Fregoli Syndrome

What is Fregoli syndrome?

Fregoli syndrome (Fregoli delusion) is the belief that a stranger is a familiar person who changes their appearance or is in disguise.

Fregoli syndrome can make it feel like you’re in the audience watching a play. People change their costumes and voice pitch to act like someone else and hide their true identity. This happens because your brain has trouble identifying the people around you. As a result, you might feel anxious, agitated and paranoid because you think other people are deceiving you.

Fregoli syndrome is a type of delusional disorder or misidentification syndrome.

How rare is Fregoli syndrome?

Fregoli syndrome and other types of delusional disorders aren’t common. The exact prevalence around the world is unknown.

What are the features of Fregoli syndrome?

The features of Fregoli syndrome include the belief that:

• A familiar person changes their appearance or is in disguise as a stranger or acquaintance.
• The familiar person in disguise is following you.
• The familiar person in disguise is trying to harm you.
• The people you know are deceiving you.

These features are known as delusions of misidentification. They make it difficult to distinguish between a stranger and someone you know. Fregoli syndrome misidentification can also involve animals and inanimate objects.

While your feelings are real, the people you know aren’t shape-shifting, getting cosmetic surgery or changing costumes to trick or hurt you. Accepting this can be difficult because your beliefs and feelings are so strong. A healthcare provider can help you when you’re ready.

What are the symptoms of Fregoli syndrome?

In addition to believing a stranger is someone you know in disguise, you may also experience the following symptoms with Fregoli syndrome:

• Difficulty sleeping.
• Hallucinations (hearing or seeing things that aren’t there).
• Memory loss.
• Mild cognitive impairment.

What causes Fregoli syndrome?

The exact cause of Fregoli syndrome isn’t well understood, as cases aren’t common. Research does suggest it could happen with:

• Levodopa: This is a medication that treats conditions like Parkinson’s disease. Fregoli syndrome may be a side effect of taking this medication.
• Traumatic brain injury: Damaged brain tissue (lesion) from an injury to the right frontal lobe, the left temporal lobe or the left parietal lobe may lead to Fregoli syndrome symptoms. Certain parts of your brain are responsible for allowing you to recognize and identify others.
• Other conditions: Fregoli syndrome can happen alongside other conditions like schizophrenia or dementia.

What are the complications of Fregoli syndrome?

Fregoli syndrome can significantly impact your mental health and emotional well-being. It’s common to experience strong feelings when you think that someone is following you, deceiving you or trying to harm you. As a result, you may act aggressively or violently toward a misidentified person. You’re also more at risk of experiencing suicidal thoughts with Fregoli syndrome.

If you’re thinking about hurting yourself or others, don’t hesitate to call or text 988 (U.S.). This is the Suicide & Crisis Lifeline. Someone is available to talk with you, no matter what situation you’re in, 24/7.

How is Fregoli syndrome diagnosed?

A healthcare provider, usually a psychiatrist, will diagnose Fregoli syndrome after a mental health evaluation and testing. Your provider will learn more about your feelings, beliefs and symptoms.

Testing can determine a possible cause (like detecting a brain lesion, for example) or rule out conditions with similar symptoms. Your provider may order the following tests to make a diagnosis:

• An MRI or a CT scan.
• An electroencephalogram (EEG).

How is Fregoli syndrome treated?

A healthcare provider may recommend a combination of the following to manage Fregoli syndrome symptoms:

• Medications (antipsychotics, antidepressants and/or antiseizure medications).
• Cognitive behavioral therapy.

It’s common for your provider to adjust the dosage or type of medication they prescribe, either to treat Fregoli syndrome symptoms or its cause, especially if levodopa is the culprit. These changes help your provider create a treatment plan that’s specific to what your body needs to feel better, as there isn’t a one-size-fits-all treatment for Fregoli syndrome.

In addition, some people find hypnosis to be helpful alongside medications and therapy.

Can Fregoli syndrome be prevented?

As the cause of Fregoli syndrome isn’t well studied, there’s no sure way to prevent the condition.

What’s the outlook for Fregoli syndrome?

Many people experience a positive outlook when they follow their healthcare provider’s treatment plan. Your symptoms may decrease over time as you learn coping and management strategies.

As complications of Fregoli syndrome may lead to unsafe situations, keeping up with your treatment plan leads to the best outcome. Stopping treatment, even if you feel better, can negatively impact your health. Your symptoms may return if you stop taking prescribed medications or delay follow-up appointments with your providers.

When should I see a healthcare provider?

You know yourself best. If you feel that something’s not right with how you see others or that someone is trying to hurt you, seek help. A healthcare provider will offer a safe space for you to explain what’s going on. They’ll recommend treatment options so you can feel better.

What questions should I ask my healthcare provider?

• What’s causing my symptoms?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• How soon until I feel better?
• Are there alternatives to levodopa if that medication causes Fregoli syndrome symptoms?