Understanding Delusions and delusions of misidentification syndrome

You may have heard your friends say delulu is the only solulu, which indicates that being delusional is the only solution to the problem. Often this phrase is used to explain a person’s romantic conflict, that even if the person is a red flag eventually I’ll fix them. But are delusions that simple?  Is being delusional normal or it indicates a possible sign of psychopathology? This article aims to explore the psychopathology of delusions, and their profound impact on the person and family and seeks to shed light on the delusion of misidentification syndrome, a relatively under-researched area. 

What are Delusions?

Delusions are beliefs. The concept of delusion can be understood by three (3) Fs; False, Fixed, and Firmed beliefs that are held on inadequate grounds and are not affected by rational arguments, that means even if you provide logical answers or evidence their belief will remain unshakable and indicate possibilities of mental disorders. For example; A lady might believe that her cancer diagnosis is related to her husband’s sister, having done black magic on her. Many types of delusions are very common in schizophrenia, delusional disorder and other psychotic disorders but delusions are also very common in psychotic depression and bipolar 1 manic episodes. Common delusions which are often seen as a symptom of any serious mental disorders are:

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• Delusions of persecution: Delusions of persecution are the most common in schizophrenia, people with this delusion believe that they are being plotted against, spied on, slandered, threatened, attacked or deliberately victimized. e.g. People are against me, my husband has an affair with my sister and they have planned to kill me. 

• Delusions of reference: In this type of delusion one believes that they are being referred to by others. e.g. people are talking about me, this news channel is playing news about my emotions.

• Delusions of grandeur: It is characterized by believing that one is a specially empowered individual. e.g. I am God almighty, I am the superior 

• Delusions of control: It is characterized by believing that one is being controlled by an external force, known or unknown. e.g. My neighbour is controlling me; my thoughts, speech and also what I think. 

•  Delusion of love (Erotomania): people may believe that Someone from a higher socioeconomic class is in love with him/her. e.g  Katrina Kaif broke up with Ranbir Kapoor because she was in love with me.

• Delusion of infidelity: it is characterized by believing that the sexual partner is cheating and shares many sexual and romantic partners, for which they have no evidence. e.g  My girlfriend is cheating on me

• Delusion of guilt: Patients feel guilty and the guilt is at the delusion level. Even if you try to convince the patient, he doesn’t accept it. e.g. A woman with depression believes that she has been a mad mother. But her children denied it and said that she was a wonderful mother and all of them are well settled.

Types of Delusions

Not all false beliefs are delusions and not every delusion can be necessarily false. Delusions are of two types Bizarre and Non-bizarre:

• Bizarre: Bizarre delusions are beliefs that cannot be accepted as they lack logic and are not possible or can only be true in imaginations and dreams. e.g. whatever I am thinking is being broadcasted on national television, my urine will cause a flood.

• Non-Bizarre: The basic difference between bizarre and non-bizarre delusions is a false belief that can be true in some contexts that are non-bizarre delusions but are not true in reality however it can be true if we think it logically. e.g. my wife is cheating on me, we know it’s a delusion but the idea is logical and can be accepted. 

Delusion: The Two-Factor Theory 

The two-factor theory of delusions has recently gained the attention of new researchers, which indicates that delusions are more to be characterized by two specific factors. 

• Factor 1: Factor 1 talks about the neuropsychological deficits responsible for abnormal data that further results in abnormal contact. The abnormal data leads to unusual or incorrect perceptions.

• Factor 2: Factor 2 is cognitive process either dysfunctional beliefs were supported at an early stage or long-term ignorance of the cognitive deficits in belief. For example, at the initial stage of delusions, the person was encouraged or not given enough attention. 

Recently several new studies of two-factor theories have developed, one such theory is about whether the delusions are pathological or adaptive. In psychiatry, delusions are considered to be pathological only when the belief is the outcome of dysfunctional behaviour or Harmful to the person and others. 

Syndromes under delusional misidentification 

Many categories of delusions are not well researched but they affect several people causing distress in daily life, these are Delusions of Misidentification syndrome. According to psychiatric and neurological literature, there are 12 different misidentification syndrome, however the most common of them all are:

• Capgras Syndrome: People may believe that a similar person has been replaced by an imposter/stranger who has the motive to harm them. e.g. Patients may believe that a stranger has disguised himself as his wife and came with the motive to cause harm.

• Fregoli Syndrome: People may believe that a familiar person has replaced themselves as an imposter/stranger to harm them. e.g. Patients may believe that their father has disguised himself as a teacher to punish him.  

• Syndrome of Intermetamorphosis: Patients may believe that people can transform themselves into others (physically/psychologically). e.g. A patient believes that her husband and his brother have exchanged identities just to have sexual contact.

• Syndrome of Subjective Doubles: People may believe that many false doubles are present and are living their own lives differently. e.g. Patients after committing a crime claim that many doubles of me look the same as me, so the murder is committed by one of my doubles.

These syndromes are very distressing for the person and others as well. Sometimes these patients can show violent behavior.

Case Study

A woman named R needed to be admitted to the health care psychiatric facility by her daughter as she was talking to herself, she created a lot of fuss while admitted to the ward and she assaulted a staff as well, it was not the first time that she was being admitted for the psychiatric problem but earlier she was taken to the hospital as for her schizophrenia, she explained her condition that told that she heard voices which use to insult her and reportedly these voices became frequent and threatening because of which she was hospitalized earlier.

At present, she assaulted a staff of the hospital claiming that he/she is her neighbour MR. T and not the staff. She used to portray her neighbour as her persecutor (one who wants to harm), although there was no direct contact or conflict between the two. In her family history, two of her sisters had psychotic disorder and the birth mother of the case was in a depressive phase.

Reportedly the patient was abused by the husband of the mother and she had the first abnormal episode in 23 years. After several months of treatment, she was discharged from the long-term psychiatric facility after many failures of psychotropic medication trials. 

DIAGNOSIS: Schizophrenia with the delusion of misidentification (fregoli syndrome)

Conclusion

The above case of fregoli syndrome provides an understanding of how the episode of delusion can have a severe impact on a person’s life, his family and the hospital staff. Dealing with any type of delusion is difficult and it requires tailored interventions with medication, hospitalisation, rehabilitation and psychotherapies for the patient to start with their normal life again.