In general, nihilists are depressed people

Cotard Syndrome (Nihilistic madness, Nihilistic depression, CS)

Cotard syndrome is a disease in which those affected deny their own existence or the presence of certain parts of the body.

Currently, the syndrome is not defined as a disorder in its own right, but as an accompanying disorder of other mental illnesses. It is a psychopathological syndrome due to a serious brain disease or physical illness. Those affected experience considerable psychological strain in their delusions.

The syndrome was first described in 1882 by the Parisian psychiatrist Jules Cotard as "nihilistic delusion" (délire de négation).


The range of delusions is wide: those affected are convinced that they have lost their powers, their intellect, their feelings or even organs such as the stomach, intestines or brain. In the foreground of the disease, however, is "not being". If the Cotard syndrome is pronounced, the patients deny their own existence, and often also deny the existence of the entire world. They strongly believe that they are dead and already rotten. When asked, they often state that they just appear to exist.

Causes of the disease

Overall, Cotard syndrome occurs very rarely. Experts estimate that around 0.6% of all older psychiatric patients have these characteristics. The occurrence is mostly related to severe depression, bipolar disorder, brain tumors or personality disorders.

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As with many other psychiatric illnesses, the causes have not yet been fully clarified. In some studies, a noticeably reduced metabolism in the brain was found in those affected. If the disease occurs as part of schizophrenia, it is usually short-lived. As a concomitant disease of depression, the symptoms are usually very resistant and become chronic as the disease progresses.

Depending on the underlying disease, patients with self-loss experience in many cases also suffer from other complaints:

  • depressive mood
  • anxiety
  • Despair
  • Excitement
  • pathological restlessness
  • Hallucinations
  • paranoid ideas
  • decreased feeling of pain
  • Narrowing of the mental faculties to the contents of the delusional idea

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The treatment of Cotard syndrome depends on the underlying disease. The risk of suicide is high, in spite of your own belief that you have already died. If the disease occurs in the context of schizophrenia, the usual antipsychotic medication can significantly alleviate the symptoms. Both antidepressants and neuroleptics have proven helpful. There have also been positive experiences with electroconvulsive therapies.

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Astrid Leitner
Medical review:
O. Univ. Prof. Dr.h.c. mult. Dr med Siegfried Kasper
Editorial editing:
Nicole Kolisch

Status of medical information:

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ICD-10: F22