Studies show that one in six people who have Alzheimer or other kinds of dementias suffer from delusional misidentification syndromes like Capgras, Fregoli Syndrome (FS), intermetamorphosis, and subjective double syndromes.
FS was named after a renowned actor Leopoldo Fregoli.
In the early 1900s, he launched shows where he entertained audiences using his uncanny ability to disguise himself in different voices and appearances.
He would effortlessly change from one character to another with a complete change of clothes. FS was first mentioned in 1927 by two French psychiatrists, Fail and Corbin, in a paper that detailed the case of a twenty-seven-year-old woman who believed Fregoli appeared to her every day in different forms.
What is Fregoli Syndrome?
It is a condition associated with aggressive behavior and verbal threats. Also referred to as the delusion of doubles, the rare disorder causes a person to believe that different people appear as one individual by changing appearances or disguising himself.
This class of delusional syndrome is characterized by hostility towards misidentified individuals or things, paranoia, and unpredictably harsh behavior, ranging from verbal threats to inflicting severe physical injuries.
It’s also quite difficult to find a doctor who can correctly assess and diagnose the condition.
In my case I would misidentify friends, family, and strangers, viewing them as imposters in disguise. Nobody could convince me otherwise, regardless of any evidence they offered. I had developed the condition after a tragic road accident that caused the death of Greg, my fiancé.
Other hospitalized patients who have the syndrome misidentify doctors and nurses, leading to assaultive behavior towards them. They also believe that they can detect subtle effects that other people can’t. Dr. Karel de Pauw, a psychiatrist, observed that patients think that the ‘imposter’ has taken on different cunning disguises. This revelation was made after observing a ten-year-old delusional child.
The disorder is explained by associative nodes that act as links (biological) of information about other people with a certain familiar face to the patient. I always thought everybody was my late fiancé, Greg. For any recognizable face, I would recall him and call them as such. The characteristic violence evidenced by individuals who have FS has been understudied.
Causes
Traditional models described FS as poor interpretations of previous experiences (the endorsement model) or the flawed way that an individual forms new beliefs (the explanationist model). The models explained the causes of FS inaccurately as they were not based on scientific evidence.
Today, however, various neurological approaches attempt to explain the real causes of the condition by studying dysfunctional areas of the brain that cause FS. As such, studies show two leading causes of FS:
Levodopa Treatment
It is commonly used to treat dopamine-responsive dystonia, and Parkinson’s disease is known to cause FS. Clinical studies indicate that the use of the treatment causes delusion and visual hallucinations that FS is associated with. In fact, prolonged use of this drug causes delusions to occupy his mind most of the time. Experimental studies show a reduced number of delusions when the concentration of the levodopa is minimized.
Traumatic Injury of the Brain
Injury to the left temporal and right frontal, parietal areas causes FS. Right hemispheric lesions are particularly associated with FS. Overactivity in the perirhinal cortex also accounts for the condition. The injury to the right frontal, parietal area of my brain also caused severe impairment of the executive and memory functions.
Tests showed that I could pay attention and that the visuomotor processing speed was normal. However, I made lots of errors when I was required to engage in detailed tasks and tests that involved auditory targets.
Symptoms of Fregoli Syndrome:
- Reduced visual memory.
- Delusions and hallucinations.
- Increased seizures.
- Inability to monitor oneself.
- Epileptogenic episodes.
- Lack of awareness.
- Failure to exhibit normal behavior and perform conclusive thoughts.
Treating FS
There are several venues of interest to consider in the treatment of Fregoli Syndrome:
- Habilitation Therapy
Just like other psychotic syndromes, it is important to try non-medication remedies first unless there are other triggers are causing violent behavior.
In my case, confronting delusional persons with reality was very ineffective as it only added to my distress and fear. Habilitation therapy achieved greater success. As the doctor helped re-live my experiences, I could develop positive emotional experiences.
He appreciated my experience in the presence of an intruder and reassured me of safety.
If the suspected ‘intruder’ was present, the problem was solved by asking him to leave briefly and enter the room with a warm smile. Sometimes, I would respond more to voice recognition than visual identification, hence the suspected ‘imposter’ succeeded by talking before making an appearance.
- Medication
Antipsychotic medicines are used to treat FS. A doctor will recommend this remedy when other less risky approaches have failed. Cognitive enhancers like Donepezil may be prescribed though their effectiveness in treating behavioral symptoms is restricted.
Find a doctor who can also prescribe antidepressants and anti-seizure drugs to fight other symptoms of the disorder. Family members of the patient should go through counseling to help them deal with his violence or other stunts.
More Real-Life Examples
John du Pont’s Fregoli Syndrome is perhaps the most popular given his unusual behavior and struggles with alcohol. At first, his mother helped him cope with the syndrome, but as he grew older, he demonstrated more paranoid behavior.
John first exhibited the syndrome when he erected a twelve-foot steel fence on his estate and topped using barbed wire and several German shepherd dogs to protect him during the Patty Hearst kidnapping.
His spouse, Gale divorced him after six months of marriage and claimed that John believed she was a Russian spy and vowed to kill her.
Pont’s behavior changed drastically after the death of his mother in 1988 when some members of his proprietary Team Foxcatcher accused him of sexual harassment.
Some athletes cited Pont’s ill-behavior of grabbing their private parts. His condition progressed when he hired a security firm and drove an armored personnel carrier into his estate, as well as his apparent fear of the color black.
He later killed his lifelong friend Dave Schultz. Before the murder, John complained of seeing ghosts on walls and bugs under the skin and instructed people to address him as His Holiness.
Conclusion
Dealing with FS syndrome can be challenging for the patient and his caregivers. However, habilitation therapy and learning how to deal with the patient goes a long way managing the condition. In my case, the doctor also prescribed antipsychotic drugs and anti-depressants.