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by Carol W. Berman, M.D.

Did you ever believe someone else, invisible to you and everyone else, was living in your house? A ghost, a phantom, an alien? If so you may have "Phantom Boarder" delusions.

“Phantom Boarder” delusions have been reported in Alzheimer's disorder and other dementias for years. In this condition, a person thinks someone else is present when there is no one there. Usually no one is actually seen, but the person has the feeling that someone is present. Often the delusions occur in the home, although they may occur in other places as well. Not many psychiatrists or other doctors are familiar with Phantom Boarder Syndromes (PBS).

Sally,* a 95-year-old white female former factory worker, believed that her deceased husband walked with her to and from the supermarket. Also at times she thought he was lying in bed with her. He had been dead for 18 years when she reported these symptoms. She never actually saw him on the street or in bed, but she felt his presence. She lived an isolated life, having alienated her two children. In the past, she had received a diagnosis of borderline personality disorder. She had some symptoms of depression, i.e., insomnia, sad feelings and suicidal ideation (never acted on), but not enough to warrant a diagnosis of major depression. Physically she only had hypertension and chronic glaucoma. A CT scan did show some brain atrophy. Her symptoms of feeling the presence of her dead husband did not disturb her. In fact, she found the feelings comforting. She did not want to try any antipsychotic medications that her doctor recommended.

Lawrence, a 72-year-old white male who still worked as an attorney, asked his wife about the presence of a third person in their small apartment. His wife of thirty years was surprised that he referred to a non-existent person. She would ask who he was talking about. In a nonchalant manner, he would reply: “You know it's my little brother or my father.” His father had been deceased for ten years and his brother had only visited their apartment one time. Sometimes he believed that his wife was not herself, but a third person and he would ask her where his wife was. The wife took him to a psychiatrist who diagnosed early Alzheimer's disease. The patient was in good physical health, but a CT scan showed brain atrophy. He was started on 5 mg of Aricept and after several weeks of treatment (and an increase to 10mg), he stopped reporting the presence of a third person.

Most standard textbooks of psychiatry do not even mention "Phantom Boarder" delusions (PBD), although many doctors who treat Alzheimer's disease are aware that their patients are suffering from it. In these two cases, Sally* and Lawrence* were both geriatric and experiencing cognitive decline. Neither one was disturbed by the presence of the "phantoms." Sally* found the belief in the presence of her deceased husband comforting and the delusion served to decrease her loneliness. Lawrence* thought the phantom was his brother, father or wife. PBD basically fits in with the person’s sense of the world. The relatives of these patients are usually more disturbed than the patients.

PBD has been labeled a "misidentification syndrome" like Capgras, in which patients believe that their loved ones have been replaced by exact duplicates. Sally* did not misidentify anyone, she only sensed the presence of someone. Lawrence* did misidentify his wife sometimes and think that she was someone else, which is similar to Capras. In other instances he felt the presence of non-existent relatives.

According to DSMV classification, these patients have Delusional Disorder 297.1.

Treatment consists of administration of anti-psychotic medication or anti-dementia medication. Reassurance, psychotherapy, and family therapy would also be helpful.

Given this fairly common symptom, it is easy to understand how the belief in non-hostile ghosts developed. Many people have not dealt emotionally with the loss of their relatives and they need to hold on to lost, loved ones in the form of "phantom boarders.”

*not their real names


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