False identification delusions are a particularly striking type of delirium because it involves ignoring others, sometimes even oneself.
In this article we will talk about symptoms and causes of Frégoli syndrome, One of the most popular misidentification delusions.
What is Frégoli syndrome?
Frégoli syndrome is a delirium consisting of the belief that one or more known people are being usurped by someone who wears a costume or changes their appearance in some other way.
It is often associated with a paranoid component, because people with Frégoli syndrome often think that the impersonator is chasing them to hurt them or at least to hurt them.
It is a monothematic illusion classified in the category of what we call “illusions of false identification”. It is associated with disorders such as psychosis, dementia and brain damage.
Like other similar delusions, Frégoli syndrome it is associated with a lack of facial recognition: The perception of unfamiliar faces would trigger a misidentification of these with more familiar people, generally relatives or celebrities. It can also be influenced by other senses, such as hearing and smell.
History of the disorder
Frégoli syndrome was described by two French psychiatrists, Courbon and Fail, In his 1927 article Syndrome d’illusion de Frégoli et schizophrenia (“Syndrome d’illusion de Frégoli et schizophrenia”).
Courbon and Fail told the story of a 27-year-old housemaid, avid theater fan, who believed that famous actresses Robine and Sarah Bernhardt disguised themselves as people she knew 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 talent for transformism, imitation and disguise.
Oliver Sacks popularized this delirium through his 1985 book “The Man Who Mistaken His Wife for a Hat”.
Since its description in 1927, only 40 cases have been documented worldwide, although the disorder is believed to be likely underdiagnosed.
Signs and symptoms
People with Frégoli syndrome usually have a series of changes that predispose to the onset of symptoms; in particular, deficits in visual memory, self-monitoring, executive functions, cognitive flexibility and self-awareness were detected.
This means that they may have more difficulty remembering visual information, controlling and supervising their own behavior, differentiating themselves from others, or thinking about multiple concepts at once.
Frégoli syndrome too it is more likely in people with a history of seizures, especially if it occurred during epileptic seizures.
The underlying symptoms of this disorder often coexist with hallucinations and other delusions. The delusions are unshakeable beliefs although there is some evidence to refute them definitively, 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 delusion of persecution.
In diseases that affect the brain, especially dementia, it is common for psychotic delusions such as Frégoli’s to occur as the brain damage progresses.
Another common cause is levodopa treatments, 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; in particular, cases have been documented in people with lesions of the frontal lobe, in the temporoparietal region and in the fusiform gyrus, Which is involved in visual recognition and contains a specific area for the 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 damage and predispose to the onset of this and other delusions.
Other delusions of false identification
False identification illusions consist of the mistaken recognition of people, places or other stimuli. Among these are several disorders very similar to Frégoli syndrome.
The best known of these delusions is Capgras syndrome or social delirium, In which a loved one would have been replaced by an identical duplicate. As in Frégoli syndrome, it is most often an illusion of persecution in which negative intentions are attributed to the alleged impostor.
In the delirium of intermetamorphosisAlso described by Courbon, the patient feels that the people around him exchange their identities, even maintaining the same appearance.
The syndrome of subjective doubles consists of the belief that one has one or more doubles with his own personality and his body which usurp the identity.
Treatment of these syndromes
Cognitive-behavioral treatments for delusions focus on cognitive restructuring through symptom normalization, non-confrontational verbal challenge, and reality testing to refute client assumptions.
In the event of psychosis, whether or not induced by brain diseases, the symptoms may disappear with the use of antipsychotic drugs, which fundamentally alter dopaminergic activity.
Anticonvulsant drugs they are effective in combating epilepsy, including the delusional symptoms that can occur with this disease.