A “Contemporary” Case of Frégoli Syndrome

Abstract

To the Editor: Fregoli syndrome belongs to the group of delusional misidentification syndromes and was first described in 1927.1 The hallmark of Fregoli syndrome is the belief that a familiar person is disguised as a strange person, ie, the familiar person has taken on a different physical appearance but remains the same person psychologically. The syndrome has been associated with organic cerebral dysfunction, in particular of the right hemisphere; however, most cases occur in the setting of schizophrenia.2,3 We report the case of a patient with schizophrenia who developed Fregoli syndrome within the context of using social networking Web sites. Case report. Mr A, a 21-year-old man, was referred to our psychiatric outpatient service in 2010 with a first episode of schizophrenia (DSM-IV criteria). He had developed the belief that his daily facial cream strongly attracted female students and claimed that this cream was able to perfect his facial look. He spent an excessive amount of time on Facebook, where he met a young woman with whom he wished to engage in an intimate relationship, but the young woman withdrew. Subsequently, he developed the belief that each time he was contacted by other young women via Facebook, it was in fact the young woman with whom he had been in contact before and who now was disguising herself. He strongly believed that she was applying the same cream as he did himself to transform her facial looks. Thus, he was convinced that, despite her withdrawal, she was actually interested in pursuing a relationship with him. Full neurologic assessments, including cerebral magnetic resonance imaging, revealed no abnormalities. Fregoli syndrome has been associated with some degree of objective face-processing impairment.3,4 It is understood as a syndrome of hyperidentification caused by a breakdown of the identification process, thus leading to the inability to attribute uniqueness to a specific person.2 As in the present case, hyperidentification may not be limited to one single person only.2 This is the first case reporting emergence of Fregoli syndrome in association with using social network Web sites. As these networks generally feature portraits of familiar persons and strangers alike and are massively used today throughout the world to initiate and foster social contacts, the combination with Fregoli syndrome is intriguing. To what extent this shift in social behavior will be paralleled by a shift of context in which this disorder occurs remains an open yet tempting question that may be answered by further reports and case studies of Fregoli syndrome.