“Dear Rachael, my wife doesn’t always recognize me and sometimes thinks I’m her secret boyfriend. She’s afraid to get in bed with me, thinking her ‘real husband’ is coming home. Sometimes she even says to me, ’You look like my husband, but you’re not him, you’re just an imposter.’”
This is an interesting situation and it actually deserves a special diagnosis: Capgras Syndrome.
Let’s be clear: Capgras is different than what I call, Timeline Confusion™. Timeline Confusion is when a person living with dementia is unable to place a loved one on their timeline. As an example, a mom living with dementia may think that her son is her late husband, based on the fact that her son is a grown man. She is looking for a younger version of her son, but here is a 65-year-old man. It makes sense, then, that she may assign a different identity to him that makes sense on her timeline.
There is some of this going on—where she’s unable to quite place him on her timeline—but then there is also some Capgras Syndrome. Capgras is when a person is convinced that their loved one is actually an imposter. The NIH describes it as such: Capgras syndrome is the most prevalent delusional misidentification syndrome and is characterized as a delusion of doubles. Patients falsely believe that an identical person has replaced a person close to him or her.
This is something that can happen with dementia, although it can also happen with other brain disorders and diseases. Overall, it’s fairly rare. In my own experience, this is only the second time I’ve been asked about Capgras during my career!
As always, we don’t want to argue with someone who isn’t sure who we are, or worse, thinks we’re impersonating ourselves. When Capgras is happening, it’s best to remove yourself from the situation IF the individual is upset and confused by your presence. If they’re not upset, it is okay to stick around, but do not argue about “who” you are. A reply like, “I’m sorry you’re feeling that way,” or, “I would never try to trick you,” will suffice.
