Understanding Fregoli Syndrome: A Rare Delusional Misidentification Disorder

Fregoli syndrome is a rare and complex psychiatric condition characterized by the delusional belief that different individuals are actually a single person in disguise or constantly changing appearance. The syndrome is named after Italian stage performer Leopoldo Fregoli, renowned for his rapid costume changes—mirroring the central delusion of the disorder. It is categorized under delusional misidentification syndromes (DMS), which also include Capgras and intermetamorphosis delusions.

Fregoli syndrome is often associated with underlying neurological and psychiatric conditions such as schizophrenia, bipolar disorder, dementia, epilepsy, and traumatic brain injuries. Recent neuroimaging studies suggest abnormalities in the right frontal lobe, fusiform gyrus (crucial for facial recognition), and the amygdala, which processes emotional responses. These dysfunctions may impair the brain’s ability to distinguish familiar from unfamiliar faces and lead to false associations of identity.

Patients with Fregoli syndrome may display heightened paranoia and anxiety, convinced that a persecutor is constantly following them in different forms. This can lead to social withdrawal, aggression, or even violence in extreme cases. The delusion is often persistent and resistant to logic or contradictory evidence, making treatment particularly difficult.

Management typically involves a combination of antipsychotic medications—such as risperidone or olanzapine—and cognitive behavioral therapy to help challenge and restructure irrational beliefs. In cases with an organic cause like brain trauma, addressing the underlying condition may improve symptoms. Early detection and multidisciplinary intervention are critical to preventing deterioration in mental and social functioning.

Understanding Fregoli syndrome offers insight into how identity, perception, and memory intertwine in the human brain. It also underscores the importance of empathetic, personalized care in psychiatry, especially for those grappling with such disorienting and isolating delusional experiences.
Understanding Fregoli Syndrome: A Rare Delusional Misidentification Disorder