Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 9 4 2025 02 22 177 179 Farnaz Ghannadi Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammadsaleh Talebinejad Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Morvarid Ahadi Psychiatry Department, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. 2024 12 05 2024 12 18 As a rare subtype of delusional misidentification syndromes (DMSs), Fregoli Delusion involves the belief that two or more individuals are actually the same person disguised as another. In this case report, a 23-year-old male presents with Fregoli Delusion, self-inflicted harm, and a history of being kidnapped and abused. While the patient had abstained from alcohol and drugs for two years, neuroimaging revealed non-specific developmental anomalies, adding to the complexity of the clinical situation. Diagnoses and treatments are complicated by the coexistence of psychotic symptoms, mood dysregulation, and complex delusional constructs. A combination of antipsychotic medication and cognitive behavioural therapy is more effective in treating schizophrenic patients. It is important to closely monitor this patient due to their history of non-adherence to their treatment plan and drug abuse. As a result of this situation, trauma-focused care and personalized interventions are necessary, as well as additional research to enhance the treatment of Fregoli Delusions resulting from this situation. https://crcp.tums.ac.ir/index.php/crcp/article/view/1005 https://crcp.tums.ac.ir/index.php/crcp/article/download/1005/680