Capgras Syndrome Triggered by Marital Separation: A Rare Case of Trauma-Induced Delusional Misidentification

Capgras syndrome is a rare psychiatric condition classified under delusional misidentification syndromes, characterized by the belief that a familiar person has been replaced by an identical impostor. Although it is most commonly observed in association with schizophrenia, neurodegenerative diseases, or structural brain lesions, it may also arise in the context of acute psychological trauma or severe emotional disturbance. We present the case of a 46-year-old African American woman with no prior psychiatric or neurological history who presented to an outpatient psychiatry clinic accompanied by her sister, with a sudden onset of delusional misidentification involving her husband and adolescent daughter. The symptoms developed shortly after the unexpected discovery of her husband's extramarital affair and his decision to initiate divorce proceedings, events which she described as profoundly destabilizing. Within days, she became convinced that both her husband and daughter had been replaced by impostors who were physically identical but emotionally unfamiliar, leading to avoidance behaviors, interpersonal conflict, and significant functional impairment. The patient denied hallucinations or other psychotic symptoms, and cognitive screening with the Montreal Cognitive Assessment (MoCA) was within normal limits (28/30). A comprehensive medical and neurological evaluation, including laboratory workup and bedside neurological examination, revealed no abnormalities, and although neuroimaging and electroencephalography (EEG) were declined by the patient, there were no clinical indications of organic pathology. The clinical picture was most consistent with delusional disorder with features of Capgras syndrome in the context of acute psychological trauma. Treatment was initiated with low-dose risperidone, gradually titrated to 2 milligrams per day, alongside trauma-focused psychotherapy focused on narrative reconstruction and emotional integration. Over a three-month period, the patient exhibited marked improvement in insight and reduction in the intensity of her delusional beliefs, eventually acknowledging that her perceptions may have been distorted by emotional distress. This case demonstrates a rare but clinically important presentation of Capgras syndrome triggered by acute psychosocial trauma in the absence of psychosis or neurological disease. It highlights how severe emotional stress can lead to a functional disconnect between facial recognition and emotional familiarity, resulting in delusional misidentification even in high-functioning individuals. Prompt psychiatric treatment combining antipsychotic medication and trauma-focused psychotherapy can support recovery and help prevent further psychological decline.