What is Capgras delusion?

Introduction: Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to encountering an acquaintance, or the voice of a familiar person, or a pet, or some personal possession. All five scenarios involve believing something familiar has been replaced by something unfamiliar. Methods: We evaluate the proposal that these five kinds of delusional belief should count as subtypes of the same delusion. Results: Personally familiar stimuli activate the sympathetic nervous system (SNS) much more strongly than unfamiliar stimuli. In Capgras delusion, this difference is absent, prompting the delusional idea that a familiar person is actually a stranger. We suggest this absence of an effect of familiarity on SNS response will occur in all five scenarios and will prompt the idea that the familiar has been replaced by the unfamiliar. Conclusions: We propose that: (a) all five scenarios be referred to as subtypes of Capgras delusion; (b) in all five, ideas about replacement are prompted by weakness of SNS responses to familiar stimuli; (c) this is insufficient to generate delusion. For a delusional idea to become a belief, a second factor (impaired hypothesis evaluation) must also be present.