Cotard’s Delusion in Forensic Contexts: Implications for Competency, Criminal Responsibility, Risk Assessment, and Treatment Over Objection

First observed in 1880 by French neurologist Jules Cotard, Cotard’s delusion is a rare condition characterized by the patient’s belief that they are dead, dying, do not exist, have lost internal organs, or, in some cases, are immortal. Although historically associated with psychotic depression, the recent literature suggests that Cotard’s delusion is better understood as a neuropsychiatric syndrome or delusional phenomenon that may occur in the context of several psychiatric, neurological, and medical conditions. This paper reviews Cotard’s delusion from a forensic perspective, with particular attention to cases involving treatment refusal, self-neglect, suicidality, and rare instances of aggression. Forensic implications, including competency to stand trial, criminal responsibility, civil commitment, treatment over objection, malingering considerations, and risk assessment, are discussed.