Delusions of false identification are a type of delusion that is especially striking since it involves the erroneous recognition of other people, sometimes even oneself.
In this article we will talk about Symptoms and causes of Frégoli syndrome one of the most popular false identification delusions.
Frégoli syndrome is a delirium consisting of belief that one or more known people are being impersonated by someone who uses a disguise or otherwise changes appearance.
It is frequently associated with a paranoid component, since people with Frégoli syndrome usually 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 injuries.
Like other similar delusions, Frégoli syndrome is associated with a deficit in face recognition : the perception of unknown faces would trigger the erroneous identification of these with other more familiar ones, usually loved ones or celebrities. It can also be influenced by other senses, such as hearing and smell.
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 explained the case of a 27-year-old domestic servant, a big theater fan, who believed that the famous actresses Robine and Sarah Bernhardt dressed up as people she knew to negatively influence her thoughts and behavior – for example 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 skill at cross-dressing, imitation and disguise.
Oliver Sacks popularized this delusion through his book “The Man Who Mistook His Wife for a Hat,” in 1985. Since then, it has inspired several films, such as Total Challenge, 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 them 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 monitoring their own behavior, differentiating themselves from others, or thinking about several concepts at once.
Frégoli syndrome also more likely in people with a history of seizures especially if they have occurred during epileptic seizures.
The core symptoms of this disorder often coexist with hallucinations and other delusions. The delusions are beliefs that are held immovably 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 Frégoli syndrome
Psychosis is one of the most common causes of Frégoli syndrome. The 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 Frégoli’s to occur as the brain involvement progresses.
Another common cause is levodopa treatments. a catecholaminergic drug primarily used 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 trauma 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 the fusiform gyrus which is involved in visual recognition and contains a specific area for faces, the ventral fusiform cortex.
Alterations in selective attention, working memory or cognitive flexibility that characterize many Frégoli patients are common consequences of brain injuries 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 Frégoli syndrome, it is most often a persecutory delusion in which negative intentions are attributed to the supposed imposter.
In the delirium of intermetamorphosis also described by Courbon, the patient believes that the people around him exchange identities, even if they maintain the same appearance.
The syndrome of subjective doubles consists of the belief that one has one or more doubles with their own personality and body that usurp their identity.
Treatment of these syndromes
Cognitive-behavioral treatments for delusions focus on cognitive restructuring through normalization of symptoms, non-confrontational verbal challenge, and reality testing to refute the client’s hypotheses.
In cases of psychosis, whether or not induced by brain diseases, the symptoms can 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.
