Abstract

The hallmark of the delusional misidentification syndromes is the presence of a misidentification delusion of the self or others. Delusional misidentification may present with an increased risk for dangerous behaviors. Individuals suffering from delusional misidentification syndromes may express hostility in ways ranging from serious verbal threats to homicidal acts. The causes of dangerous misidentification delusions remain for the most part undetermined. In this article, we report a series of six cases of individuals who harbored dangerous misidentification delusions. These individuals were studied phenomenologically and forensically. They were also studied biologically, including neuropsychological testing. A cognitive hypothesis aimed at explaining dangerousness and delusional misidentification is proposed. Implications of the hypothesis for further research are briefly outlined.

References

1.
Segal
,
J. H.
, “
Erotomania Revisited: From Kraepelin to DSM-III-R
,”
American Journal of Psychiatry
 0002-953X, Vol.
146
,
1989
, pp.
1261
-
1266
.
2.
Shore
,
D.
,
Filson
,
C. R.
,
Johnson
,
W. E.
,
Rae
,
D. S.
,
Mochrer
,
P.
,
Kelley
,
D. J.
,
Davis
,
T. S.
,
Waldman
,
I. N.
, and
Wyatt
,
R. J.
, “
Murder and Assault Arrests of White House Cases: Clinical and Demographic Correlates of Violence Subsequent to Civil Commitment
,”
American Journal of Psychiatry
 0002-953X, Vol.
146
,
1989
, pp.
645
-
651
.
3.
Jones
,
J.
,
Let Me Take You Down—Inside the Mind of Mark David Chapman, the Man Who Killed John Lennon
,
New York
,
Villard Books
,
1992
.
4.
Signer
,
S. F.
, “
Capgras' Syndrome: The Delusion of Substitution
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
48
,
1987
, pp.
147
-
150
.
5.
Silva
,
J. A.
,
Leong
,
G. B.
,
Shaner
,
A. L.
, and
Chang
,
C. Y.
, “
Syndrome of Intermetamorphosis: A New Perspective
,”
Comprehensive Psychiatry
 0010-440X, Vol.
30
,
1989
, pp.
209
-
213
.
6.
Silva
,
J. A.
,
Leong
,
G. B.
, and
Shaner
,
A. L.
, “
A Classification System for Misidentification Syndromes
,”
Psychopathology
 0254-4962, Vol.
23
,
1990
, pp.
27
-
32
.
7.
Joseph
,
A. B.
, “
Focal Central Nervous System Abnormalities in Patients with Misidentification Syndromes
,”
The Delusional Misidentification Syndromes
,
Christodoulou
,
G. N.
Ed.,
Basel, Switzerland
,
Karger
,
1986
, pp.
68
-
79
.
8.
Capgras
,
J.
and
Reboul-Lachaux
,
J.
, “
L'illusion des sosies dans un délire systématisé chronique
,”
Bulletin de la Société Clinique de Médecine Mentale
, Vol.
11
,
1923
, pp.
6
-
16
.
9.
Enoch
,
M. D.
, “
The Capgras Syndrome
,”
Acta Psychiatrica Scandinavica
 0001-690X, Vol.
39
,
1963
, pp.
437
-
462
.
10.
Berson
,
R. J.
, “
Capgras' Syndrome
,”
American Journal of Psychiatry
 0002-953X, Vol.
140
,
1983
, pp.
969
-
978
.
11.
Silva
,
J. A.
and
Leong
,
G. B.
, “
The Capgras Syndrome in Paranoid Schizophrenia
,”
Psychopathology
 0254-4962, Vol.
25
,
1992
, pp.
147
-
153
.
12.
DePauw
,
K. W.
and
Szulecka
,
T. K.
, “
Dangerous Delusions: Violence and the Misidentification Syndromes
,”
British Journal of Psychiatry
 0007-1250, Vol.
152
,
1988
, pp.
91
-
96
.
13.
Silva
,
J. A.
,
Leong
,
G. B.
,
Weinstock
,
R.
, and
Boyer
,
C. L.
, “
Capgras Syndrome and Dangerousness
,”
Bulletin of the American Academy of Psychiatry and the Law
, Vol.
17
,
1989
, pp.
5
-
14
.
14.
Driscoll
,
R.
,
Chithiramohan
,
R.
, and
Brockman
,
B.
, “
Capgras Syndrome, Mania, and Delusionally Motivated Assaults
,”
Journal of Forensic Psychiatry
, Vol.
2
,
1991
, pp.
51
-
57
.
15.
Silva
,
J. A.
,
Leong
,
G. B.
, and
Weinstock
,
R.
, “
The Dangerousness of Persons with Misidentification Syndromes
,”
Bulletin of the American Academy of Psychiatry and the Law
, Vol.
20
,
1992
, pp.
77
-
86
.
16.
Thompson
,
A. E.
and
Swan
,
M.
, “
Capgras Syndrome Presenting with Violence Following Heavy Drinking
,”
British Journal of Psychiatry
 0007-1250, Vol.
162
,
1993
, pp.
692
-
694
.
17.
Malloy
,
P.
,
Cimino
,
C.
, and
Westlake
,
R.
, “
Differential Diagnosis of Primary and Secondary Capgras Delusions
,”
Neuropsychiatry, Neuropsychology and Behavioral Neurology
, Vol.
5
,
1992
, pp.
83
-
96
.
18.
Bidault
,
E.
,
Luauté
,
J. P.
, and
Tsavaras
,
A.
, “
Prosopagnosia and the Delusional Misidentification Syndromes
,”
The Delusional Misidentification Syndromes
,
Christodoulou
,
G. N.
Ed.,
Basel, Switzerland
,
Karger
,
1986
, pp.
80
-
91
.
19.
Feinberg
,
T. E.
and
Shapiro
,
R. M.
, “
Misidentification-Reduplication and the Right Hemisphere
,”
Neuropsychiatry, Neuropsychology and Behavioral Neurology
, Vol.
2
,
1989
, pp.
39
-
48
.
20.
Cutting
,
J.
, “
Delusional Misidentification and the Role of the Right Hemisphere in the Appreciation of Identity
,”
British Journal of Psychiatry
 0007-1250, Vol.
159
(suppl.
14
),
1991
, pp.
70
-
75
.
21.
Fleminger
,
S.
and
Burns
,
A.
, “
The Delusional Misidentification Syndromes in Patients with and without Evidence of Organic Cerebral Disorder: A Structured Review of Case Reports
,”
Biological Psychiatry
 0006-3223, Vol.
33
,
1993
, pp.
22
-
32
.
22.
Joseph
,
A. B.
and
O'Leary
,
D. H.
, “
Anterior Cortical Atrophy in Fregoli Syndrome
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
48
,
1987
, pp.
409
-
411
.
23.
Joseph
,
A. B.
,
O'Leary
,
D. H.
, and
Wheeler
,
H. G.
, “
Bilateral Atrophy of the Frontal and Temporal Lobes in Schizophrenic Patients with Capgras Syndrome: A Case Control Study Using Computed Tomography
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
51
,
1990
, pp.
322
-
325
.
24.
Cutting
,
J.
,
The Right Cerebral Hemisphere and Psychiatric Disorders
,
Oxford, England
,
Oxford University Press
,
1990
, pp.
203
-
219
.
25.
Ellis
,
H.
and
Young
,
A. W.
, “
Accounting for Delusional Misidentifications
,”
British Journal of Psychiatry
 0007-1250, Vol.
157
,
1990
, pp.
234
-
248
.
26.
Fleminger
,
S.
, “
Seeing Is Believing: The Role of ‘Preconscious’ Perceptual Processing in Delusional Misidentification
,”
British Journal of Psychiatry
 0007-1250, Vol.
160
,
1992
, pp.
293
-
303
.
27.
Silva
,
J. A.
,
Leong
,
G. B.
,
Weinstock
,
R.
, and
Wine
,
D. B.
, “
Delusional Misidentification and Dangerousness: A Neurobiologic Hypothesis
,”
Journal of Forensic Sciences
 0022-1198, Vol.
38
,
1993
, pp.
904
-
913
.
28.
Courbon
,
P.
and
Fail
,
G.
, “
Syndrome d'illusion de Frégoli et Schizophrenie
,”
Bulletin de la Société Clinique de Médecine Mentale
, Vol.
15
,
1927
, pp.
121
-
124
.
29.
Courbon
,
P.
and
Tusques
,
J.
, “
Illusions d'intermétamorphose et de Charme
,”
Annales de Médico-Psychologiques
, Vol.
20
,
1932
, pp.
401
-
406
.
30.
Silva
,
J. A.
,
Leong
,
G. B.
, and
Shaner
,
A. L.
, “
Syndrome of Intermetamorphosis
,”
Psychopathology
 0254-4962, Vol.
24
,
1991
, pp.
158
-
165
.
31.
Christodoulou
,
G. N.
, “
Syndrome of Subjective Doubles
,”
American Journal of Psychiatry
 0002-953X, Vol.
135
,
1978
, pp.
249
-
251
.
32.
Silva
,
J. A.
and
Leong
,
G. B.
, “
Frégoli Syndrome of the Self
,”
Canadian Journal of Psychiatry
, Vol.
38
,
1993
, p. 68.
33.
Silva
,
J. A.
,
Leong
,
G. B.
, and
Weinstock
,
R.
, “
Misidentification Syndrome and Male Pseudocyesis
,”
Psychosomatics
 0033-3182, Vol.
32
,
1991
, pp.
230
-
232
.
34.
Silva
,
J. A.
,
Leong
,
G. B.
, and
Weinstock
,
R.
, “
Delusions of Transformation of the Self
,”
Psychopathology
 0254-4962, Vol.
26
,
1993
, pp.
181
-
188
.
35.
Benton
,
A. L.
,
des Hamsher
,
K.
,
Varney
,
N. R.
, and
Spreen
,
O.
,
Contributions to Neuropsychology Assessment—A Clinical Manual
,
New York
,
Oxford University Press
,
1983
.
36.
Warrington
,
E.
,
Recognition Memory Test Manual
,
Berkshire, England
,
Nfer-Nelson Publishing Company
,
1984
.
37.
Spreen
,
O.
and
Strauss
,
E.
,
A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary
,
New York
,
Oxford University Press
,
1991
.
38.
Heaton
,
R. K.
,
Wisconsin Card Sorting Manual
,
Odessa, Florida
,
Psychological Assessment Services
,
1983
.
39.
Weinberger
,
D. R.
,
Brown
,
K. F.
, and
Zec
,
R. F.
, “
Physiologic Dysfunction of Dorsolateral Prefrontal Cortex in Schizophrenia, I: Regional Cerebral Blood Flow Evidence
,”
Archives of General Psychiatry
 0003-990X, Vol.
43
,
1986
, pp.
114
-
125
.
40.
Berman
,
K. F.
,
Zec
,
R. F.
, and
Weinberger
,
D. R.
, “
Physiologic Dysfunction of Dorsolateral Prefrontal Cortex in Schiozphrenia, II: Role of Neuroleptic Treatment, Attention and Mental Effort
,”
Archives of General Psychiatry
 0003-990X, Vol.
46
,
1986
, pp.
126
-
135
.
41.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders
, Third Edition-Revised,
Washington, DC
,
American Psychiatric Association
,
1987
.
42.
Atwal
,
S.
and
Khan
,
M. H.
, “
Coexistence of Capgras and Its Related Syndromes in a Single Patient
,”
Australian and New Zealand Journal of Psychiatry
 0004-8674, Vol.
20
,
1986
, pp.
496
-
498
.
43.
Joseph
,
A. B.
, “
Cotard's Syndrome in a Patient with Co-Existent Capgras Syndrome, Syndrome of Subjective Doubles and Palinopsia
,”
Journal of Clinical Psychiatry
 0160-6689, Vol.
47
,
1986
, pp.
605
-
606
.
44.
Kimura
,
S.
, “
Review of 106 Cases with Syndrome of Capgras
,”
The Delusional Misidentification Syndromes
,
G. N.
Christodoulou
, Ed.,
Basel, Switzerland
,
Karger
,
1986
, pp.
121
-
130
.
45.
Silva
,
J. A.
and
Leong
,
G. B.
, “
Delusional Misidentification Syndromes and Prominent Figures
,”
American Journal of Forensic Psychiatry
, Vol.
14
,
1993
, pp.
39
-
41
.
46.
Young
,
A. W.
,
Ellis
,
H. D.
,
Szulecka
,
T. K.
, and
DePauw
,
K. W.
, “
Face Processing Impairments and Delusional Misidentification
,”
Behavioural Neurology
, Vol.
3
,
1990
, pp.
153
-
168
.
47.
Sergent
,
J.
,
Ohta
,
S.
, and
MacDonald
,
B.
, “
Functional Neuroanatomy of Face and Object Processing—A Positron Emission Tomography Study
,”
Brain
 0006-8950, Vol.
115
,
1992
, pp.
15
-
36
.
48.
Wright
,
S.
,
Young
,
A. W.
, and
Hellawell
,
D. J.
, “
Frégoli Delusion and Erotomania
,”
Journal of Neurology, Neurosurgery, and Psychiatry
, Vol.
56
,
1993
, pp.
322
-
324
.
49.
Young
,
A. W.
,
Reid
,
I.
,
Wright
,
S.
, and
Hellawell
,
D. J.
, “
Face-Processing Impairments and the Capgras Delusion
,”
British Journal of Psychiatry
 0007-1250, Vol.
162
,
1993
, pp.
695
-
698
.
50.
Ellis
,
H.
,
DePauw
,
K. W.
,
Christodoulou
,
G. N.
,
Papageorgiou
,
L.
,
Milne
,
A. B.
, and
Joseph
,
A. B.
, “
Responses to Facial and Non-Facial Stimuli Presented Tachistoscopically in Either or Both Visual Fields by Patients with the Capgras Delusion and Paranoid Schizophrenics
,”
Journal of Neurology, Neurosurgery, and Psychiatry
, Vol.
56
,
1993
, pp.
215
-
219
.
51.
Breier
,
A.
,
Buchanan
,
R. W.
,
Elkashef
,
A.
,
Munson
,
R. C.
,
Kirkpatrick
,
B.
, and
Gellad
,
F.
, “
Brain Morphology and Schizohrenia: A Magnetic Resonance Imaging Study of Limbic, Prefrontal Cortex, and Caudate Structures
,”
Archives of General Psychiatry
 0003-990X, Vol.
49
,
1992
, pp.
921
-
926
.
52.
Capgras
,
J.
,
Lucchini
,
P.
, and
Schiff
,
P.
, “
Du Sentiment d'Etrangeté á l'Illusion des Sosies
,”
Bulletin de la Sociée Clinique de Médecine Mentale
, Vol.
12
,
1924
, pp.
210
-
217
.
53.
G. N.
Christodoulou
, “
Role of Depersonalization-Derealization Phenomena in the Delusional Misidentification Syndromes
,”
The Delusional Misidentification Syndromes
,
G. N.
Christodoulou
, Ed.,
Basel, Switzerland
,
Karger
,
1986
, pp.
99
-
104
.
54.
Morrison
,
R. L.
and
Tarter
,
R. E.
, “
Neuropsychological Findings Relating to Capgras Syndrome
,”
Biological Psychiatry
 0006-3223, Vol.
19
,
1984
, pp.
1119
-
1128
.
55.
Hildreth
,
E. C.
and
Ullman
,
S.
, “
The Computational Study of Vision
,”
Foundations of Cognitive Science
,
M. I.
Posner
, Ed.
Cambridge, Massachusetts
,
Massachusetts Institute of Technology Press
,
1990
, pp.
581
-
630
.
56.
Yuille
,
A. L.
and
Ullman
,
S.
, “
Computational Theories of Low-Level Vision
,”
Visual Cognition and Action—An Invitation to Cognitive Science, Volume 2
,
D. N.
Osherson
,
S. M.
Kosslyn
, and
J. M.
Hollerbach
, Eds.,
Cambridge, Massachusetts
,
Massachusetts Institute of Technology Press
,
1990
, pp.
5
-
30
.
57.
Livingstone
,
M.
and
Hubel
,
D.
, “
Segregation of Form, Color, Movement and Depth: Anatomy, Physiology and Perception
,”
Science
 1095-9203, Vol.
240
,
1988
, pp.
740
-
749
.
58.
Biederman
,
I.
, “
High-Level Vision
,”
Visual Cognition and Action—An Invitation to Cognitive Science
, Volume
2
,
Osherson
,
D. N.
,
Kosslyn
,
S. M.
, and
Hollerbach
,
J. M.
, Eds.
Cambridge, Massachusetts
,
Massachusetts Institute of Technology Press
,
1990
, pp.
41
-
72
.
59.
Leyton
,
M.
,
Symmetry, Causality, Mind
,
Cambridge, Massachusetts
,
Massachusetts Institute of Technology Press
,
1992
.
60.
Benson
,
D. F.
and
Stuss
,
D. T.
, “
Frontal Lobe Influences on Delusions: A Clinical Perspective
,”
Schizophrenia Bulletin
 0586-7614, Vol.
16
,
1990
, pp.
403
-
411
.
61.
Costello
,
C. G.
, “
Research on Symptoms Versus Research on Syndromes—Arguments in Favour of Allocating More Research Time to the Study of Symptoms
,”
British Journal of Psychiatry
 0007-1250, Vol.
160
,
1992
, pp.
304
-
308
.
62.
Maas
,
J.
and
Katz
,
M. M.
, “
Neurobiology and Psychopathological States: Are We Looking in the Right Place?
”,
Biological Psychiatry
 0006-3223, Vol.
31
,
1992
, pp.
757
-
758
.
63.
Dolan
,
R. J.
,
Bench
,
C. J.
,
Liddle
,
P. F.
,
Friston
,
K. J.
,
Frith
,
C. D.
,
Brasby
,
P. M.
, and
Frackowiek
,
R. S. J.
, “
Dorsolateral Prefrontal Cortex Dysfunction in the Major Psychoses: Symptom or Disease Specificity?
Journal of Neurology, Neurosurgery and Psychiatry
 0022-3050, Vol.
56
,
1993
, pp.
1290
-
1294
.
64.
Frith
,
C. D.
and
Done
,
D. J.
, “
Towards a Neuropsychology of Schizophrenia
,”
British Journal of Psychiatry
 0007-1250, Vol.
153
,
1988
, pp.
437
-
443
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