenas and even bees.

Needless to say, this type of diagnosis is rarely given.

Lycanthropy Studies:

11. Reduplicative Paramnesia

This type of delirium happens more often in cases of brain damage. The person comes to believe that a place has been duplicated or moved to another location. For example, patients recovering from severe brain trauma such as soldiers report thinking the hospital is located in their hometown, when in many cases it is actually located in another country.

It bears a certain resemblance to the delusions of Cotard and Capgras.

12. The Subjective Double Syndrome

In German folklore, we find a very interesting figure called Doppelgänger, from the junction of doppel (that means double🇧🇷 replica or duplicate) and ganger 🇧🇷walking🇧🇷street vendor or the one who wanders🇧🇷 The Doppelgänger has an unusual action: it has the ability to reproduce, to imitate, to act identically to a person, that is, the Doppelgänger is an exact, perfect double.

In the Subjective Double Syndrome, a similar idea appears, that the person has an identical double, but with a slightly different personality or even a different whole life, many times the double can be totally unknown and live in a strange country and many times can be linked to a close person.

Conclusion

As I said at the beginning, these 12 types of delusions (sometimes the word syndrome is used interchangeably) are rare because they are rarely diagnosed and their rarity can also be seen from the little use or knowledge of those who work in the area.

In general, the best specialists are those who use the famous criterion of Occam’s Razor, known to everyone who has studied epistemology: we should not give unnecessary explanations for the observed phenomena. In short, it’s the law of parsimony: 🇧🇷entia non sunt multiplicanda praeter necessitatem” (entities should not be multiplied beyond necessity).

Bearing this law in mind, we can easily include many of these delusions in schizophrenia or in cases of psychosis or obsessive disorder, for example. Therefore, it would not be necessary to have a diagnostic criterion for most of these delusions considered by many to be separate diagnoses.

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