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Cotard Delusion: The World's Most Terrifying Mental Illness

Astrid graduated with a Bsc Hons in Criminology and Psychological Studies in 2017 and currently works as a professional ghostwriter.

Cotard Delusion is one of the least understood mental illnesses due to its rare occurrence.

Cotard Delusion is one of the least understood mental illnesses due to its rare occurrence.

What Is Cotard Delusion?

Also known as Walking Corpse Syndrome or the Nihilistic Delusion, it is one of the rarest mental illnesses to be studied. In a nutshell, the Cotard Delusion makes the sufferer believe they are dead or do not exist in either a literal or a figurative way. In some versions of the disease, a person might go so far as to believe their organs are rotting or missing, that their flesh is putrefying, or that they have lost all their blood.

Named after French neurologist Jules Cotard in 1880, it was first called Negation Delirium due to the notion the patient feels an ever-growing sensation of their body being negated. Cotard's first patient with the syndrome was named the mysterious Mademoiselle X. Tragically, she believed she was damned for all eternity and that most of her body parts didn't exist. This led her to believe she had no need to eat and, therefore, she died of starvation.


What Causes It?

As can be expected, the Cotard Delusion presents itself among individuals who also suffer from psychosis and schizophrenia. However, it has also been known to occur in individuals who have been prescribed medication such as Acyclovir, an anti-viral drug used for the treatment of herpes. Furthermore, research has shown it to be more prevalent among those who suffer from some kind of renal impairment, although there is no current explanation as to why.

Currently, Cotard Delusion is believed to exist on a spectrum where less severe symptoms present themselves as despair and self-hatred while the more serious ones can involve chronic depression and intense delusions of being dead.


At first, the syndrome appears as a vague and general sense of uneasiness and anxiety that grows more intense over the span of weeks, or even years in extreme cases. This then escalates so the sufferer begins to experience nihilistic delusions and becomes fixated on thoughts about losing their body parts or having no life. This is often accompanied by suicidal tendencies, self-harm, analgesia where they are unable to feel pain, and mutism. Furthermore, these symptoms are associated with intense feelings of guilt, despair, and an intense preoccupation with death.

Once the syndrome has taken root within the individual, they are likely to withdraw themselves from society. They will also neglect their hygiene and basic bodily needs as they begin to detach and start to disbelieve the existence of their physical body. What this leads to is a severe inability to process reality.

In 1921, Tissot identified two components of the disorder; the affective, which includes anxiety, and the cognitive, which includes delusion.


Stages of Cotard Delusion

Later on, in 1999, Yamada et al. would develop this further by identifying three stages of the syndrome:

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  1. Germination – which manifests as psychotic depression and hypochondria.
  2. Blooming – where the syndrome begins to develop leading to delusions of bodily negation.
  3. Chronic – in which the delusions become severe, depression becomes chronic, and the patient develops a distorted view of reality.

Interestingly, the illness shares neurological similarities with another delusional disorder, Capgras Syndrome. This involves an individual believing someone close to them has been taken away and replaced by an identical-looking impostor. What is significant about the similarity between the syndromes is that brain scans show they both are related to certain areas of the brain. And it appears they occur because of disconnections between the regions that process faces and emotions. This leads to a hyper-state of derealization. Furthermore, people with Cotard Delusion are shown to have lesions within their parietal lobes and are more likely to suffer from brain atrophy.

As the syndrome is relatively unknown in comparison to other mental illnesses, there has been little research conducted into what treatments are most effective. However, it is assumed that anti-depressant and anti-psychotic medication can be beneficial.


What It's Like to Live With Cotard Delusion (Case Studies)

So we know what the science behind the syndrome looks like, but what is life like for the typical sufferer? Below, we'll take a look at five case reports where people believed they were dead.

  1. In 1996, an example given by Leafhead and Young told the story of a young Scottish man who suffered a head injury after a motorcycle crash. Afterward, his mother took him to live in South Africa and once he was there, he began to suffer terrifying delusions where he was certain he had died from AIDS or septicaemia and that he was living in Hell surrounded by dead people. Although the change in climate between the two countries explained his thinking that the heat of South Africa could be likened to Hell, his other symptoms could not be so easily reasoned.
  2. It was reported by a New York psychiatrist in 2008 that a 53-year-old woman named Ms. Lee complained to her family that she was dead and that her flesh was rotting. She begged them to take her to the nearest morgue so she could be around other dead people. As you'd expect, they called her an ambulance instead and she was soon admitted onto a psychiatric ward. Once there, she began aggressively accusing the nursing staff of setting her house on fire. Thankfully, after a steady regimen of medication, she began to recover and was later discharged.
  3. In 2009, an 88-year-old Belgian man arrived at a hospital confused as to why no one had buried him. He was certain he was dead and couldn't understand why he wasn't being treated as a corpse. Once again, after receiving medication, he began to recover from his delusions.
  4. In Greece, a 72-year-old woman took herself to the nearest emergency room because she was absolutely positive all her organs had melted and that all that remained of her was her skin. She claimed to be 'practically dead' and nothing could shift this delusion. Sadly, there is no information as to what happened to the elderly woman after her admission to hospital.
  5. In 2005, Iranian doctors were presented with probably the most severe and shocking case of Cotard Delusion. A 32-year-old father appeared at a hospital insistent he was not only dead but that he had been turned into a dog. He also believed this to be the case with his wife. Furthermore, he believed his three children were also dead but had been turned into sheep. His delusion went even further when he suggested his family was trying to poison him. However, all attempts to hurt him were fruitless as he claimed to be protected by God. What is so significant about this young man's case is that not only was he diagnosed with Cotard Delusion, but also with Lycanthropy. Both of these were treated with Electro-Convulsive Therapy after which it was noted by doctors that his symptoms began to subside.

What do you think of the syndrome? Can you think of a scarier mental illness?


Tissot F. (1921). De lire des negations termine par guerison. Cosiderations sur l’hypochondrie et la melancholie. Ann Med Psychol, 79, 321-328.

Yamada, K., Katsuragi, S. & Fujii, I. (1999). A case study of Cotard’s syndrome: stages and diagnosis. Acta Psychiatrica Scandinavica, 100, 396-399.

Young, A.W. & Leafhead, K.M. (1996) Betwixt life and death: Case studies of the Cotard Delusion. In P.W. Halligan & J.C. Marshall. (Eds.), Method in Madness: Case studies in Cognitive Neuropsychiatry). Hove: Psychology Press.

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

Questions & Answers

Question: What causes Cotard Delusion? Does it have a use as a biological weapon?

Answer: From my understanding, the disease is a rare escalation of severe depression and anxiety. But, it can also be the result of certain medications such as Acyclovir, an anti-viral drug. Thankfully, I don't think it has ever been used as a biological weapon, or could be, or even has a purpose as one.

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