The Fregoli syndrome belongs to the group of Miss identification syndromes (DMS, delusional misidentification syndromes). It is a very rare mental illness, most of which is the result of schizophrenia. Isolated occurrences of the disease have also been reported in isolated cases.
What is Fregoli Syndrome?
Patients who suffer from Fregoli syndrome assume that people they know, such as friends and relatives, can transform themselves and meet them with a different appearance. Strangers are perceived as familiar, but they are assumed to have camouflaged or disguised themselves. The supposed identification succeeds through the recognition of typical characteristics (look, voice.). Hyperidentification is also used in this context.
According to LAWFAQS, the disease was first described in 1927 by Paul Courbon and Gustave Fail. They reported the case of a woman who felt she was being followed by two actors. To this end, the actors quickly and repeatedly transformed themselves into people whom the woman knew. The patient assumed that the two actors wanted to manipulate her.
The name of this delusional misidentification is based on Leopoldo Fregoli. Fregoli was a famous quick-change and imitation artist who was able to take on the shape of other people within a short time.
There are several possible causes. For example, an injury to the brain can cause Fregoli syndrome. Disruption of the fusiform gyrus causes facial recognition to be impaired. Treatment with the Parkinson’s drug levodopa (L-Dopa) is also a possible cause. In the case of high doses, it cannot be ruled out that delusional ideas may develop in the form described.
Addiction to drugs can also be a cause. In addition, people who suffer from Alzheimer’s disease in particular are prone to misidentification syndromes. Studies have shown that at least a third of Alzheimer’s patients suffer from misjudging people.
Fregoli syndrome is often a side effect of psychosis or paranoid schizophrenia. It is also not uncommon for the syndrome to occur together with the delusions of love or with erotomania or with Capgras syndrome, which are also based on schizophrenia.
Symptoms, ailments & signs
Fregoli syndrome does not confuse people in the traditional way. There does not have to be any similarity for misidentification or hyperidentification to occur. Similar details (for example the shape of the ear, the posture of the head) can also be based on imagination.
It is insistently maintained that the stranger is “in reality” a person from the immediate vicinity, with whom the patient has met before or with whom he has regular contact. These can be different people who are believed to have intended fraud. The misunderstood people are not always addressed about it.
However, if the victim of misidentification insists on not being the intended person in a confrontation, the delusion of the patient is usually not alleviated. The obsessive thought of being systematically and deliberately deceived is sometimes reinforced.
Diagnosis & course
Such a conspicuous behavior enables a targeted and accurate diagnosis. If there is no diagnosis and treatment, experience has shown that the disease will persist for a long time and become worse. Only in the context of psychoses and psychotic relapses can it be assumed that these massive disorders are only temporary – provided that the persons concerned are already being treated.
The disease can become dangerous. In some cases, a formerly emotionally close person is “recognized” after years. You will then be pursued. Physical assault can follow. Various means are used to force the stranger to reveal and admit their “true” identity. Admission to a psychiatric institution is often the last resort in such cases.
In most cases, Fregoli syndrome is primarily a psychological complication. The patient does not identify strangers as such, but as already known people. This can lead to bizarre and unpleasant situations, especially in public, which in the worst case can result in acts of violence.
Often social contacts are restricted due to Fregoli syndrome and depression occurs. Often the person concerned feels a delusion or a lie when the other person says that the people do not know each other. This usually exacerbates Fregoli syndrome.
Treatment is not possible in all cases. Withdrawal must be carried out, especially in the case of drug addiction, so that there is an improvement. However, the use of certain medications can lead to Fregoli syndrome, so that these are discontinued. Most of the time, there is an improvement after giving up the medication or drugs.
However, the treatment is also carried out psychotherapeutically and can be supported with antidepressants. It is not uncommon for the person concerned to confront Fregoli syndrome with outbreaks of violence or an aggressive mood. This will delay treatment. Since Fregoli syndrome occurs primarily in schizophrenia, the complications of the underlying disease also occur.
When should you go to the doctor?
Fregoli syndrome is noticeable and is usually associated with an underlying disease. However, those suffering from this misidentification syndrome rarely have the impression that something is wrong with them and therefore hardly see the need to see a doctor. They think their delusions are real, actually feel deceived by other people, and strive to appear believable and normal. That makes it difficult to get help and therefore relatives and friends have a special responsibility.
They should listen carefully to what the person concerned reports about the strange situations in which they “recognized” a person they knew. You should persist in inquiring about this and, if there is the slightest suspicion of such a misidentification syndrome, ensure that a neurologist takes care of the patient.
Only this person can make the correct diagnosis, determine the cause (schizophrenia, addiction, side effects of medication or Alzheimer’s disease) and then take targeted measures. It is in no way appropriate to play down the signs of Fregoli syndrome. The danger and complexity of the disease requires rapid and courageous intervention; its therapy exceeds the skills of a general practitioner.
Treatment & Therapy
The type of treatment depends on the disease that is causing Fregoli syndrome. If the intake of certain medications (for example L-Dopa) or an addiction with medication abuse is responsible, appropriate measures must be taken. If these causes are excluded and schizophrenia has already been diagnosed, a combination of drug treatment and psychotherapy is common.
Drug therapy consists of the administration of atypical antipsychotics (e.g. risperidone) and benzodiazepines and, if necessary, antidepressants. In psychotherapy, it is important to find out which function the delusional idea fulfills and what it compensates for. If this succeeds, alternative ways and solution attempts can be worked out.
This requires a lot of patience and a high tolerance for frustration. Therapists have found that the disease is difficult to cure. Some patients have to be described as resistant to therapy. Patients who are confronted with their delusions and with the alleged quick-change artists often react with aggressive behavior and outbursts of violence. It is recommended to use socio-therapeutic measures as well.
Outlook & forecast
Fregoli syndrome is one of the delusions that usually occur in the context of other mental illnesses. It rarely occurs as an isolated disease. It is very often observed in the context of schizophrenia and is therefore often combined with other delusions. The course of Fregoli syndrome mostly depends on the underlying disease. There are courses with temporary symptoms. This is particularly the case when Fregoli syndrome is a secondary phenomenon within an acute psychosis.
Very often, however, the delusion spreads chronically. This is especially true when there is no therapy. If the person concerned is then to be convinced that their imagination lacks any basis, the madness becomes all the more solidified and intensified.
The counter-arguments only lead to the patient becoming more and more obsessed with the belief that a person who is meaningful to him and with whom he has often developed an emotional bond appears in the body of another person. Those affected often assume that they have clearly recognized the wrongly identified person by certain features such as gait, ear shape, head posture or voice.
Without drug treatment, the intensification of delusions can also result in dangerous behaviors. For example, the combination of Fregoli syndrome and mad love often leads to stalking and assault on other people. Long-term drug treatment is often necessary to alleviate the symptoms.
Prevention is difficult because Fregoli syndrome can have various causes that are difficult to influence and eliminate. If a patient is already being treated for paranoid schizophrenia, it will be necessary to pay attention to whether this is associated with Fregoli syndrome.
In this and other delusions, the relatives in the early stages are of decisive importance. They are most likely to perceive changes and recognize threats. Here it is important not to trivialize strange behavior and to seek professional advice and help in good time.
In most cases, Fregoli syndrome patients have no follow-up options available. The disease must always first be treated by a doctor, whereby the recognition of the disease is primarily and in the foreground. Self-healing cannot occur, although the life expectancy of the person affected is not reduced by Fregoli syndrome.
Treatment is usually carried out by a psychologist or a psychiatrist. The person concerned often depends on the support of their own family and that of friends. Intensive care and, above all, informing outsiders about the disease has a very positive effect on the further course and can prevent complications.
In many cases, those affected are also dependent on taking medication, whereby regular intake must be observed. In cases of doubt about possible interactions, a doctor should always be consulted. In-depth discussions with people you trust are often very helpful and can alleviate the symptoms. After successful treatment, the dose of the medication should not be reduced immediately to avoid the recurrence of Fregoli syndrome.
You can do that yourself
Anyone who suffers from Fregoli syndrome is usually already burdened with a serious underlying disease. Usually this is paranoid schizophrenia, Alzheimer’s dementia or drug addiction.
These diseases make everyday life much more difficult. Social withdrawal and loneliness are just as common side effects as declining confidence and apathetic behavior. People who know how difficult Fregoli syndrome is to treat and who have a feeling for the agony that goes with it can help in this difficult phase of life. This includes primarily those who are struggling with the same or similar delusions (Capgras syndrome, erotomania, delusions of jealousy).
The hard-to-bear feeling of not being understood, not taken seriously or deliberately deceived can be alleviated by attending self-help groups and self-help forums on the Internet. They enable the exchange between those affected and help them to experience that they are not alone with their suffering. In this way, the highly pronounced distrust of other people in delusional patients is reduced. In addition, hope grows when other sufferers report on their strategies for coping with everyday life.
Paradoxically, the first step towards self-help is seeking and accepting help. However, the lack of insight into the disease of people suffering from Fregoli syndrome is an obstacle that is often difficult to overcome.