Erotomania: definition, symptoms, causes, and treatments

Erotomania is defined as a delusional belief wherein one person believes the other individual loves them. The other person, the object of delusion, is usually of a higher social rank and is likely to be a celebrity or a prominent figure in society. People with erotomania believe someone’s in love with them even if they never personally met that person.

The symptoms of erotomania include a persistent delusional belief of being loved, misinterpretation of actions as romantic gestures, obsession with the perceived admirer, compulsive communication attempts, stalking or boundary violations, preoccupation with symbolic communication, and emotional dependence on the delusion.

The causes of erotomania include schizophrenia, bipolar disorder, brain tumors, drug or alcohol addiction, and dementia.

Treatment options available for erotomania are therapy, medications, and hospitalization.

What is erotomania?

Erotomania, a psychological condition, involves the delusional belief that another person, often of higher status or someone entirely unfamiliar, harbors romantic feelings for the individual experiencing the delusion.

The disorder typically manifests as an obsessive fixation, with the affected individual misinterpreting neutral or insignificant interactions, such as a smile or glance, as profound declarations of love.

Erotomania, an uncommon type of delusional disorder, is otherwise known as de Clérambault’s Syndrome. Delusional disorder is a type of psychotic disorder wherein a person can’t tell the difference between real and imaginary. As a delusional disorder, erotomania involves fixed, false beliefs uninfluenced by logic or contradictory facts.

Erotomania often includes the conviction that the supposed admirer is conveying messages of affection through cryptic means, such as body language, media, or symbolic gestures, despite a lack of tangible evidence.

Individuals with erotomania often engage in stalking, excessive communication attempts, or boundary violations, driven by the delusional certainty of mutual love. They stick to their ideas in spite of rejection or lack of reciprocation, therefore causing great discomfort with potential legal or interpersonal repercussions.

How common is erotomania?

Erotomania is a relatively rare condition, and its prevalence remains unknown to this day. However, delusional disorder is generally reported to occur at a rate of approximately 15 cases per 100,000 people annually, according to a 2005 review by Brendan D. Kelly titled, “Erotomania: epidemiology and management.”

The paper further reported that the disorder is more common in women than in men, with a female to male ratio of 3:1. A publication titled, “Delusional Disorder” by Shawn M. Joseph and Waquar Siddiqui last updated in March 2023 stated that the lifetime prevalence of delusional disorder is approximately 0.02%.

Delusional disorder is significantly less prevalent than other conditions, such as schizophrenia, bipolar disorder, and other mood disorders. This is possibly due in part to underreporting of delusional disorder, as individuals with delusional disorder are unlikely to seek mental health care unless compelled to do so by family or friends.

What are the other names for erotomania?

The other names for erotomania include de Clérambault’s syndrome, psychose passionelle, phantom lover syndrome, and psychotic erotic transference reaction. The term de Clérambault’s syndrome originates from French psychiatrist Gaëtan Gatian de Clérambault, who first described the condition in detail in 1921.

This name is often used in clinical and historical contexts to refer specifically to the delusional belief in a reciprocal romantic relationship. The term psychose passionelle originated from French psychiatry and translates to “passionate psychosis,” and was used by G.G. de Clérambault in his classification of the condition, according to a 2006 report from the Journal of the National Medical Association titled, “Erotomania revisited: thirty-four years later.”

The study further indicated that Canadian psychiatrist Mary V. Seeman introduced several terms to describe erotomania, including phantom lover syndrome and psychotic erotic transference reaction.

Phantom lover syndrome reflects the fantastical aspect of erotomania, where the supposed admirer exists primarily in the individual’s mind, often without any real connection to the person they believe is in love with them. The term highlights the imaginative and illusory nature of the condition.

Psychotic erotic transference reaction describes a situation where an individual projects or transfers intense romantic or sexual feelings onto another person, often a figure of authority, as part of a delusional belief.

What are the symptoms of erotomania?

Symptoms of erotomania refer to the observable indicators associated with the delusional belief that another person is in love with the affected individual. The symptoms of erotomania are listed below.

• Persistent delusional belief of being loved: Individuals with erotomania strongly believe that someone, often of higher status or a stranger, is deeply in love with them. This belief remains fixed despite clear evidence to the contrary. It’s common to mistake neutral actions or interactions—like a smile—for indications of romantic desire. The intensity of this conviction disrupts their ability to distinguish reality from delusion.
• Misinterpretation of actions as romantic gestures: Everyday actions, such as a wave, a casual conversation, or a media appearance, are interpreted as intentional expressions of love. Individuals with erotomania perceive these gestures as coded messages meant specifically for them.
• Obsession with the perceived admirer: A person experiencing erotomania often becomes intensely preoccupied with their imagined admirer. They frequently think about, talk about, or attempt to learn more about the supposed admirer. Such an obsession leads to intrusive behaviors, such as excessive research or following the person’s activities. Their fixation often consumes a significant portion of their time and mental energy.
• Compulsive communication attempts: Repeated efforts to contact the perceived admirer, such as writing letters, sending gifts, or making phone calls, are common. Such attempts are driven by the delusion of a mutual romantic connection. Despite rejection or lack of response, the individual persists, believing the admirer is secretly reciprocating.
• Stalking or boundary violations: Erotomania manifests as stalking behaviors, such as following the person to their home, workplace, or public events. The individual attempts to physically approach or observe the imagined admirer without their knowledge or consent. A 2009 case study by Blair Ritchie titled, “Erotomania in an Adolescent Male with Concomitant Gender Identity Issues” highlighted the experiences of a 16-year-old boy dubbed John, who became fixated on the idea that a senior student (“Fred”) returned his emotions of romantic attraction, even though the two never interacted and there was insufficient proof to support the claim. John exhibited stalker-like behavior by communicating with Fred via email, collecting pictures, and sending letters.
• Preoccupation with symbolic communication: Individuals with erotomania often perceive hidden messages in media, gestures, or unrelated actions. For example, a news broadcast, song lyrics, or specific colors worn by the admirer are potentially seen as symbols of love. This symptom reinforces the delusional belief, as the individual finds “evidence” supporting their conviction in everyday occurrences.
• Emotional dependence on the delusion: The imagined relationship becomes a source of emotional stability, comfort, or purpose. Individuals often feel an intense emotional attachment to the delusion, which they use to cope with loneliness or insecurity. The delusion provides a sense of importance or identity tied to the imagined admirer. Any challenge to this belief causes distress or defensive reactions.

What are the causes of erotomania?

The causes of erotomania are not entirely clear but similar to other types of delusions, wherein multiple factors play a role in its development. The most significant causes of erotomania are listed below.

• Schizophrenia: Schizophrenia, a severe mental health disorder, often involves delusions, hallucinations, and distorted thinking. Erotomania potentially develops as part of the delusional beliefs characteristic of this condition, where individuals misconstrue reality. A 22-year-old unmarried man with paranoid schizophrenia was one of the subjects of a 2021 study by Sowmya et al., titled, “Erotomania: A case series.” The man was under the impression his psychiatrist was in love with him and had plans to marry him. The symptoms consisted of auditory hallucinations and well-systematized delusions.
• Bipolar disorder: Bipolar disorder, particularly during manic or hypomanic episodes, result in grandiosity and impulsivity, contributing to erotomanic delusions. Individuals experiencing heightened energy and confidence during manic states are likely to misinterpret interactions as romantic advances. Such episodes reinforce obsessive and delusional thoughts about a perceived admirer.
• Brain tumors: Tumors in the brain, especially those affecting areas related to judgment, emotion, or perception, trigger delusional disorders such as erotomania. The pressure and neurological disruption caused by the tumor tend to impair cognitive function and foster irrational beliefs. For instance, after receiving treatment for a brain tumor in the left frontal region of her brain, a 50-year-old homeless lady, known as “Ms. A,” began to exhibit erotomanic and persecutory delusions, according to a 2017 case report from Stupinski et al., titled, “Delusional Disorder Arising From a CNS Neoplasm.” One month after receiving radiotherapy, the woman had delusions, especially erotomanic ones concerning Chris Martin, the lead singer of Coldplay, whom she thought had proposed to her after dedicating a song to her.
• Drug or alcohol addiction: Substance abuse alters brain chemistry, impairing cognitive processes and emotional regulation, which result in delusional thinking like erotomania. Prolonged physical addiction to substances leads to psychosis or amplifies pre-existing mental health issues, fostering obsessive or irrational beliefs. Intoxication or withdrawal states distort reality, leading individuals to misinterpret interactions as romantic signals.
• Dementia: Cognitive decline in dementia causes erotomania by impairing memory, reasoning, and social judgment. Affected individuals develop delusions of romantic interest due to confusion or misinterpretation of relationships. Emotional instability and the progressive loss of logical thinking exacerbate the formation and persistence of such beliefs. A 2021 report by Suehiro et al., titled, “Case Report: De Clerambault’s Syndrome in Dementia With Lewy Bodies” presented the case of an 83-year-old woman who exhibited erotomanic delusions in conjunction with signs of Dementia with Lewy Bodies (DLB). Initially, she experienced persecutory delusions concerning her family doctor, but then came to believe the doctor was in love with her and had proposed marriage. The patient misconstrued routine interactions with her physician as indications of romantic interest.

How is erotomania diagnosed?

Erotomania is diagnosed through a detailed and systematic process conducted by a mental health professional to understand the individual’s symptoms and rule out other conditions. The process begins with a comprehensive clinical interview, where the professional assesses the presence of a fixed delusional belief that someone is romantically interested in the individual, even when evidence contradicts this belief.

The professional confirms the condition by evaluating the duration, intensity, and impact of the delusion on daily life, utilizing diagnostic criteria from frameworks such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) or the International Classification of Diseases 11th Revision (ICD-11).

Cognitive function, emotional state, and co-occurring mental health issues are all evaluated through psychological examinations, such as standardized questionnaires or tests. The evaluation additionally aims to rule out other mental health conditions, such as schizophrenia, bipolar disorder, or substance-induced psychosis, which tend to present similar symptoms.

Supplementary medical evaluations, including neuroimaging and blood testing, are performed to eliminate potential underlying neurological or physiological conditions, such as brain tumors or dementia, that possibly contribute to the delusions.

What are the risk factors for erotomania?

Risk factors for erotomania are the underlying traits, disorders, or events raising the likelihood of a person developing erotomanic delusions. The risk factors for erotomania are listed below.

• Genetic predispositions: Variations in certain genes are associated with the development of erotomania. For example, a study by Debnath et al. from the May 2006 issue of the Canadian Journal of Psychiatry identified the HLA-A*03 gene as being involved in delusional disorders like erotomania and paranoid schizophrenia. However, as with various other mental health conditions, a combination of different genes is likely involved, as genetics doesn’t act alone but is coupled with other causes.
• Major stress or trauma: People develop erotomania as a coping mechanism in response to major stress or trauma they experienced. A 2016 study by Powers et al. published in Childhood Abuse & Neglect stated that trauma contributes to psychosis (delusions or hallucinations) because early exposure to such experiences affect brain functioning. Additionally, delusions occur as a person struggles to cope with and process their trauma in a healthy manner.
• Neurological abnormalities: Neurological issues, such as brain injuries, tumors, or abnormalities in brain regions responsible for judgment and emotion regulation contribute to erotomania. Disruptions in these areas affect cognitive processes, leading to misinterpretations of social cues and delusional beliefs. Conditions like dementia or epilepsy further impair reasoning, increasing susceptibility to delusions.
• Social isolation: Lack of meaningful social connections or supportive relationships increases the likelihood of developing erotomania. Social isolation fosters loneliness and emotional deprivation, leading individuals to create imagined connections to fill the void. Over time, imagined relationships evolve into fixed delusions, reinforced by the absence of contradictory social interactions.
• Psychological vulnerabilities: Low self-esteem, unresolved trauma, or a history of emotional neglect create a foundation for erotomanic delusions. Individuals with such vulnerabilities often seek comfort in fantasies, where delusions of being loved offer emotional validation. These psychological factors amplify the need for external affirmation, fostering fixation on imagined relationships. The inability to cope with reality deepens the reliance on delusional beliefs.

Who is affected by erotomania?

People affected by erotomania often include those with certain mental health conditions, neurological issues, or psychological vulnerabilities. Individuals diagnosed with schizophrenia, bipolar disorder, or major depressive disorder with psychotic features are particularly at risk due to the delusional and emotional dysregulation associated with these conditions.

People experiencing brain injuries, dementia, or other neurological impairments are vulnerable as well, as these issues distort perception and reasoning. Socially isolated individuals are often more prone to developing erotomanic beliefs to cope with loneliness or unmet emotional needs. Additionally, substance abuse and exposure to stressful life events increase susceptibility, particularly in those already struggling with low self-esteem or unresolved trauma.

What are the treatments for erotomania?

Treatments for erotomania are the medical and therapeutic remedies applied to treat the underlying conditions and delusional ideas related with erotomania. The treatments for erotomania are listed below.

• Therapy: Psychotherapy, particularly cognitive behavioral therapy (CBT), is a key treatment for erotomania as it helps individuals identify and challenge delusional beliefs. CBT focuses on restructuring thought patterns, teaching individuals to distinguish between reality and their irrational thoughts. A study by Anne Desnoyers Hurley published in the March 2012 issue of Advances in Mental Health and Intellectual Disabilities found that CBT was effective in treating erotomania, especially when combined with a community support system. After three years, the person resumed their previous level of functioning and showed no signs of the condition.
• Medications: Antipsychotic medications are often prescribed to treat erotomania by addressing the chemical imbalances in the brain that contribute to delusional thinking. These medications, such as risperidone or olanzapine, help reduce the intensity and frequency of the delusions by stabilizing brain activity. In cases with co-occurring conditions like bipolar disorder or depression, mood stabilizers or antidepressants are likely to be used as well.
• Hospitalization: In certain cases, symptoms of erotomania are severe and involve a high risk of harming oneself or other people. Hospitalization is the most suitable approach in such situations because it is where the patient receives much-needed help under medical supervision. The duration of a hospital stay varies from patient to patient. It’s possible for patients to spend several days in a hospital or clinic, whereas persons with the most severe symptoms need a longer stay.

How to prevent erotomania?

Preventing erotomania is challenging because it often arises from complex interactions between genetic, psychological, social, and neurological factors, many of which are beyond an individual’s control. While it is not entirely possible to prevent the condition, reducing risk factors and addressing potential triggers help mitigate its onset or severity.

Managing underlying vulnerabilities in mental health illnesses such as mood disorders, schizophrenia, or neurological problems early on is vital. Reducing loneliness or isolation—often associated with erotomania—by means of a strong social support network and promotion of good connections helps ease such emotions.

Furthermore, advocating for mental health awareness and urging individuals to pursue assistance for delusional ideas or social withdrawal aids in early intervention. For individuals at higher risk, such as those with a family history of psychiatric disorders, regular monitoring and preventative strategies, including stress management and coping skills, are often beneficial. Although complete prevention is unlikely, early care and proactive strategies reduce the severity of symptoms.

Can erotomania be cured?

No, erotomania cannot be fully cured, but it’s possible to effectively manage the condition with treatment. The delusions that characterize erotomania are deeply ingrained and tend to persist over time, especially if the underlying conditions, such as schizophrenia or bipolar disorder, are not addressed.

However, with appropriate interventions like antipsychotic medications, therapy, and ongoing support, the intensity of the delusions are often reduced, and individuals learn to cope better with their symptoms.

Although a complete cure is improbable, long-term management significantly enhances quality of life and enables individuals to continue functioning in their daily lives.