The living being dead: Cotard syndrome presenting as a dead spirit

Jules Cotard described a syndrome with melancholic anxiety, delusions of possession, ideas of suicide and, thoughts of the non-existence of their own body and/or soul. ‘Perethaya’ is a greedy dead spirit recognized in Sri Lankan culture who expresses a dangerous longing for food until their subsequent incarnation. A 68-year-old female previously diagnosed with depressive disorder stated she is deceased and turned to a ‘perethaya’. She ate from garbage bins and attempted to consume water from toilet bowls as a ‘perethaya’ would do. A 42-year-old male diagnosed with recurrent depression stated he has died and is now a ‘perethaya’. He believed any person who would talk to him is dead as well. These reports present a culturally unique way of Cotard syndrome in Sri Lanka.