Nihilistic delusions, where a person believes they do not exist or are dead, can be seen in patients with certain mental health conditions and brain injuries. These beliefs persist even when presented with contradictory information, and can be difficult to treat.
Nihilistic delusions are persistent beliefs that a person does not exist or is dead. Like other delusions, these beliefs persist even when patients are presented with information that contradicts them, such as a third party acknowledgment that the patient is alive and appears to exist. This psychological phenomenon was first described in the 19th century by Jules Cotard, a French researcher, and is sometimes known as Cotard’s delusion in reference to this. It can be seen in patients with certain mental health conditions and in people with brain injuries.
Patients with nihilistic delusions can express them in many different ways. Some patients simply believe they don’t exist, and in some cases, they never did. They do not recognize information that invalidates this claim and may think it is invisible or unnoticeable to the people around them. Others think they are dead, and some experience vivid hallucinations to accompany the illusion, believing themselves to be rotting corpses, for example, or thinking they are missing limbs.
If a care provider interviews the patient, they may often not reveal any personal information. Patients who think they don’t exist believe they have no names, ages, or parents, for example. They may not remember anything from their past. Those who believe they are dead can tell health care workers how they died and might offer insight into their lives.
Cotard believed that nihilistic delusions were the result of “negativism”. The actual psychology behind them might be a little more complex. Patients with conditions such as schizophrenia, bipolar disorder and borderline personality disorder can develop a feeling of disconnection from the world around them. This can manifest itself in the form of delusions which seem quite logical to the patient, even though they appear bizarre to bystanders. Thus, a patient may develop nihilistic delusions after being ignored or silenced in an attempt to explain those experiences.
In the case of brain injuries, delusions can be the result of damage to parts of the brain involved in self-perception. Such patients can be difficult to treat, as they may not respond to therapy and medications in the same way as those with mental illnesses, because problems with the brain are very different. After an injury, the brain can gradually remap connections and build new associations, but this may take time. During this process, the patient may need supportive care to carry out tasks of daily living and slowly erode these delusions.
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