Fregoli syndrome belongs to the group of misidentification syndromes (DMS, delusional misidentification syndromes). It is a very rare mental disorder that is most often the result of schizophrenia. Isolated occurrence of the disorder is also reported occasionally.
What is Fregoli syndrome?
Patients suffering from Fregoli syndrome assume that people they know, such as friends and relatives, may transform and present to them with altered appearances. Strangers are perceived as familiar, but they are thought to be in disguise or disguise. The supposed identification succeeds by the recognition of typical characteristics (look, voice.). In this context it is also spoken of hyperidentification. The disease was first described in 1927 by Paul Courbon and Gustave Fail. They reported the case of a woman who felt pursued by two actors. To this end, the actors would have repeatedly and rapidly transformed themselves into persons known to the woman. 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 transformation and impersonation artist who could take the form of other people within a short time.
Causes
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. If the dosage is high, it cannot be ruled out that delusional ideas in the form described may develop. Addiction to narcotic drugs can also be a cause. In addition, people suffering from Alzheimer’s dementia in particular exhibit a tendency to misidentification syndromes. According to studies, at least one-third of Alzheimer’s patients suffer from misidentifying people. Fregoli syndrome often accompanies psychosis or paranoid schizophrenia. It is also not uncommon for the syndrome to occur together with delusions of love or erotomania, respectively, or with Capgras syndrome, which also have an underlying schizophrenia.
Symptoms, complaints, and signs
People who have Fregoli syndrome do not confuse people in the conventional way. There does not have to be similarity for misidentification or hyperidentification to occur. Even similar details (for example, the shape of the ear, the posture of the head) can be based on imagination. It is persistently held that the strange person is “in reality” a person from the closer environment whom the patient has met before or with whom he has regular contact. These can be different persons to whom the intentions to deceive are imputed. The misidentified persons are not always approached about it. However, if the victim of misidentification insists in the course of a confrontation that he or she is not the person meant, this usually does not alleviate the patient’s delusion. The obsessive thought of being systematically and deliberately deceived is thus sometimes reinforced.
Diagnosis and course
Such conspicuous behavior allows for a specific and accurate diagnosis. If diagnosis and treatment are left undone, experience shows that the illness will persist and intensify for a long time. Only in the context of psychoses and psychotic episodes can it be assumed that these massive disturbances are only temporary – provided that the affected persons are already undergoing treatment. The illness can take on dangerous features. In some cases, a formerly emotionally close person is “recognized” after years. She is then stalked. Physical assaults may follow. Various means are used to force the stranger to reveal and admit his or her “true” identity. Admission to a psychiatric institution often remains the last resort in such cases.
Complications
In most cases, Fregoli’s syndrome primarily presents with psychological complications. In this case, the patient identifies strangers as not 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 limited due to Fregoli syndrome and depression occurs. Often the feeling of deception or lying occurs in the affected person, when the other person states that the people do not know each other. This usually further exacerbates Fregoli syndrome. Treatment is not possible in all cases. Especially in the case of drug addiction, withdrawal must be done in order for there to be improvement. However, taking certain medications can also lead to Fregoli syndrome, so these are discontinued. Most of the time, there is improvement after the medication or drug is discontinued. However, treatment is also carried out psychotherapeutically and can be supported with antidepressants. It is not uncommon for violent outbursts or an aggressive mood to occur when the sufferer is confronted with Fregoli syndrome. This delays treatment. Since Fregoli syndrome occurs mainly in schizophrenia, the complications of the underlying disease also occur.
When should you see a doctor?
Fregoli syndrome is striking and usually accompanies a preexisting underlying condition. However, individuals suffering from this misidentification syndrome rarely feel that anything is wrong with them and therefore rarely see the need to see a doctor. They believe their delusions are real, actually feel deceived by other people, and strive to appear credible and normal. This makes help difficult and therefore relatives and friends have a special responsibility. They should listen carefully to what the affected person reports about the strange situations in which he or she “recognized” a familiar person. They should persistently inquire about this and, at the slightest suspicion of the presence of such a misidentification syndrome, ensure that a neurologist attends to the patient. Only the latter can make the correct diagnosis, determine the cause (schizophrenia, addiction, side effect of medication or Alzheimer’s disease) and then take specific measures. It is by no means appropriate to play down the signs pointing to Fregoli syndrome. The dangerousness and complexity of the disease require rapid and spirited intervention, and its therapy is beyond the competence of a general practitioner.
Treatment and therapy
The type of treatment depends on the disease that is the cause of Fregoli syndrome. If the use of certain medications (for example, L-dopa) or an addictive disorder with substance abuse is responsible, appropriate measures should be taken. If these causes have been ruled out and schizophrenia has already been diagnosed, then a combination of drug treatment and psychotherapy is common. Drug therapy consists of the administration of atypical antipsychotics (for example, risperidone) and benzodiazepines and, if necessary, antidepressants. In psychotherapy, it is important to find out what function the delusion fulfills and what is compensated for with it. If this is successful, alternative ways and attempts at solutions can be worked out. This requires a lot of patience and a high tolerance for frustration. Therapists have found that the disorder is difficult to cure. Some patients must be described as resistant to therapy. Patients who are confronted with their delusions and with the presumed transformers often react with aggressive behavior and violent outbursts. It is recommended that sociotherapeutic measures also be used concomitantly.
Outlook and prognosis
Fregoli syndrome is one of the delusions that usually occur in the context of other mental illnesses. Rarely does it occur as an isolated disorder. Very often, it is observed in the context of schizophrenia and is therefore often combined with other delusions. The course of Fregoli syndrome is usually dependent on the underlying disorder. Thus, there are courses with transient symptomatology. This is especially the case when Fregoli syndrome is a secondary manifestation within an acute psychosis. Very often, however, the delusion spreads chronically. This is especially true if no therapy takes place.If the affected person is then to be convinced that his idea lacks any basis, the delusion is all the more solidified and reinforced. The counterarguments only lead to the patient becoming more and more obsessed with the conviction that a person significant to him, to whom he has often also developed an emotional bond, appears in the body of another person. In the process, sufferers often assume that they have clearly recognized the misidentified person by certain features such as gait, ear shape, head posture, or voice. Without drug treatment, the reinforcement of delusions can also lead to dangerous behavior. For example, the combination of Fregoli syndrome with delusions of love often leads to stalking and physical assaults on other people. Long-term drug treatment is often necessary to alleviate the symptoms.
Prevention
Prevention proves difficult in that Fregoli syndrome can have a variety of causes that are difficult to influence and eliminate. If a patient is already being treated for paranoid schizophrenia, attention will need to be paid to whether this is associated with Fregoli syndrome. In this and also in other delusions, the relatives are of decisive importance in the early stages. They are most likely to perceive changes and recognize dangers. Here it is important not to trivialize strange behavior and to seek professional advice and help in good time.
Aftercare
In most cases, patients with Fregoli syndrome have no options for aftercare. In this case, the disease must always be treated first by a physician, and the first and foremost priority is the detection of the disease. A self-healing cannot occur, but the life expectancy of the affected person is not reduced by the Fregoli syndrome. Treatment is usually carried out by a psychologist or a psychiatrist. The affected person is often dependent on the support of his own family and friends. In this case, intensive care and, above all, informing outsiders about the disease has a very positive effect on the further course of the disease and can prevent complications. In many cases, those affected are also dependent on taking medication, and regular administration is important. In cases of doubt about possible interactions, a doctor should always be consulted. Often, in-depth conversations with familiar people are also very helpful and can alleviate the symptoms. After successful treatment, the dose of medication should not be reduced immediately to avoid the recurrence of Fregoli syndrome.
What you can do yourself
Those who suffer from Fregoli syndrome are usually already burdened with a serious underlying disease. This is usually paranoid schizophrenia, Alzheimer’s dementia or drug addiction. These illnesses lead to a massive complication of everyday life. Social withdrawal and loneliness are common side effects, as are declining confidence and apathetic behavior. People who know how difficult Fregoli syndrome is to treat and who have a sense of the anguish involved can help during this difficult phase of life. This primarily includes those who struggle with the same or similar delusions (Capgras syndrome, erotomania, jealousy delusions). The hard-to-bear sensation of not being understood, not being taken seriously, or being deliberately deceived finds relief by visiting self-help groups and self-help forums on the Internet. They facilitate exchange between those affected and help them to experience the relief of not being alone with their suffering. This reduces the mistrust of other people that is so pronounced in delusion patients. In addition, hope grows when other sufferers report on their strategies for coping with everyday life. Paradoxically, the first step toward self-help is to seek and accept help. However, the lack of insight into the illness on the part of people suffering from Fregoli syndrome represents an obstacle here that is often difficult to overcome.