Cotard delusion is when a person believes that they or their body parts are dead or dying. While rare, it can present in people with bipolar disorder.
Cotard delusion, also called Cotard’s delusion or Cotard syndrome, is a false belief that you don’t exist, are dead, or are rotting. It’s also known as walking corpse disorder.
Cotard delusion is a symptom of some mental health or medical conditions, such as bipolar disorder, particularly in women under 25. It’s not listed as a separate diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).
Cotard delusion doesn’t have a clear cause, but treatment is available. You can learn more about what Cotard delusion is and what treatment options exist in this article.
Cotard delusion is the feeling that you or some part of you, like a limb, organ, or even your soul or spirit, is dead or dying. It’s associated with depression and nihilism (the belief that nothing matters or has value).
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However, since Cotard delusion has been found in people without bipolar disorder, one is not a guarantee of the other. That is, someone can experience Cotard delusion without having bipolar disorder, and someone can live with bipolar disorder without ever experiencing Cotard delusion.
People with bipolar disorder experience extreme mood shifts, such as depressive episodes and manic or hypomanic episodes. Some people also experience bipolar disorder with psychosis.
Psychosis happens when your experiences or thoughts make it hard to tell what is real, such as having hallucinations or delusions (false beliefs).
Bipolar disorder with psychosis is more common than many people think. A 2000 study reported that over half of people with bipolar disorder would experience psychosis, with grandiose thinking being the most common type.
Aside from Cotard delusion, the types of delusions connected to bipolar disorder include:
- Paranoid delusions: believing that people want to sabotage or hurt you
- Delusions of grandeur: believing you can do anything, like fly to the moon
- Persecutory delusions: believing people are out to get you
Symptoms of a depressive episode include:
- extreme sadness
- low self-esteem
- losing interest in activities once enjoyed
- sleep changes (too much or too little)
- thoughts of self-harm or suicide
- extreme happiness or excitement
- thinking, talking, or moving faster than usual
- agitation or restlessness
- sleeping much less but not feeling tired
- impulsivity and engaging in activities with unwanted consequences, such as drug misuse, speeding, or excessive spending
It isn’t exactly clear what causes Cotard delusion. Sex or gender may play a role, as it appears more commonly diagnosed in women than men.
Cotard delusion may also have links with health anxiety.
Aside from bipolar disorder, mental health conditions associated with a greater risk of Cotard delusion include:
Being diagnosed with Cotard delusion occurs through a process of ruling out other conditions, like Capgras syndrome. There’s no formal set of criteria for diagnosis.
ECT involves applying electrical currents to the brain and is used in severe and treatment-resistant major depression and bipolar disorder cases.
There are no approved medications for treating Cotard delusion, but researchers suggest that treating underlying bipolar disorder and Cotard delusion with mood stabilizers may be helpful.
Depending on the underlying condition contributing to Cotard delusion, different medications may be used. For example, there have been reports of successful treatment with:
If you’re experiencing Cotard delusion, ask your psychiatrist or a mental health professional about antidepressants or antipsychotics that may work for you. This may help reduce the severity or recurrence of delusions.
It’s unusual to experience Cotard delusion, but it does happen.
If you recognize these symptoms in yourself or a loved one, especially if bipolar disorder runs in the family, consider reaching out for support from a healthcare professional or mental health professional as soon as possible.
Bear in mind there are treatment options, including ECT and medications, that may help you or a loved one find relief.
In the meantime, coping strategies to help manage bipolar disorder and associated symptoms may include things like: