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Diagnostic Criteria

Although the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) does not include cotard delusion as a specific disorder, it does include diagnostic criteria for delusional disorders, which encompasses cotard delusion. It is important to note the diagnostic criteria according to the DSM-5 because this is how pyschiatrists are able to diagnose individuals presenting with symptoms of a mental disorder. The diagnostic criteria for delusional disorders is as follows:

A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods. E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder.

Under the category of delusional disorders, it is also important to specify whether the disorder is erotomanic, grandiose, jealous, persecutory, somatic, mixed, or otherwise unspecified. According to the DSM-5, Cotard delusion would also fall under the category of somatic type delusions. In other words, the delusions involve bodily functions or sensations.

Case Studies

One patient, referred to as WI for privacy reasons, was diagnosed with cotard delusion after experiencing significant physical brain damage following a trauma. Damage to the cerebral hemisphere, frontal lobe, and the ventricular system was apparent to WI's doctors after examining magnetic resonance imaging (MRI) and computed tomography (CT) scans. In January of 1990, WI was discharged to outpatient care. Although his family had made arrangements for him to travel abroad, he continued to experience significant persistent visual difficulties, which provoked his referral for ophthalmological assessment. Formal visual testing then led to the discovery of further damage. For several months following the initial trauma, WI continued to experience difficulties with recognizing familiar faces, places, and objects. He also was convinced that he was dead and experienced feelings of derealisation. Later in 1990, after being discharged from the hospital, WI was convinced that he had been taken to hell after dying of either AIDS or septicaemia. When WI finally sought out neurological testing in May 1990, he was no longer fully convinced that he was dead, although he still suspected that he was. Further testing revealed that WI was able to distinguish between various dead and alive individuals, just not himself. After receiving treatment for depression, it appeared that after one month WI's delusions of his own death had diminished.