So for my 100 followers post, I decided to do my first guide.
Keep in mind, please - I don’t know everything about the disorder, and this is just based on the research I’ve done on cotard delusions. If there are any huge errors, let me know and I’ll fix that in this post.
What is Cotard Delusions?
Cotard Delusions is a severe mental disorder in which the sufferer believes that they have died, do not exist, are putrefying, or have lost their blood or internal organs. It’s a rare disorder, often caused by a combination of trauma and lesions in the parietal lobe.
What causes it?
Theory says it’s a delusional misidentification issue. It’s thought to be similar to Capgras Delusions (the belief that people around you have been replaced by impostors). It’s also got roots in adverse drug reactions and encephalopathy. It primarily shows up with other psychoses such as schizophrenia.
There are three stages of Cotard Delusion. The first stage - the most mild - is categorized by psychotic depression and hypochondria. This is also called the germination stage. The second stage - blooming - presents the full development of the disorder and delusions of negation. The third - chronic - brings with it severe depression and severe delusions. Withdrawal from society, lack of personal hygiene, and intense delusions also go hand in hand with this disorder. Though hallucination is not necessarily going to happen, the delusion is so strong that it may be comparable to hallucinations.
The Cotard Reality
Patients with Cotard Delusion truly and firmly believe that they have died. They may speak often of death, and in some cases also believe that those around them, including the plants and animals, are dead. There are cases documented in which the Cotard patient believes that he has been brought to hell, or purgatory, and he cannot pass on until he has done certain things to appease the creatures keeping him there. This reality is so distorted that they may go as far as seeing the people around them as decaying, or themselves. Patients with Cotard may not eat or drink by choice, causing them to require tube feeding, because they do not believe they have a need to eat or drink anymore.
Effective treatments for Cotard Delusion have been found. Medications - namely antipsychotics, antidepressants, and mood stabilizers - used in conjunction with electroconvulsive therapy have proved effective, as well as medications along with psychotherapy (though psychotherapy is shown to take more time and sometimes not work as well).
How to Play
A character with Cotard Delusion should have a core set of things to him in order to work properly: reason for the disorder to present itself; specific form of delusion; reality in which he lives; and treatments that are effective/ineffective. Keeping these things in mind, you’ll be able to play your character without any issues.
First things first: Reasons for the disorder to present itself. If you have a character with Cotard Delusion, you should already have the trauma that induced it planned out, or he should have a dual diagnosis of schizophrenia or Capgras Delusion. In the instance of a trauma - make it realistic. A soldier who was wounded in battle or a teenager who survived a house fire that killed their parents is realistic; a person witnessing a robbery? Not so much. And you can play around with this as much as you want to. My Cotard character was a soldier whose entire platoon was killed in a base attack. You can use the form of trauma that induces the disorder later on.
Next up: specific form of delusion. Here’s where you have to really, really think. Do you want your character to believe he’s dead? Or would you rather play with him believing he’s alive and decaying, or completely missing a body part? If your character believes he’s dead - is he a rotting corpse? This gives you room to do a lot of things. If your character believes he’s rotting or decaying, you can play around with the stage of decay that he’s currently in, whether it’s physically painful for him or not, whether he can slow or quicken the decaying process in some way, whether the decaying flesh has a scent to it… There’s an array of possibilities. If he’s missing a body part, does he still feel pain in the limb? Or is it just a total mental loss of limb, even past pain?
Further, in this area, is whether or not people around him are also dead or decaying. If the people around him are in the same world as he is, if they are just as dead and just as decaying, then you may have a dual diagnosis going on. Keep that in mind - you need not have Capgras diagnosed, necessarily, and certainly not immediately, but if the other people are in the same state as he is, there is a distinct possibility that the dual diagnosis ought to be present.
Following determining the specifics of his form of delusion is determining his reality. Now, the patient with Cotard Delusion has a severely altered reality in which he believes he lives. This is where you get to determine just how far into his delusion he may be. In some instances - as is the case with the decaying or missing limb patients - their entire delusion is around themselves. They alone are the ones who are decaying, they alone are the ones without a limb. They may have a severe suspicion of the people around them, as they may be told that they are perfectly healthy, but the vast majority of their delusion is going to be surrounding their own person.
With the dead patient, though, you have a wide array of possibility. You can have the patient believe he is merely stuck on Earth - doomed to wander it for all eternity. This adds on a delusion of immortality as well, as is commonly joined with the disorder. You can also, however, play with the idea of your character believing that they are in an entirely different world. Cotard Delusion may have a degree of hallucination to it, as earlier stated. This means you have an endless array of options at your disposal when it comes to his reality. Does he believe he’s in purgatory? Or is he in hell? Is he stuck back where he died? Play with the sensations he has around him. If he’s in purgatory, can he feel anything at all? Are there even other people there? Or is he totally alone? If he’s in hell, describe the heat, or the freezing, that he feels around him. Talk about the devils that are forcing him to stay there. If he’s back where he died, then have even more fun here. Make it as real as possible. Speaking with my Cotard patient again, he was a soldier in war. His current reality is that he is stuck back on the battlefield of the very war that he believes he died in. The enemy troops are the ones keeping him there, and he is stuck there until he has paid for his crimes of war.
The final thing you should figure out for your character prior to beginning him is what forms of treatment he will react to, and what he won’t. Does psychotherapy help at all? Or is he going to require electroconvulsive therapy to be cured? What meds is he on, and what meds have failed to work at all? Play around with this. No two patients are the same - you can do anything you wish in this area, as long as it’s realistic.
And that’s all you need to know for a character with Cotard Delusions. As I said in the beginning - all of this is based on my own research on Cotard. If anything is innately wrong, let me know and I’ll fix it, and I hope this was helpful to you!