Misidentification of the Self in a Patient with a Psychotic Disorder and Post-Traumatic Stress Disorder

Article excerpt

Abstract: The central characteristic of the delusional misidentification syndromes is a delusion of personal misidentification of the self or of others. Other symptoms of psychopathology in addition to delusional misidentification may be important contributors to the misidentification of people. In this article we report the case of a man who suffered from the syndrome of subjective doubles, reverse subjective doubles associated with a psychotic disorder and post-traumatic stress disorder. The contribution of his psychiatric disorders in the genesis of delusional misidentification is explored. Capgras Syndrome was also present.

Introduction

The misidentification of persons can occur in both normal and psychopathological states (1-3). From a psychiatric perspective, the misidentification of persons is most dramatically highlighted by the delusional misidentification syndromes (DMSs). In these syndromes, a person's physical as well as psychological characteristics can be misidentified (2-7). Capgras Syndrome is the best known delusional misidentification syndrome and involves the delusional belief that another person's psychological identity has changed radically, without any change in physical appearance, resulting in a new personal identity (2-7). Often, the affected person explains his or her misidentification by positing physical replicas or "doubles" of the original identities (2,3). In a related condition, the syndrome of subjective doubles, the affected person believes that physical replicas of him or her exist, usually with different minds than that of the patient (8-11 ). A common delusional misidentification syndrome (DMS) of the self is the syndrome of reverse subjective doubles. In this DMS the affected person usually believes that his mind has changed radically without changes in bodily makeup, resulting in a new identity (4, 5, 12, 13). A related form of this syndrome occurs when the patient believes that he or she is an impostor (4, 14,).

Delusional misidentification can occur in several psychotic disorders, including schizophrenia, psychotic disorders due to a general medical condition and psychotic disorder not otherwise specified (3, 15,16). The misidentification of a person or place can also occur in post-traumatic stress disorder (PTSD). However, the misidentification of people and places in people with PTSD is most frequently due to dissociative psychopathology (17, 18). In this disorder the affected person may misidentify others as well as places during flashbacks and other dissociative states. For example, a combat veteran may attack another person during a flashback during which he believes he is fighting an enemy soldier (17,18). In this article we describe the case of a man with delusional misidentification who also suffered from PTSD. The relative contributions of psychopathologies related to PTSD and a psychotic disorder not otherwise specified, in the genesis of delusional misidentification in the current case are discussed.

Case History

Mr. C. is a 44-year-old male being treated in a psychiatric out-patient clinic with the chief complaint of frequent paranoid ideations. According to Mr. C., he felt that others, especially law enforcement professionals, were monitoring him. He repeatedly stated that he could trust no one, and found the repeated monitoring very frightening. He mentioned believing he had more than one physical double, stating, "The original me is still in prison. I go to see him every night and then he turns into me again. This is not the real me...the real Mr. C. is in jail."

He had been treated for psychotic symptoms since age 41. Approximately four years prior to treatment, he had been arrested for allegedly stealing electronic merchandise. While in jail, he was assaulted repeatedly, requiring extensive medical care. After these attacks, Mr. C. began to experience insomnia. He also began to experience nightmares in which he was repeatedly physically attacked by two jail inmates. …