The Rarest Mental Syndromes in the World
In the medical world, nothing can really be compared to mental issues and psychological disorders, and this is sooner or later discovered by pretty much anyone who has got to understand medicine, even in its slightest. It is widely known that diseases which affect other parts of the body are most of the time curable or at least possible to be identified thanks to the patient’s sanity and collaboration with the medical experts – that, however, is not the case for many of the issues that target the brain. As the main organ in our body, essentially the pinnacle of the human power and identity, damaging it often brings horrific outcomes – the loss of one’s capacity to think or communicate, losing the sense of awareness and presence are many of the various well-known symptoms that shaped psychiatry into being probably one of the most disturbing medical fields to work in.
This list, however, has another intention, and that is not to present the regular, common diseases that both doctors and medical professionals already have extensive experience with, such as schizophrenia or bipolar disorder – quite frankly, our today’s topic features the more peculiar, obscure and utterly horrific cases that haunted the medical field for quite some time – and for a good reason, as these are, as the title suggests, the rarest medical syndromes in the world.
1. Alice in Wonderland syndrome
In order to properly understand why this syndrome got its funny name, we first must have a slight understanding of the novel’s topic: Alice in Wonderland explores the tale of a young girl that travels through a magical land, where time and space are distorted – therefore the effects are understandable – victims of this condition feature visual and reality distortions, which result in more than 60 different phenomena, from which we are going to mention the most important:
- People and objects appear smaller (which is known as micropsia), and also the opposite way, with elements seeming bigger than in reality (this is called macropsia);
- Other elements, including faces or whole bodies looking distorted (a phenomenon known as metamorphopsia);
- Objects appearing closer than their actual distance is (this is named pelopsia), and the opposite effect, of objects looking farther than in reality (medically called teleopsia);
- Hallucinating marked by seeing the same element or face many times (known as polyopia).
Outside the visual distortions we mentioned above, patients also suffer from an altered perception of time and the feeling they are or detached from their own body and feelings (which is called depersonalization) or that they are disconnected from the external world (this is named derealization). All these symptoms appear in episodes that last about 30 minutes on average.
The disturbing part of this condition is that an accurate incidence rate is currently unknown, which is especially because of the extremely low sickness rate – only about 150 cases in recorded medical history.
The causing factors of this condition vary between multiple sources that specialists managed to identify. People at risk of this syndrome included those who already suffer from epilepsy, migraines, as well as other cerebrovascular or psychiatric disorders and also fevers and intoxication.
While fever is commonly a source for the syndrome to arise in adults, children usually develop this condition in a different way – and that is encephalitis, specifically the type caused by the infection with the Epstein-Barr virus.
Because the syndrome is only associated with underlaying causes and not a disease by its own, treatment varies from patient to patient, as it reflects the original developed condition.
2. Alien hand syndrome
The alien hand syndrome stands out as one of the more unique entries on
this list, especially due to 2 important factors - the first one being the fact that this condition is manifested physically (in the limb), and the second being the mandatory past trauma for the disease to appear, rather than developing on a preexisting psychological disorder.
While the effects of this condition may vary, symptoms mostly follow involuntary movement in one arm, often with no awareness or control. These movements include the limb grasping, lifting by itself, and even developing more complex patterns – such as undoing the action of the other hand – a phenomenon called intermanual conflict. In one peculiar case, a woman reported that her limb affected by Alien Hand syndrome tried to strangle her, however, this most likely not a reliable outcome to look after.
What makes this syndrome hard to deal with outside the obvious suffering of the patients is also represented by the variety of possible causes for this condition. As we previously mentioned, Alien Hand syndrome appears after cerebral trauma – incidents like strokes, tumors, cerebral lesions and cerebral atrophy caused by neurodegenerative diseases are some examples of brain trauma that can (in very rare cases) lead to the condition.
The most often cause, however, is a cerebral lesion, which is known to affect the right hemisphere and also the corpus callosum, that connects the two hemispheres. The frontal lobes are responsible with the voluntary and executive movements and actions, which means that damaging them can disrupt communication between the left and right hemispheres. This can result in one hand acting voluntarily, while the other one doesn’t.
After studying the condition, some medical specialists are starting to considerate this syndrome as having 2 subtypes, each one with a different cause and effect:
1) The first subtype is frontal, and is being caused by damage to the medial prefrontal cortex – this results in involuntary grasping and groping;
2) The second subtype is callosal, which means the trauma is located at the corpus callosum – this is the subtype that is characterized by intermanual conflict.
Recognizing the syndrome is also extremely important for the patient, as many other conditions can feel similar, although require completely different treatment. Similar diseases that share striking similarities can be:
- movement disorders (such as Parkinson’s disease, chorea and also tics);
- psychiatric disorders (including schizophrenia and depersonalization);
- delusional disorders (in this case, the belief that one’s own limb is being controlled by someone else or not in their control).
Treatment for Alien Hand syndrome can include both medication (such as botulinum toxin A and benzodiazepines), but also therapy – methods here vary from visuospatial coaching, cognitive-behavioral therapy (this reduces anxiety) and mirror box therapy (in which a mirror is placed between the hands, in order to trick the brain to view the reflected image as part of the body).
3. Capgras syndrome
As the list goes on in depth and conditions become more and more obscure,
a pattern that may become visible is the delusional factor between many of these following syndromes. In shorter terms, many of these diseases feature reality and sense distortion for the patients, which makes up for both the disturbing behavior of the ones affected and a difficult understanding on the condition by medical specialists. On of these syndromes is Capgras.
Capgras is, like mentioned before, a delusion, in which one starts to strongly believe that a person they knew has been replaced with an identical imposter. While this is the main characteristic of the condition, other effects can be visible as well, including paranoia, aggressive behavior and also disorganized speech.
As the theme of the list suggests, Capgras in extremely rare – as statistics indicate, only about 3% of the hospitalized psychosis patients also experience Capgras syndrome.
While Capgras typically has higher chances of developing among people already affected by psychiatric conditions such as schizophrenia, schizoaffective disorder, and bipolar disorder, it can also arise in people that experienced cerebral trauma, similarly to the previously discussed Alien Hand syndrome. In this category we include people that suffered brain injuries, but also Alzheimer’s disease, different types of dementia and multiple sclerosis.
Some researchers believe that Capgras is triggered by a disruption between the temporal lobe and limbic system – this damages the ability to recognize faces and associate them with emotions.
Identifying Capgras among other conditions is crucial in order to determine a correct and effective treatment. Unfortunately, since so little is known about this condition, there is almost no research upon the effectiveness of different treating agents, although antipsychotic medication is usually effective at treating it.
4. Fregoli delusion
Similarly to Capgras, Fregoli delusion also involves one’s strong beliefs regarding the false identity of someone, but with its unique twist. Unlike Capgras, that makes patients believe that an imposter replaced someone they knew, in Fregoli the situation is opposite – that a familiar person is disguising themselves as someone else, or even multiple people, in order to follow them.
Fregoli is most common among those who already suffer from a psychotic disorder (which is most common schizophrenia), but also other conditions, such as a stroke, traumatic brain injury or a neurodegenerative disease. The cerebral lesions of Fregoli patients usually appear in the frontal lobe or on the right side of the brain.
Treatment of the Fregoli delusion consists of antipsychotic medication (in the case of patients that developed the condition after a psychotic syndrome) and also cognitive-behavioral therapy.
5. Stendhal syndrome
Stendhal syndrome features a very particular mental anomaly – and that is experiencing strong physical and emotional disturbances when viewing or interacting with art, or other beautiful, artistic elements.
At first glance, the manifestation of this condition can feel bizarre and oddly specific, and quite frankly, the obscurity of the syndrome is also enhanced by the lack of diagnostic recognition. It is only thanks of the recent studies and medical reports that Stendhal became considered a distinct phenomenon.
The symptoms vary extremely much, including episodes of increased heart rate, dizziness, fainting, epigastric pain, anxiety, euphoria and even exaltation. As you probably already figured out, the effects are mostly psychological and altogether relevant in the case of emotional distress.
While concentrated forms of art such as galleries and museums are mostly known for causing this phenomenon, the beauty of nature is also recognized to being a triggering factor. Other possible triggers medical professionals suggested include repressed sexual drives, fatigue, sleep deprivation, the feeling of uncertainty or change in one’s life or even reaching the end of an important trip.
For example, a well case of Standhal dates from 1817, when a French author experienced the condition after a trip to Florence, which resulted in the condition also being called Florence syndrome. Another name for the disease is hyperculturemia.
A similar syndrome, called Jerusalem syndrome, also exists, in which the condition develops after the religious pilgrims finally reach their destination, the holy city. Medical experts actually explained that people who go on highly meaningful religious or personal trips as well as those with a history of mental illness share an increased risk to develop this syndrome, even though it is extremely rare as a whole.
Scientists believe that the syndrome is caused by neurological processes that affect emotional processing, social situations and also introspection. In extreme cases of Stendhal, patients experience transient paranoid psychosis, disorientation, confusion and also strong anxiety that can lead to panic attacks – euphoria and exaltation are also possible symptoms, as mentioned previously.
Treatment for the condition is determined after the patient’s history is available, in order to identify the highly variable syndrome correctly, among other disorders. Antipsychotics are used especially for patients that already have a psychotic disorder, although the episodes can also be resolved on their own.
6. Cotard delusion
Continuing the list with one of the more disturbing entries, Cotard delusion brings in a phenomenon hard to comprehend at first – one’s feeling and strong belief that they have died. While syndromes range from rejecting one’s organs and feeling a sensation of decomposition to auditory and olfactory hallucinations, the most common way for people affected by the syndrome to express their condition is to simply state: “I am already dead.”
Medically, this is known as a nihilistic delusion. The condition is also called Corpse Syndrome.
Although most cases of Cotard are based on schizophrenia, the condition can also develop on other psychotic disorders, severe depression and bipolar disorders but also infections of the central nervous system, traumatic brain injuries, tumors or temporal lobe epilepsy – the last ones being possible physical damaging triggering factors, themed across some of the previously discussed syndromes as well, such as Capgras and Fregoli.
The brain scans made on Cotard patients reveal that the condition may be caused by abnormalities in the frontal and temporal lobes – these are associated with functions such as self-awareness and the processing of reality.
Treatment for Cotard is especially complex, with its blend of medication and therapy.
Medication typically consists of antipsychotics – here we include olanzapine, clozapine, pramipexole and aripiprazole – these can be taken by themselves or complemented by antidepressants and mood stabilizers.
Therapies that proved effectiveness are electroconvulsive therapy, but also behavioral and psychotherapies – however these have to be adapted depending on the patient.
7. Clinical Lycanthropy
By “lycanthropy”, also known as shapeshifting, we understand the mythical power that allowed the man to transform into an animal, most commonly associated with a wolf or werewolf.
As the name suggests, this condition makes the patient strongly believe that they can turn into an animal, any particular one. During episodes of hallucination, people affected are known to behave like animals and are sometimes even found hidden in forest areas or wild habitats.
The condition itself is labeled as a type of delusional misidentification syndrome – this is strongly associated with psychotic disorders, but also depression or bipolar disorder.
Because of this, treatment usually consists of antipsychotics, as it’s often effective, but antidepressants and mood stabilizers can also be administered, if other symptoms arise.
8. Depersonalization / Derealization disorder
The conditions of depersonalization and derealization are heavily tied with the patient’s broken perspective on reality. People affected by this disorder often feel separated from their own bodies, even feeling that they are watching themselves. They can also believe elements around them and surroundings are not real and even the fact that time itself is distorted – either feeling slower or faster.
Because the condition causes distress and anxiety over time, treatment includes a combination of medication and psychotherapy.
However, it is highly important that the symptoms persist in order for the condition to be classified as the official syndrome. Doctors remind us that similar symptoms can also appear temporarily due to the effect of medication, drugs, and also other physical and mental health conditions.
9. Apotemnophilia
This condition, also known as body integrity disorder, is a disturbing medical syndrome in which the one affected starts to feel an overwhelming desire to amputate healthy parts of their body.
Despite the scary factor of the condition, little is actually known about it, although it is believed to be neurological, and may be linked to damage to the right parietal lobe.
Treatment is difficult to be offered as many of the confirmed cases don’t seek medical attention, believing that amputating the desired part of the body is the right thing to do, leading to potential self-harm.
However, when the patient is hospitalized, both cognitive behavioral therapy and aversion therapies are attempted in treating the condition.
10. Delusional parasitosis
Also known as delusional infestation or the Ekbom syndrome, this severely disturbing condition features the unshakable belief of the affected person that their body is infested with bugs or other parasites.
Syndromes are especially convincing for the patients – sensory hallucinations trigger extremely realistic sensations such as crawling, biting or stinging (which is medically called formication).
Because the ones affected by the syndrome feel a desire to dig off whatever they think is crawling under their skin, physical wounds such as skin damage, ulcers and infections can also appear as a result of involuntarily self-harm.
Although the syndrome can appear by itself, it can be also triggered by other conditions such as schizophrenia, dementia or depression. It can also develop from organic sources, including B12 deficiency, diabetes and drug use (especially cocaine and amphetamines).
Treatment for the condition includes antipsychotic medication, as well as building a trusted relationship between the patient and specialists in order for the underlying psychological causes to be examined.
In the end, we are left with the careful breakdown of these more than certainly overwhelming conditions. Some of them being more obscure and disturbing than the others on this list. However, at the end of the day, what we are left with are these peculiar cases, waiting to be understood, discovered and meticulously analyzed, for the love of the souls that fight them every single day, and for the love of the endless ocean of medical knowledge, some still waiting to be discovered by us…
Sources:
- https://www.clinicaladvisor.com/factsheets/rare-psychological-disorders-list/
- https://online.csp.edu/resources/article/10-rare-mental-health-conditions/
- https://en.wikipedia.org/wiki/Clinical_lycanthropy
- https://my.clevelandclinic.org/health/diseases/9791-depersonalization-derealization-disorder
- https://en.wikipedia.org/wiki/Delusional_parasitosis
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10871419/
- https://www.healthline.com/health/mental-health/delusional-parasitosis
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