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Discussion on the Cotard delusion often focuses on the patient’s delusional belief that he/she is dead. Of interest to this paper, however, is the little referred to claim made by some Cotard patients that they are immortal. How might one explain the juxta-position of death and immortality evident in patients sharing the same clinical diagnosis, and how might these delusional beliefs inform our understanding of patient phenomenology, particularly regarding experiences of existential change? This paper sets out to explain delusions of death and immortality in Cotard patients with reference to changes in their experience of being, owed in part to a conflict in recognition evident in other delusional disorders such as the Capgras and Frégoli delusions. This experiential change is positioned within an interactionist framework of bottom-up and top-down processing that is also compatible with explanationist and endorsement approaches to delusions.