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Letter to the Editor

A "Contemporary" Case of Frégoli Syndrome

Tanya Kochuparackal, MD, and Andor E. Simon, MD

Published: January 26, 2012

A “Contemporary” Case of Frégoli Syndrome

To the Editor: Frégoli syndrome belongs to the group of delusional misidentification syndromes and was first described in 1927.1 The hallmark of Frégoli 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 Frégoli 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.

Frégoli 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 Frégoli 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 Frégoli 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 Frégoli syndrome.


1. Courbon P, Fail G. Syndrome d’ llusion de Frégoli et schizophrenie. Bull Soc Clin Med Ment. 1927;15:121-124.

2. Christodoulou GN, Margariti M, Kontaxakis VP, et al. The delusional misidentification syndrome: strange, fascinating, and instructive. Curr Psych Rep. 2009;11(3):185-189. doi:10.1007/s11920-009-0029-6

3. Walther S, Federspiel A, Horn H, et al. Performance during face processing differentiates schizophrenia patients with delusional misidentifications. Psychopathology. 2010;43(2):127-136. PubMed doi:10.1159/000277002

4. Ellis HD, Young AW. Accounting for delusional misidentifications. Br J Psychiatry. 1990;157(2):239-248. PubMed doi:10.1192/bjp.157.2.239

Tanya Kochuparackal, MD

Andor E. Simon, MD

Author affiliations: Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Psychiatric Outpatient Services, Department of Psychiatry, Bruderholz (Drs Kochuparackal and Simon); and University Hospital of Psychiatry, University of Bern, Bern (Dr Simon), Switzerland.

Potential conflicts of interest: None reported.

Funding/support: None reported.

Published online: January 26, 2012.

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