An Odd Disorder Convinced This Man That All Strangers Were His Crush in Disguise

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In 2010, a 21-year-old man called Mr. A arrived at a psychiatric outpatient service with a rather unusual backstory.

In the period leading up to his admission, according to his case report, Mr. A began using a facial cream that he believed improved his looks and made him more attractive to women. Around the same time, he checked Facebook obsessively, eventually meeting a young woman online. Eager to form a relationship, he began pursuing her — but Mr. A’s romantic overtures were unsuccessful, and the woman withdrew.

And that’s where Mr. A’s tale grows strange: He became convinced that, any time he was contacted by other women on Facebook, they were really that same woman who had originally spurned him. She was just disguising herself, he figured. Indeed, he grew to believe she was applying the same type of facial cream that he used, which allowed her to transform her face. In these new disguises, the woman was now pursuing him.

And so, despite her earlier withdrawal, Mr. A became convinced the woman was still interested in a relationship — just in the form of different people.

At the psychiatric outpatient service, Mr. A showed no abnormalities in his neurological assessments, which included brain scans like a cerebral MRI. After ruling out brain lesions and other problems, doctors diagnosed him with Fregoli syndrome, which falls into a category of conditions known as delusional misidentification syndromes. People with Fregoli syndrome believe that some strangers they meet are actually people they know in disguise. In some ways, it’s the reverse of a better-known condition known as Capgras syndrome, which is when people believe family members or others close to them have been replaced by impostors.

Fregoli syndrome was first described in 1927, when two doctors observed a patient who believed an actress named Robine was continually disguising herself and reappearing in the patient’s life as different personas. (The doctors named the syndrome after Italian actor Leopoldo Fregoli, a renowned quick-change artist in the late 19th and early 20th centuries.) The condition is rare —delusional disorders more broadly are estimated to affect just 0.02 percent of the U.S. population — and researchers have yet to pinpoint an underlying neurological basis for the disease.

But psychologist Stéphane Thibierge, research director at the Université Paris-Diderot, believes that the disorder tells us something essential about human perception: specifically, that identification and recognition are two different processes. In a paper published last year in The Journal of Mind and Behavior, Thibierge and his co-author explained that patients with Fregoli syndrome have no trouble identifying a person, but have trouble recognizing that the person is a separate entity. More plainly, these people can identify differences in appearance, but cannot then sort some of these appearances into unique identities.

The cases of Fregoli syndrome “show us that human perception is a construction,” Thibierge says. “We can’t consider it just as simple ‘data.’”

To illustrate this, consider another misidentification syndrome, prosopagnosia. In this neurological disorder, better known as face blindness, people’s brains aren’t wired to automatically identify and file away each face — they have trouble reading the “data.” But in delusion disorders like Fregoli syndrome, people have no such neurological difficulties — the problem is that they make false assumptions about the faces they recognize. The identification is fine; it’s the recognition that’s faulty.

The distinction is crucial, as it suggests that our ability to place people in their proper context is a multi-step process. Delusion misidentification syndromes point to different places in the brain where that process can break down — in Fregoli syndrome, it happens after the initial visual identification of a person, and before the correct recognition of that person as a separate, unique entity.

Mr. A’s case is also fascinating for another reason: the fact that his symptoms were tangled up in his use of the internet. “This is the first case reporting emergence of Fregoli syndrome in association with using social network Web sites,” the report’s authors wrote.

Researchers are still not sure how delusion misidentification syndromes might manifest on social media, but Andor Simon, one of the co-authors of Mr. A’s case report and a psychiatrist at the University of Basel in Switzerland, explained that it likely complicates the problem. “Patients with delusional misidentification disorder are actually expected to re-experience such delusional thoughts within these new and enormous networks,” he said. That’s because social networking sites are typically an amalgam of the strange and the familiar, with new contacts and old friends mixed together.

“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,” the report continued. In other words: On the one hand, this means that the internet may offer researchers another way to study our identification and recognition systems, as well as what happens when they go haywire. On the other hand, though, it also means that as the way we communicate online continues to evolve, our understanding of Fregoli syndrome — already shaky as is — will have to catch up.

The Man Convinced That Strangers Were His Crush in Disguise