Frégoli syndrome: definition, symptoms and causes

Delusions of false identification are a type of delusion that is especially striking since it involves the misrecognition of other people, sometimes even oneself.

In this article we will talk about the symptoms and causes of Frégoli syndrome, one of the most popular false identification delusions.

• Related article: "The 12 most curious and shocking types of delusions"

What is Fregoli syndrome?

Frégoli syndrome is a delusion consisting of the belief that one or more known people are being impersonated by someone using a disguise or otherwise changing appearance.

It is often associated with a paranoid component, since people with Frégoli syndrome tend to think that the impersonator is after them to harm them or at least harm them.

It is a monothematic delusion classified within the category of what we know as “delusions of false identification”. It is related to disorders such as psychosis, dementia and brain damage.

Like other similar delusions, Frégoli syndrome is associated with a deficit in face recognition

: the perception of unknown faces would trigger the misidentification of these with others more familiar, usually loved ones or celebrities. It can also be influenced by other senses, such as hearing and smell.

• Related article: "Prosopagnosia, the inability to recognize human faces"

History of the disorder

Fregoli syndrome was described by two French psychiatrists, Courbon and Fail, in his 1927 article Syndrome d'illusion de Frégoli et schizophrénie (“Frégoli Illusion Syndrome and Schizophrenia”).

Courbon and Fail described the case of a 27-year-old domestic servant, a great fan of the theater, who believed that the famous actresses Robine and Sarah Bernhardt were dating. disguised themselves as people he knew to negatively influence her thoughts and behavior - for example by preventing her from working or forcing her to masturbate.

The name “Frégoli syndrome” refers to the Italian actor Leopoldo Frégoli, who was known for his ability to transform, imitation and disguise.

Oliver Sacks popularized this delusion through his 1985 book The Man Who Mistook His Wife for a Hat. Since then it has inspired several films, such as Total Recall, The Perfect Women or Anomalisa.

Since its description in 1927, only 40 cases have been documented worldwide, although it is believed that this disorder is probably underdiagnosed.

Signs and symptoms

People with Frégoli syndrome usually present a series of alterations that predispose to the appearance of symptoms; In particular, deficits have been detected in visual memory, self-monitoring, executive functions, cognitive flexibility, and self-awareness.

This means they may have more difficulty remembering visual information, controlling and supervising their own behavior, to differentiate themselves from others, or to think about several concepts at the same time.

Frégoli syndrome also more likely in people with a history of seizures, especially if they have occurred during epileptic seizures.

The underlying symptoms of this disorder often coexist with hallucinations and other delusions. delusions are unshakeable beliefs despite the fact that there is evidence that conclusively refutes them, while hallucinations consist of the perception of external stimuli that do not exist.

Causes of Fregoli syndrome

Psychosis is one of the most frequent causes of Frégoli syndrome. delusions are one of the cardinal symptoms of schizophrenia and other similar disorders. In this case we speak in most cases of a persecutory delusion.

In diseases that affect the brain, particularly dementia, it is common for psychotic delusions such as Fregoli's to appear as brain involvement progresses.

Another common cause is levodopa treatments, a catecholaminergic drug used primarily to treat Parkinson's disease. The longer the treatment and the higher the dose, the more likely it is that hallucinations and especially delusions will develop.

brain injuries they can cause the appearance of Frégoli syndrome; Specifically, cases have been documented in people with lesions in the frontal lobe, in the temporoparietal region and in the fusiform gyrus, which is involved in visual recognition and contains a specific area for faces, the ventral fusiform cortex.

The alterations in selective attention, working memory or cognitive flexibility that characterize many Frégoli patients are common consequences of brain lesions and predispose to the appearance of this and other delusions.

Other delusions of false identification

Delusions of false identification consist of the erroneous recognition of people, places, or other stimuli. Among these we find various disorders very similar to Frégoli syndrome.

The best known of these delusions is Capgras syndrome or Sosías delusion, in which a loved one is believed to have been replaced by an identical double. As in the Frégoli syndrome, it is most often a persecutory delusion in which negative intentions are attributed to the supposed impostor.

In the delusion of intermetamorphosis, also described by Courbon, the patient believes that the people around her exchange identity, even maintaining the same appearance.

The syndrome of subjective doubles consists of the belief that one or several doubles with their own personality and body usurp the identity.

• You may be interested in: ""Cotard syndrome": living people who believe they are dead"

Treatment of these syndromes

The cognitive behavioral treatments for delusions focus on cognitive restructuring through the normalization of symptoms, non-confrontational verbal challenge, and reality testing to refute the hypotheses of the customer.

In cases of psychosis, whether or not induced by brain diseases, the symptoms may subside with the use of antipsychotic drugs, which fundamentally modify dopaminergic activity.

Anti-seizure medications They are effective in combating epilepsy, including the delusional symptoms that can occur in the context of this disease.