Fregoli Delusion

What is Fregoli Delusion?

The Fregoli Delusion is a condition in which the subject believes a stranger is someone known to him/her and is in disguise.

While the stranger isn’t recognizable, the subject believes that this person is someone of personal acquaintance disguised for the purpose of spying on the subject. Taking the delusional disorder further, the subject believes that this person, or a group of persons, has been changing disguises to appear as a series of different strangers with whom he or she has encounters throughout daily living.

Additionally, someone who suffers from Fregoli Delusion will recall places and events inaccurately, attributing characteristics to objects that are false.

Paranoid delusions stemming from this condition are suspected to be induced by brain lesions and affect the brain’s facial recognition abilities.

The condition was named after Leopoldo Fregoli, who was a renowned Italian stage actor. The performer earned recognition for his ability to change disguises quickly during his performances.

Fregoli Delusion Symptoms

As previously mentioned, delusions are the key component of this condition and fuel ideas that strangers are actually people the patient knows from his/her life. While the delusions and associated paranoia are the key factors, there are more symptoms that are common to the Fregoli Delusion.

Visual Memory Deficit

More commonly known as retrograde amnesia, this affects the subject’s ability to recall memories prior to a traumatizing incident. For example, head trauma might result in an accident victim losing the ability to recognize family members or co-workers.

Self-Monitoring Deficit

Normally, people are aware of their own affectations and observe how they use motions, habits, and expressions in the presence of others. Lacking this conscious exertion of control indicates a predilection for the Fregoli Delusion.

Deficit in Self-Awareness

With Fregoli, the subject lacks the awareness that he/she is a separate, conscious individual. The subject will perceive a larger collective of which he/she is a part and will feel unable to express freedom of choice.


Tied to delusions, the subject experiences visual hallucinations that reinforce the idea of a conspiracy. Individuals unknown to the subject are perceived as disguised agents intent on observing his/her actions.

Deficit of Executive Functions

Associated with higher intelligence, executive functions generally control the subject’s inhibitions. A lack of control here indicates a tendency to act on impulses without rational thought. It also suggests an inability to filter out nonsensical thoughts and exterior distractions, during the thought process.

Cognitive Flexibility Deficit

Someone who suffers from Fregoli Delusion is incapable of thinking about more than one thing at a time. Also, the subject will find it difficult to entertain multiple concepts simultaneously. They will be easily distracted.

History of Seizures

Subjects may have had past seizures and/or Epileptic episodes.

Fregoli Delusion Causes

There are a number of factors that contribute to Fregoli Delusion:

Levodopa Treatment

Also known as L-DOPA, this is a common treatment for Parkinson’s Disease. While L-DOPA does minimize the symptoms of Parkinson’s, it also causes the patient to experience delusions and, in some instances, visual hallucinations.

Prolonged use of the treatment will cause the patient to become obsessed with the delusions, though discontinued use of Levodopa will decrease the delusional side effects. Research reveals that anti-Parkinson treatments are the leading causes of Fregoli Delusions.

Traumatic Brain Injury

Specifically, damage to the right frontal lobe and the temporo-parietal area of the brain can result in Fregoli Delusions. Patients with these types of injuries demonstrated deficits in executive and memory functions, as well as an inability to complete complex tasks.

Fusiform Gyrus Lesions

Damage to this portion of the brain inhibits the subjects ability to access long-term memory. As such, visual recognition is impaired and patients may have increased difficulty with facial recognition.

Abnormal P300 – The P300 test measures working memory in a subject. Tests comparing Delusional Misidentification Syndrome (DMS) patients to non-DMS subjects found that the latter group tested lower in memory performance than the control group.

This suggests that DMS patients have trouble concentrating on a stimulus. In turn, the researchers found that a neurological degeneration of the brain’s right hemisphere was responsible for Fregoli Delusions and similar Delusional Misidentification Syndromes.

Fregoli Delusion Treatments

The greatest obstacle in treating Fregoli Syndrome is in identifying and diagnosing the condition.

Once the patient is under the care of a physician, Fregoli can be managed with medication. Typically, antipsychotic drugs will alleviate the delusions, paranoia, and hallucinatory symptoms. Depending on the severity of the condition, some subjects will also be prescribed anticonvulsants and antidepressants.

Trifluoperazine is sometimes prescribed, though usually only when other forms of mental illness are also present.

Fregoli Delusion Prevention

Currently, there is little in the way of preventing the onset of Fregoli Delusions, other than avoiding the previously mentioned root causes of the syndrome. However, the treatments used to eliminate the symptoms of Fregoli and other DMS conditions have proven effective in stalling more symptoms from surfacing.

Case Studies of Fregoli Delusion

While incidents of Fregoli Delusion aren’t as common as other mental disorders, they have been documented and shared by psychiatrists specializing in Delusional Misidentification Syndromes. For instance, Dr. Karel de Pauw worked with a 10-year-old girl who demonstrated Fregoli Delusions.

At one point, the girl was convinced that a nurse in the hospital was actually her father in disguise, trying to spy on her. When Dr. Pauw pointed out that the nurse was a female and looked nothing like her father, the patient responded that her father was very clever.

That young girl is one of a very few sufferers of Fregoli Syndrome, or so it’s believed. There have only been 40 cases of Fregoli reported at this time. Even so, it’s believed that many more cases go unreported and can be recognized in a variety of forms.

Fregoli Delusion has even been found online with social media playing a part in some delusions.

Andor Simon had one such case. Dr. Simon is a psychiatrist and a senior lecturer at the University of Bern, but it was in his capacity as a therapist at an outpatient service for adolescents and adults suffering from psychosis that introduced him to his Fregoli patient.

The case involved a 21-year-old male patient, suffering from unrequited love. While the young man was deeply in love with a women in his same age group, she had declined his affections. He confessed to Dr. Simon that, although she claimed to have no interest in him, he felt she was stalking him on Facebook. He believed that all of his friends on the social media site were actually this girl attempting to spy on him. He explained that she used a special face cream to look like those different people. By feeding into this delusion, the young man could convince himself that she was really interested in him, after all.

One of the most widely known cases of Fregoli Delusion revolves around 64-year-old “Betty” from the U.K.’s Midlands. An unexpected stroke left Betty with some brain damage, creating a perfect storm for the onset of Fregoli.

Once she returned home, Betty became convinced that her cousin and her cousin’s husband had begun spying on her, resorting to disguises to try to fool her. Betty told her therapist that the couple employed the use of dark glasses, wigs, and false beards to hide themselves, as they spied on her. She added that the pair had the ability to alter their gender and change their clothing at a moment’s notice.

In one day, Betty said she had seen the two posing as schoolgirls, a man and his dog, and, later, as two well-dressed women of high society. She also told doctors that the couple frequently changed cars, hoping to follow her around town without being recognized.

Betty’s eccentricities took a dark turn, when she began acting on her delusions. First, she began confronting random drivers in traffic, accusing them of following her. Later, Betty began filing police reports against her cousin to initiate an arrest.

As Betty received treatment, the medication eliminated her delusions and hallucinations. However, even as her mind cleared, she refused to admit to any deficits. Instead, she maintained that her tormentors had simply gone into hiding to avoid capture.

Psychologist Robyn Langdon, who lectures at Macquarie University in Australia, believes Fregoli Delusions are the result of a progressive obsession. Langdon says an individual spends more time thinking about a specific person, which, in turn, causes the subject’s long term memory to become hyperactive, firing off thoughts and memories about that one person. It advances to the point that the subject thinks every person is the specific individual from their thoughts.

When attention is drawn to the fact that these strangers look nothing like the person in question, the subject is forced to come up with qualifiers to explain the differences.

Langdon says this is when Fregoli Delusions begin to form.

Professor Langdon says Betty’s behavior is not uncommon. As treatment begins to take effect, many Fregoli patients refuse to admit anything had been amiss, especially under circumstances in which the subjects’ own doctors had become a part of the delusion.

Not all cases of Fregoli Delusions require treatment. Langdon says the symptoms will sometimes go away for no apparent reason. She adds that there’s still much we don’t know about Fregoli and even some of the rare cases may have been misdiagnosed.

Fregoli Delusions in Film and Cinema

While Fregoli Delusions are uncommon, the condition has already been used in the plots of a number of Hollywood films. Possibly the most widely known story arc concerning Fregoli-like symptoms is “Invasion of the Body Snatchers” (1956) and its subsequent remakes. In that story, alien spores recreate human beings, replacing our loved ones and associates with emotionless copies.

“The Stepford Wives”(1975) and “Total Recall” (1990) share similar plots in that those familiar to the lead characters have been replaced.

A more recent film, 2015’s “Anomalisa,” more directly deals with Fregoli Delusion. In the film, British author Michael Stone (David Thewlis) is affected by a version of Fregoli. Accept for one person, Michael sees everyone he meets as the same man and sharing the exact same voice.

If there’s any doubt that writer and director Charlie Kaufman was intending to explore Fregoli with “Anomalisa,” one only need to look deeper at the project. Originally a radio show, Kaufman developed the story for the stage, under the pseudonym of Francis Fregoli. Further, the story takes place at the Fregoli Hotel in the film.

Fregoli Delusion is difficult to diagnose, particularly because sufferers don’t realize there’s a medical condition responsible for creating delusions. As mental illness gains more attention and the associated stigma is eliminated, it may become easier to identify those suffering from Fregoli and other Delusional Misidentification Syndromes. Even today, researchers are continuing to study Fregoli in the hopes of learning more about the condition, including how to identify it more readily and treat it more effectively.

Last Reviewed:
September 22, 2017
Last Updated:
December 22, 2017
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