Paranoia is more or less mainstream these days, and not without justification. Thankfully, though, a great many fears remain baseless. Paranoid delusions like “someone has stolen my face,” or “everyone knows what I’m doing” are for the most part demonstrably false. They exist at the margins of clinical psychology, affecting only a small handful of patients, usually in conjunction with some other mental illness or head injury.
But for those suffering them, each of the ten delusions below are in fact absolute realities—in some cases confirmed over decades—and there’s no way to persuade patients otherwise. Many are even aware of how irrational they sound but continue to believe in them anyway. After all, as the old maxim goes, “just because you’re paranoid doesn’t mean they’re not out to get you.”
Erotomania (or Clérambault’s Syndrome, phantom lover syndrome, psychotic erotic transference, or simply amor insanus) afflicts women far more than it does men. It involves the delusion that someone, usually of a higher social standing, like a celebrity, is somehow in love with the patient—despite never having met them in many cases. Often, this alleged affection is “communicated” to the patient by way of subtle signals or messages—on TV, for instance, or via telepathy, or encoded in certain states’ license plates.
One young woman believed she’d actually given birth to her secret admirer’s children, and that they were taken away by psychiatrists. She also believed the bond between her and her admirer (in this case a classmate she’d never really been close to) was so strong that the entire world was aware of it, including the president of the United States.
Generally, people with erotomania say they’re only attracted to their admirer because their admirer is so attracted to them. But they frequently get aggressive in their pursuit. One of the most famous cases is that of Robert Hoskins who, in 1995, stalked and threatened Madonna in the belief they were destined to marry. As is typical of erotomaniacs, his obsession persisted for many years despite numerous setbacks, including getting shot for trespassing and sentenced to ten years in jail.
9. Capgras Delusion
Nobody really knows what causes Capgras delusion exactly, but it’s often associated with methamphetamine abuse, schizophrenia, and neurodegenerative diseases like Alzheimer’s. According to a Japanese psychiatry journal, it may even have something to do with the existence of parallel worlds.
Those who suffer from the delusion are convinced that people around them—usually their nearest and dearest and sometimes even pets—have been replaced by lookalike imposters. And it’s not all that rare as you’d think. Affecting a great many patients with dementia, it’s much better described as “uncommon.”
Capgras can also be related to head trauma. Following an almost deadly traffic accident, one patient emerged from a five-week coma accusing his parents of being frauds. Curiously, he was otherwise compos mentis, making an articulate case that the woman who made his breakfast was too good a cook to be his mother and the man who drove him around was too good a driver to be his dad.
Some people with Capgras think everyone around them has been replaced. One 39-year-old patient not only accused his entire family of being imposters, for example, but he also believed that the government was being run by duplicates of the President, the First Lady, and the senators. Later, in a bid to carry out “God’s work,” he shot and killed his father, wounded his nephew, and also wounded a stranger he presumed to be an evil accomplice. Another Capgras patient used a toy gun to hold up a newsreader live on air, forcing them to relay his beliefs to the public.
8. Fregoli Delusion
Recently portrayed in the animated movie Anomalisa, the Fregoli delusion is in a way the polar opposite of Capgras. Instead of recognizing the face and not the person behind it, Fregoli sufferers recognize the person but not the face they’re “wearing.” In other words, they believe an apparent stranger (or group of strangers) is really someone they know in disguise.
Often, this conviction manifests as an unshakeable feeling of familiarity around people they’ve only just met. And while it may be episodic—sometimes lasting no more than a day—it tends to be extremely unpleasant to live through, fraught with wild paranoia and conspiratorial thinking.
“Betty,” for instance, became convinced that a former lover and his girlfriend were inhabiting her neighbors’ bodies and changing their appearance at will, all in a convoluted attempt, apparently, to keep her quiet about her own relationship with the man. Another patient, a schizophrenic, physically attacked his doctor, believing him to be the nurse who medicated him incorrectly on another night—supposedly in a scheme to hurt him.
Unlike the Capgras delusion (named for the psychiatrist who discovered it), the Fregoli delusion was named after an Italian actor, Leopold Fregoli, whose knack for rapidly changing his appearance was legendary. It is thought to be caused by brain injury—particularly to the right frontal and left temporoparietal regions—or levodopa (L-DOPA) treatment for Parkinson’s.
Intermetamorphosis as a delusion is comparable to Capgras and Fregoli, but with the crucial difference that strangers aren’t involved—either as the person misidentified or their alleged true identity. Instead, patients with this condition tend to mistake someone they know well for another person they know (or knew) well. Intermetamorphosis commonly presents itself alongside other mental disorders, and neurodegeneration in general.
One woman suffering from depression and paranoia, for example, believed her husband had transformed into their neighbor. He didn’t just take on this neighbor’s face and mannerisms, she said, he was also unable to repair a powercut despite being an electrician. The related delusion of reverse intermetamorphosis, meanwhile, afflicts people who believe that they themselves have transformed into another.
6. Syndrome of Subjective Doubles (SSD)
Many of us have probably entertained the notion that somewhere out there, going about their business, is an identical clone of ourselves. But while most of us might locate these hypothetical doppelgängers in an equally hypothetical parallel universe, many SSD sufferers think they’re living next door.
The discoverer of this condition, Greek psychiatrist George Nikos Christodoulou, related the case of a young woman who believed her neighbor was effectively stealing her identity—right down to the clothing, build, and even face. And when a doppelgänger is believed to have fully absorbed one’s personality, the result is depersonalization.
Patients have described the feeling of meeting their double as a sense of vague familiarity followed by mounting horror. Some are so traumatized by the experience of “being divided in two,” in fact, that they end up resorting to suicide, desperately hoping to reunite them as one.
Like many on this list, SSD tends to accompany other psychological disorders, including epilepsy, as well as other paranoid delusions. But doppelgängers have also been reported by otherwise healthy high altitude climbers, who very commonly encounter them on mountains.
5. Reduplicative Paramnesia
There are apparently doppelgängers for places too—at least according to reduplicative paramnesiacs. Such patients are typically convinced that their home, or another familiar place, has been cloned to another location.
So, for instance, they might believe the mental hospital they’re being treated at is somehow a duplicate of their house, or that their house is disguised as the hospital. One woman even complained, after being discharged, that “they” never returned all her furniture. Yet patients rarely feel more troubled than this. Indeed, the condition might sometimes serve as a comfort, as it likely does for wounded soldiers convinced their field hospital is in their hometown.
4. The Truman Show Delusion
While it’s hardly a delusion to think we’re being watched, few of us would say by TV. For some, however, the feeling of constant, televised surveillance is all too real—much like The Truman Show (or the more recent real-life version, Susunu! Denpa Shonen, in which a naked man was observed for a year).
Sufferers tend to believe they’re surrounded by hidden cameras and that a production crew is somehow controlling their fate, just like in the movie. Writer Kevin Hall actually believed he was on a show named after the movie, the “TrumanKev Show” as he called it. In one dramatic “episode,” he stole a truck and drove it around Tokyo, simply because the keys were on board—a sign, he presumed, the director had this in mind.
Another characteristic of the Truman Show delusion is the belief that everyone is involved—not just those making the programme and the millions at home watching, but also friends, family, and even strangers—all of them actors and extras following a script.
Oddly enough, one patient with the delusion actually worked on a reality TV show for real, gradually coming to believe that he was the one being broadcast. Like many sufferers, he was diagnosed with bipolar disorder and particularly manic episodes.
3. Cotard’s Syndrome
Some delusions have nothing whatsoever to do with other people and are characterized instead by horrific beliefs about one’s body. Sufferers of Cotard’s syndrome are a prime example, with some of the worst cases convinced that they’re dead—even to the point of being able to smell their own flesh rotting.
“Mademoiselle X.,” in 1880, was one of the first cases to come to French neurologist Jules Cotard’s attention and he called her condition le délire de négation (negation delirium). According to his notes, the 43-year-old woman claimed to be missing her vital organs and asked for her corpse to be burned. Strangely enough, though, despite giving up food, she wasn’t really all that concerned, because, in this state, she said, she was destined to “live forever.”
There’s often no way to rationally argue with these people either. In 2012, a Japanese doctor presented with such a patient pointed out the logical inconsistency that dead men cannot speak. In response, his patient simply agreed that his condition defied logic. And even after the delusion had passed, he remained adamant that it was true at the time, insisting he had somehow returned from the dead.
Cotard’s often arises from head injuries and serious accidents, which at least provide a basis for the belief. Sometimes, however, patients believe they’ve always been “dead,” as in the case of a Greek patient in 2003 who claimed he was born without a brain. Others combine the symptoms of Cotard’s with other psychological delusions, such as clinical lycanthropy. An Iranian man, for example, not only believed he was dead but also that he was a dog.
2. Ekbom’s Syndrome
Not to be confused with Wittmaack-Ekbom or restless legs syndrome (though it may come up as a symptom), Ekbom’s syndrome is the belief that one is infested with insects. Sufferers usually see these on or under the skin and can feel them biting as well. Needless to say, it can rapidly get out of hand.
One patient felt compelled to change her mattress over and over again, as well as her entire wardrobe, all to no avail. And as her delusion worsened, she came to believe that her insides were infested as well, finding bits of bugs even in her feces and spit. Many sufferers, having already scratched their flesh raw, take to peeling the scabs off to “let the bugs out.”
Although technically “rare” (affecting less than 1 in 1,500 people in the US), it is estimated that more than 100,000 Americans suffer from Ekbom’s syndrome. And cases can sometimes span decades, occasionally plaguing sufferers right up until the day that they die. Often, all it takes is the discovery of one or two real bugs around the house to validate and exacerbate the delusion.
Worse still, like any real infestation, Ekbom’s is typically contagious. Before long, others in the household will start complaining of similar symptoms.
1. Thought Insertion
Having thoughts that are not one’s own or hearing voices inside of one’s head are symptoms commonly associated with schizophrenia. But they’re also a growing concern among so-called targeted individuals (TIs); that is, people who strongly believe the government is watching them (more than the average person, anyway). Thoughts are “transmitted” to them, many say, via “microchip implants” and tend to be aggressive in nature—encouraging targets to kill their families, for example, or threatening the targets themselves.
But these thoughts can also be dull or nonsensical; what bothers sufferers the most is the continual, invasive interruption. Sometimes things get so bad that they’ll go to any lengths to get rid of the implants—similar to the desperate picking and scratching of Ekbom’s. One woman managed to find a surgeon willing to gouge out part of her finger, supposedly to remove illegally implanted nanotech. Even so, she continued to live a life on the run, shielding her brain from electromagnetic radiation by wearing a literal tin foil hat, or more often a lead balaclava.
Obviously this is a tricky delusion to deal with—and that’s assuming it’s a delusion in the first place (after all, we can’t listen in on thoughts; and if we could, we could feasibly plant them). Treatments are non-specific, limited to the underlying cause if it can be found. Otherwise, patients might come up with their own ways of coping. To reclaim ownership over their thoughts, for example, some schizophrenics take to verbalizing those that seem alien. Of course, given the frequency, not to mention the nature, of some of these thoughts, it’s hardly an ideal solution.