Syndrome of subjective doubles is a rare delusional misidentification syndrome in which a person experiences the delusion that they have a double or doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own. The syndrome is also called the syndrome of doubles of the self, delusion of subjective doubles, or simply subjective doubles. Sometimes, the patient is under the impression that there is more than one double. A double may be projected onto any person, from a stranger to a family member. This syndrome is often diagnosed during or after the onset of another mental disorder, such as schizophrenia or other disorders involving psychotic hallucinations. There is no widely accepted method of treatment, as most patients require individualized therapy. The prevalence of this disease is relatively low, as few cases have been reported since the disease was defined in 1978 by George Nikolaos Christodoulou, a Greek-American psychiatrist. However, subjective doubles is not clearly defined in literature, and therefore may be under-reported.
Signs and symptoms The symptoms of the syndrome of subjective doubles are not clearly defined in medical literature; however, there are some defining features of the delusion:
The existence of the delusion, by definition, is not a widely accepted cultural belief. The patient insists that the double they see is real even when presented with contradictory evidence. Paranoia and/or spatial visualization ability impairments are present. Similarities to other disorders are often noted in literature. Prosopagnosia, or the inability to recognize faces, may be related to this disorder due to the similarity of symptoms. Subjective doubles syndrome is also similar to delusional autoscopy, also known as an out-of-body experience, and therefore is occasionally referred to as an autoscopic type delusion. However, subjective doubles delusion differs from an autoscopic delusion: autoscopy often occurs during times of extreme stress, and can usually be treated by relieving the said stressor. Syndrome of subjective doubles is usually accompanied by another mental disorder or organic brain syndrome, and may appear during or after the onset of the other disorder. Often, co-occurrence of subjective doubles with other types of delusional misidentification syndromes, especially Capgras syndrome, also occurs. Several variations of the syndrome have been reported in literature:
The doubles may appear at different ages of oneself. Some patients describe their double as both a physically and psychologically identical copy, rather than a purely physical copy. This is also known as clonal pluralization of the self, another type of delusional misidentification syndrome that may or may not be the same type of disorder (see § Controversy below). In this case, depersonalization may be a symptom. Reverse subjective doubles occurs when the patient believes his/her own self (either physical or mental) is being transformed into another person. (see the case of Mr. A in § Presentation)
Presentation The following case describes a patient who was diagnosed with psychotic depression, bipolar disorder, and syndrome of subjective doubles: Taken from Kamanitz et al., 1989:
"Mrs. B. is a 50-year-old white married homemaker and the mother of five children with three previous psychiatric hospitalizations for depression and bipolar illness. [...] She firmly believed that another Mrs. B. existed who had replaced herself in her husband's affections. [...] Mrs. B. was convinced that the 'grooves in her fingers were smoother,' and that the double had taken her fingerprints. She was so concerned about the existence of another Mrs. B. that she required the constant presence of her driver's license to reassure herself that she was the real Mrs. B. In addition to her delusional belief, Mrs. B. reported that she had actually seen the other Mrs. B. She believed that the other Mrs. B. was also a patient in the unit who looked exactly like her facially but was heavier in the body. (Another, younger, patient, who was pregnant, was actually the person upon whom this illusion was superimposed.)" The following case describes a patient who has been diagnosed with schizoaffective disorder along with multiple delusional misidentification syndromes (subjective doubles, Capgras delusion, intermetamorphosis): Taken from Silva et al., 1994:
"Mr. B believed that five physical copies of himself existed. Each copy had a different mind than his own. On one occasion, he thought himself to have been Jesus Christ, but denied having undergone any bodily changes. Mr. B stated that five replicas of the city in which he lived existed as well as the existence of five different planet earths. He, however, acknowledged having lived on only one of these earths. Mr. B had a history of several arrests for attacking police officers, whom he believed were impostor replicas of real police officers." The following case describes a patient who has been diagnosed with chronic paranoid schizophrenia and reverse subjective doubles: Taken from Vasavada and Masand, 1992:
"Mr. A, a 40-year-old divorced white male, was hospitalized for his complaint that his identity had been changed in the last six years. He stated that he was not Mr. A but Mr. B and preferred to be called by that name. [...] When asked to describe Mr. B, he replied that the only thing he remembered was that Mr. B was an orphan and had made his fortune by working hard. He denied that Mr. B had any family members. He would get angry when addressed as Mr. A and would insist on being called Mr. B. [...] In the above case our patient believed that he had been changed both physically (face, fingerprints, etc.) and psychologically (he could recount details of his life as Mr. A but few as Mr. B)."
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