Berrios and N Kennedy outlined in ‘Erotomania: a conceptual history (2002)7
several periods of history through which the concept of erotomania has changed.
historical convergences are thus identified in the history of erotomania:
According to the
first, which lasted from classical times to the early 18th century,
erotomania was a general disease caused by unrequited love.
According to the
second, erotomania was a disease of excessive physical love (nymphomania) and
this view remained active well into the 19th century.
convergence focuses on the view that erotomania is a form of mental disorder
and this was held throughout the 20th century.
The fourth and
current definition (a development of the third stage) sees erotomania as ‘a
delusional belief of being loved by someone else.’
incidence of erotomania is not known. It does not appear to be confined to any
one culture, society, continent, age, sex, race or socioeconomic status. It is
probably often not recognised as a distinct syndrome and is consequently
classified under one of the larger psychiatric categories. Nor do all persons
with this syndrome come to the attention of mental health professionals. Doust
and Christie8 report 20 recent cases, including the 15 cases
discussed by Enoch et al.9
functioning deficits or limbic lesions10, particularly in the
temporal lobes in combination with isolative and ambivalent romantic
experiences, may contribute to misinterpretations in erotomania and deficits in
cognitive flexibility may contribute to the maintenance of the delusional
information suggests that diffuse brain dysfunction may contribute to
erotomania, perhaps by interfering with the operations of the cerebral regions
subserving the complex emotional functions. A woman developed the delusional
syndrome four years after subarachnoid haemorrhage from a ruptured basilar
disorders occurring late in life suggest a hereditary predisposition.
Researchers also suggest that these conditions are the result of early
childhood experiences with an authoritarian family structure. According to
other researchers, any person with a sensitive personality is particularly
vulnerable to developing a delusional disorder.
its exact cause is unknown, it is believed that genetic, biochemical and
environmental factors play a significant role in the development of delusional
been suggested12 that the heterosexual attachment, delusional in
nature, is substituted for denied unconscious homosexual impulses. This
reflects Freud’s belief that erotomania is one of several permutations of the
core conflict of paranoia in a male. Here, through the defensive operations of
denial, displacement and projection, a formula evolves: ‘I do not love him;
rather I love her because she loves me’. One could easily substitute ‘she’ for
‘he’ and vice versa in Freud’s formula; hence for women, this would be
transformed into ‘I do not love her. I love him because he loves me’.
et al13 further add that erotomania evolves out of the search for a
safe and unattainable erotized father figure and the need to ward off
views erotomania as a ‘defensive facade of delusional, histrionic, romantic
love behind which lies the drama of an ontogenetically earlier phase of life
elaborated in psychosis.’ He further relates that under conditions of
regression, there is an attempt at restoration of the earlier blissful union
with the mother figure.
and Sullivan15 view erotomania as an adaptive function, warding off
depression and loneliness and providing an outside source of nurturance,
protection and control, following periods of loss.
and Callatian16 advance the notion brought forward by Raskin and
Sullivan and suggest that this type of delusional thinking is the result of ego
deficit and may be shaped mainly by an intrapsychic struggle and the individual
life experiences of being unloved; a narcissistic blow is overcome by a
grandiose feeling of love.
unshakeable conviction that he/she is loved by a specific individual who is
often of higher social standing and sometimes is a prominent figure or even a
other person has had little (or absolutely no) previous contact with the
patient, the latter usually believes that the other initiated the relationship.
usually has strong erotic feelings towards the other person, although sometimes
the relationship is regarded as platonic.
The other person
is usually unattainable in some way, for example because of marital status or
high social visibility. In many cases, the patient never makes any attempt to
contact the love-object, often writing letters or buying presents but never
sending them. Even when given a chance to make real contact, the patient will
frequently avoid doing so and will devise spurious explanation to account for
individuals who do not make contact with the other person, reasons are found to
explain the paradoxical (i.e rejecting) behaviour which is naturally shown by
the latter. In some instances, there may be anger about this perceived
rejection associated with acting out behaviour.
other person is believed to protect, watch or follow the patient and all kinds
of behaviours are misinterpretated as evidence of passionate interest.
The onset of
erotomania may be sudden or gradual.
may be present and some individuals with tactile hallucinations may believe
that they have been visited by a lover during the night, a phenomenon known as
When the case is
one of ‘pure’ or ‘primary’ erotomania, the accompanying features are those of
delusional disorder, that is it is a monodelusional disorder with relative
preservation of normal personality features and often some capacity to remain
functional in society. In these cases, the patient frequently is able to
conceal the abnormal belief from other people.18
Disorder, erotomanic disorder
especially of paranoid type: here, usually there will be other delusions with a
variety of themes, hallucinations and relatively widespread thought disorder.
Disorders: Erotomania has been noted in association with unipolar and bipolar
affective disorders 19 and there is a description based on one case
which suggests that it can appear as a variant of pathological mourning.20
organic brain disorders: There have been descriptions of erotomania occurring
in epilepsy, as part of the after-effects of head injury and among the late
effects of substance abuse.21 It has also been seen in senile
dementia and apparently as a side effect of certain therapeutic drugs including
oral contraceptives and steroids.
Callacot (1987) and Ghaziuddin and Tsai (1991) have reported erotomanic
delusions in mentally retarded individuals.
misidentification syndrome: Erotomania has been described in association with
the syndrome in a small number of cases.22
erotomanic beliefs: It does appear that certain people may have very powerful
erotomanic emotions which are in the nature of over-valued ideas rather than
cases are rare, sporadic, colourful and interesting and have with very few
exceptions so far, eluded effective treatment. In 1883, Winslow24
described a case of erotomania in which cure was, apparently a perfect one; the
mind was restored to health.
et al25 also report satisfactory adjustment in their two patients
following initial treatment with chlorpromazine 100mg tds and later
fluphenazine decanoate 50mg every 2 weeks and administration of trifluoperazine
for his other patient, both of whom were compound cases of De Clerambault’s and
et al 26 reported that chemotherapy, electroconvulsive treatments
and insight oriented psychotherapy proved ineffective for one patient and
temporarily effective for another, but that the delusions soon returned and
thereafter remained resistant to all treatments.
reports that the delusions in his case of erotomania in association with folie
a deux remained in spite of 6 weeks of intensive antipsychotic therapy.
and Callahan28 indicate that these patients are not suited for
insight oriented psychotherapy and that their delusions appear unmodified
following treatment with various phenothiazines. Doust and Christie29
on long range follow ups, report no change in their patients’ delusions after
various prolonged treatments with ataractic drugs, phenothiazines and
outcome for these persons appears dismal as Enoch et al26 conclude
that ‘these patients may even be dangerous and may finish up by making an
attempt on the life of their victim or members of his or her family (or their
own).29 This is particularly liable to occur when the patient
reaches the stage of resentment or hatred which replaces love, after repeated
advances are unrequited and they may thus require prolonged hospitalisation to
prevent them from acting out threats which are contained in their letters.’
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