For when the “xxxtra email security” site setting is enabled, I like the hipchat approach otherwise, and I think it’s smart. Via email to the specified email address:
Title: Account already exists at {site}
You just tried to create an account at {site}. However, an account already exists for name@example.com.
I added support to the change email form in user preferences. It will respond as if it was successful, and send the email to the owner of the other account.
You just tried to create an account at Localhost Discourse, or tried to change the email of an account to doggy@woof.com. However, an account already exists for doggy@woof.com.