Erotomania and Delusional Love

Delusions are fixed, false beliefs held with conviction that persists despite evidence to the contrary. They occur as part of various conditions such as severe depression, schizophrenia, or bipolar disorder, or they can occur independently.

Some delusions might not cause difficulties, but some do, resulting in conditions known as “delusional disorders.” These are conditions in which long-standing delusions are the only, or the most conspicuous, clinical characteristic, and where the person does not have another condition such as schizophrenia, a mood disorder, or an organic (physical) brain disorder (e.g., a tumor) that better accounts for the delusions.

In delusional disorder, the delusions can vary in content; they can be paranoid, hypochondriacal (i.e., health-focused), grandiose, or jealous in character, among many other possibilities. There may be other symptoms from time to time, including low mood or hallucinations (i.e., perceptions without appropriate external stimuli, often consistent with the delusion).

For a diagnosis of delusional disorder, the delusions must be present for three months and must not be attributable to the person’s culture or sub-culture. Onset can be later in life (late paraphrenia), and delusions can focus on bodily concerns (dysmorphophobia). Some forms, such as delusional jealousy, are associated with significant risk and require careful treatment and monitoring.

What Is Erotomania?

Many of the key issues relating to delusional disorder can be demonstrated by considering one of the better-known variations of delusional disorder, erotomania. This is a relatively rare condition that occasionally commands public attention due to its relationship with stalking.

References to erotomania are found in the works of Hippocrates, Plutarch, and Galen, among others. In 1921, Bernard Hart, an English psychiatrist, using the language of the times, described “old maid’s insanity,” a condition that is very similar to what is now known as “de Clerambault’s syndrome” or erotomania.

In erotomania, the patient (subject) develops the delusional belief that they are loved from afar by another person (object). The subject is usually female, though males dominate forensic samples (e.g., in courts, prisons, or secure hospitals). The object is commonly perceived to belong to a higher social class, appears unattainable (e.g., a teacher), and is generally believed to be the first to declare love. The patient might cite farfetched proof of the object’s affections and paradoxically interpret rejections as covert declarations of love, despite much evidence to the contrary.

The delusional love in erotomania is usually intense and might or might not be reciprocated by the patient. Some people with erotomania only come to attention when they engage in disruptive or even criminal acts, such as repeated emailing, persistent telephoning, or other forms of harassment. There are also relationships between erotomania and both stalking and homicide.

How Common Is Erotomania?

The incidence of erotomania is not clear but appears to be low.

The condition can coexist with other psychiatric disorders, including schizophrenia, bipolar disorder, Fregoli syndrome (a delusion that different people are a single person in disguise), Capgras syndrome (a delusion that an identical impostor has replaced someone), and folie à deux (shared delusions or hallucinations).

Erotomania can also occur as part of the clinical picture in Alzheimer’s disease, epilepsy, meningioma (a type of brain tumor), head trauma, and alcoholism, as well as some drugs.

There are many psychological theories about erotomania. Some commentators note that the condition often arises in the context of loneliness and social isolation, and it has even been suggested that it can compensate for disappointments in life.

Treating Delusions of Love

Management of erotomania is based on treating any other associated condition in the first instance (e.g., depression). It has been suggested that delusional disorders (including erotomania) respond preferentially to pimozide, a specific antipsychotic medication that is no longer commonly used.

More recently, there has been increased interest in using newer, atypical antipsychotic medications in the treatment of erotomania and other delusional disorders. In addition, psychological and social treatments can be very useful in combination, particularly among people whose delusions are maintained, at least in part, by social isolation or loneliness.

Clinicians describe limited success in the treatment of erotomania, suggesting that delusions tend to persist or can recur. Nonetheless, treatment tends to reduce socially unacceptable behaviors, even though the delusions themselves may continue. It has also been suggested that controlled erotomania might provide solace to lonely individuals who would otherwise feel entirely unloved.

The Future of Erotomania

It is possible that, in time, advances in neuroscience might demonstrate that primary erotomania is biologically indistinguishable from other conditions or mental illnesses. Another possible development is the increased use of newer antipsychotic medications and other treatments in managing erotomania and other delusional disorders, along with psychological therapies, such as cognitive-behavior therapy (CBT) for specific delusions.

If erotomania pursues a chronic or relapsing course, it is hoped that the relatively attractive side-effect profile and acceptability of these approaches will enhance treatment programs, reduce risk, and improve outcomes for all affected.