Erotomania: definition, causes, symptoms, 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 may be a celebrity or a prominent figure in society. People with erotomania may believe someone’s in love with them even if they never personally met that person.

The causes of erotomania are multifactorial and may include trauma, genetics, brain abnormalities, emotional abandonment, and sexual inexperience. Neurological and mental illnesses can also contribute to the development of erotomania.

Symptoms of erotomania may vary from one person to another, but usually include stalking, spending too much time on delusion, believing someone loves them despite rejection and lack of interest and engaging in risky behaviors. Symptoms may depend on the causes with which erotomania is associated including schizophrenia, bipolar disorder, brain tumor, alcohol and drug addiction, and dementia.

Treatment of erotomania involves therapy and medications. People with severe erotomania and a high risk of self-harm or being a danger to others may need to be hospitalized.

What is erotomania?

Erotomania is a delusional belief wherein the affected person is convinced someone is in love with them, even when they’re not. Regardless of no evidence for such a belief, a person believes the other individual, usually of a higher social status, loves them. This delusion persists even if they don’t know the other individual personally.

Erotomania, a type of delusional disorder, is also 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. People have different delusions or false beliefs such as being convinced a person is sick or that they are superior to everyone, and erotomania is one type of delusion as well.

Erotomania is classified as a subtype of delusional disorder in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It is also categorized under Persistent Delusional Disorder in the International Classification of Diseases, 10th Revision (ICD-10) by the World Health Organization (WHO). It’s also worth noting that erotomania may occur due to other mental health problems and neurological conditions including schizophrenia.

The object of delusional belief in erotomania can be anyone. In many cases, it’s a public figure, a celebrity, or a prominent figure in society. It can be someone a person knows or a total stranger, as mentioned above. People with erotomania may also participate in stalking, but not every person with this disorder takes part in such action.

It’s important to keep in mind erotomania isn’t a crush. Crush is when one person is in love with the other but isn’t in a relationship with that individual. The difference between the two is that a person with erotomania believes the other person is in love with them despite their rejection and they make finding information about the other individual a priority. PsyhCentral explains that a person with erotomania goes to extreme lengths to connect with the object of their delusion.

For centuries scholars and physicians have been interested in psychiatric manifestations regarding the theme of love. Ever since the time of Ancient Greece to the modern day, there have been efforts to explore and explain cases when people firmly believe someone is in love with them without any evidence of confirmation.

Several authors have contributed to the evolution of the concept of erotomania, throughout history. But in 1921, Gatian de Clérambault (a French psychiatrist) was the first person to describe the core characteristics of this disorder. Hence the name de Clérambault’s Syndrome. The French psychiatrist described erotomania as a disorder where a patient (subject), usually a female, believes she is loved by a man (object).

Other characteristics of the disorder, described by de Clérambault, were that the object of delusion has been the first to fall in love with the patient or to make the first advances (according to the patient), and they love the patient more and more. The patient may not even have feelings for the object of their delusion.

According to de Clérambault, erotomania is all about being loved, not loving the other person. He also described two forms of erotomania: primary and secondary. The primary or pure form regards erotic delusion as a psychotic manifestation that isn’t related to other illnesses. The secondary form has a gradual onset, opposite to the abrupt primary form, and it is associated with other mental disorders such as depression.

While trying to conceptualize erotomania Mary Seeman, a Canadian psychiatrist, divided the condition into two groups. First is the fixed group where people are more psychiatrically ill and are frequently diagnosed with schizophrenia. In this group, delusions have a chronic course and they don’t change. Second is the recurrent group patients are less psychiatrically ill and usually have bipolar disorder or personality disorder.

In 1985, psychiatrists Ellis and Mellsop also defined characteristics of erotomania, describing it as a delusional conviction of being in amorous communication with another person of a much higher rank. They also retained characteristics that de Clérambault originally described, according to a paper from the October 2020 issue of BMC Psychiatry written by Dr. Maria Teresa Tavares Rodrigues Tomaz Valadas and Lucilia Eduarda Abrantes Bravo from Department of Psychiatry and Mental Health, Local Health Unit of Lower Alentejo in Beja, Portugal.

Erotomania has a long history during which it wasn’t always considered a delusional belief. A paper by G.E. Berrios and N. Kennedy at University of Cambridge, published in the December 2002 issue of History of Psychiatry, the history of erotomania consists of four convergences. The first, which spanned from Classical times to the 18th century, regarded erotomania as a general disease caused by unrequited love. The second convergence, which persisted well into the 19th century, considered erotomania to be a disease of excessive physical love i.e. nymphomania. Erotomania, in the third convergence, which lasted throughout the 20th century, was viewed as a type of mental disorder. Fourth, convergence is based on the third but expands it to erotomania as a delusional belief. It’s the description of erotomania that is generally accepted today. The same paper explains that it is unlikely that there will ever be a final, scientific definition of erotomania.

How common is erotomania?

Erotomania is not common, similar to other delusional disorder types. A review from Dr. Brendan D. Kelly at University College Dublin and published in the August 2005 issue of CNS Drugs reported there are 15 cases of erotomania per 100,000 population per year. This isn’t such a surprise since the prevalence of the delusional disorder is between 0.05% and 0.1% in the general population, according to the post by Dr. Shawn M. Joseph from LSU Health Sciences Center – Shreveport and Waquar Siddiqui at UMKC on the website of National Library of Medicine.

The abovementioned paper from BMC Psychiatry explained that erotomania is relatively rare and the exact prevalence is unknown. The same paper added that the incidence of erotomania could be underestimated since it is often classified under broader symptoms.

The exact prevalence of erotomania in women and men is unknown. However, the abovementioned review from CNS Drugs reported the disorder is more common in women than in men. Female to male ratio is 3:1.

At this point, there is no information about the prevalence of erotomania in children and teens, primarily due to the specific type of this delusion. The prevalence of this disorder in the elderly is also unclear. There are some sporadic case reports including three patients with dementia who had erotomania. One such paper was by M. Brune et al. published in the December 2003 issue of Journal of Geriatric Psychiatry and Neurology and it reported these delusions emerged in the early stages of the underlying condition (two cases with Alzheimer’s disease and one patient with vascular dementia).

What are the causes of erotomania?

The causes of erotomania are not entirely clear but similar to other types of delusions, multiple factors could play a role in its development. Biological, psychological, and environmental causes and their combination may contribute to erotomania. The most significant causes of erotomania are listed below:

• Major stress or trauma: people may develop erotomania as a coping mechanism in response to major stress or trauma they experienced. A paper by Ruzita Jamaluddin from Hospital Tuanku Fauziah in Malaysia, published in the September 2021 issue of Case Reports in Psychiatry described a case of an erotomania patient with a history of abuse from a previous relationship. Generally speaking, trauma plays a major role in the development of delusional disorder. This is particularly the case with childhood trauma. According to a study by A. Powers et al. from the June 2016 issue of Childhood Abuse & Neglect, trauma contributes to psychosis (delusions or hallucinations) because early exposure to such experiences may affect brain functioning. Also, delusions may occur as a person struggles to cope with and process their trauma in a healthy manner.
• Brain abnormalities: changes in the structure and function of specific brain regions and abnormalities affecting neurotransmitters could contribute to the development of erotomania. Case reports by D.E. Fujii et al. from the April 1999 issue of Neuropsychiatry, Neuropsychology, and Behavioral Neurology revealed that patients with erotomania may have deficits in cognitive flexibility and associative learning. Frontal-subcortical systems mediate these deficits including deficits in visuospatial and verbal skills. Erotomania is also associated with abnormalities in temporal areas. Frontal-subcortical systems mediate motor activity and behavior. Temporal areas participate in processing auditory information and also take part in encoding memory. Delusional disorder, including the erotomania subtype, is associated with irregularities of dopamine and serotonin neurotransmitters and their receptors. Changes in brain functioning affect the way a person perceives and processes reality, which can pave the way to delusional thinking and erotomania.
• Genetics: variations in some genes could be associated with the development of erotomania. For example, a study by M. Debnath et al. from the May 2006 issue of Canadian Journal of Psychiatry identified the HLA-A*03 gene is involved in delusional disorder and paranoid schizophrenia. However, it’s unlikely that a single gene causes this or any other mental illness. A combination of different genes is involved. Genetics doesn’t act alone but is coupled with other causes.
• Emotional abandonment: may lead to signs of trauma including self-sabotaging behaviors and insecure attachment. September 2017 issue of Schizophrenia Bulletin published a paper by A.A. Abajobir et al. that explained that people exposed to multiple forms of maltreatment, especially emotional neglect or abandonment, are more likely to develop hallucinations and delusions. For certain individuals, emotional abandonment is a traumatic experience whether it happened in childhood or adulthood. The inability to cope with such an experience may affect brain functioning, as described above with trauma, and contribute to the development of delusional thinking. In the case of erotomania, a person’s delusion is about being loved as a way of filling the gap caused by emotional neglect.
• Sexual inexperience: erotomania may also result from sexual inexperience. While more research on this subject is necessary, current evidence including a paper by A.V. Sowmya et al. from the October 2021 issue of Industrial Psychiatry Journal shows people with erotomania tend to be sexually inexperienced. In addition to sexual inexperience, people with erotomania have never had a meaningful relationship and lead lonely lives. The underlying mechanisms through which sexual or romantic inexperience cause erotomania are unknown. They could influence brain function in combination with other causes.
• Other neurological or mental health disorders: erotomania, like other types of delusions, may stem from other conditions including schizophrenia, dementia, and bipolar disorder. These conditions affect brain functioning and impair neurotransmitters. That way, they may change the way a person perceives reality and thereby cause delusions.

What are the symptoms of erotomania?

Symptoms of erotomania are different from one person to another because people experience delusions of love differently. Signs of these delusions tend to be emotional and behavioral. Emotional signs of erotomania include a longing for the object of delusion, feelings of loneliness and emptiness, low self-esteem, feelings of guilt and shame, and denial of someone’s rejection and lack of interest. A person can’t take no for an answer. A person with erotomania may become jealous and become suspicious thinking the object of their love delusion is cheating on them.

Behavioral symptoms of erotomania include getting angry at people who don’t believe them, harming others, aggressiveness, stalking and repeatedly trying to contact the other person, attempting to “decode” supposed messages that a person sends through media or wardrobe choices and their everyday behavior, and neglecting personal responsibilities due to too much time spent on delusion. A person with erotomania may even approach the object of their delusion online or in-person furtively.

It’s also important to mention that symptoms of erotomania are largely tied to the condition associated with this delusion. The most common symptoms of erotomania are listed below:

• Schizophrenia
• Bipolar disorder
• Brain tumors
• Drug or alcohol addiction
• Dementia (this is rare)

1. Schizophrenia

Schizophrenia is a type of psychotic disorder characterized by an abnormal perception of reality. People with schizophrenia experience psychotic symptoms such as hallucinations and delusions that seem real to the patient. Schizophrenia causes delusions due to brain abnormalities in areas associated with thinking and perception.

Physical effects of schizophrenia include increased risk of weight gain, abdominal obesity, metabolic syndrome, diabetes, and cardiovascular disease, according to a review that Dr. A. Heald from Leighton Hospital in Cheshire, UK published in the June 2010 issue of European Psychiatry. The disease also lowers the quality of life and reduces a person’s life expectancy. Physical effects of schizophrenia also include multiple physical-health comorbidities, according to a paper that D.J. Smith et al. published in the April 2013 issue of BMJ Open.

Behavioral effects of schizophrenia involve useless or excessive movement, a complete lack of response, difficulty or resistance to following instructions, social isolation, irrational anger or aggressiveness (rarely), difficulty maintaining relationships, problems at work or school, frustration, and neglecting personal hygiene and daily activities such as grocery shopping. Other behavioral effects of schizophrenia may include bizarre behaviors, and problems with communication and speech such as making up words, switching from subject to subject, and giving answers that are unrelated to the question.

2. Bipolar disorder

Bipolar disorder is a type of affective (mood) disorder indicated by extreme changes in mood from euphoric highs (mania) to lows (depression). Delusions may occur in both manic and depressive episodes. However, they are more common in mania. Psychotic symptoms such as delusions in bipolar disorder occur due to several factors including sleep deprivation, hormones, and genetic predisposition, Healthline explains. For example, sleep deprivation impairs a person’s grasp on reality and their thinking becomes poorer. This may lead to delusional thoughts.

Physical effects of bipolar disorder include abdominal pain, nausea, vomiting, diarrhea, and overall poorer gastrointestinal health. Other physical effects of bipolar disorder include sweating, rapid breathing, a weakened immune system, and weight changes. Muscular aches and pains, changes in sex drive, and increased heart rate are also physical effects of bipolar disorder. Additionally, physical reactions of bipolar disorder also include high blood pressure.

Behavioral effects of bipolar disorder range from hyperactivity to risky and dangerous behaviors, severe irritability, suicidal thoughts and tendencies, and conflicts with friends and family. It’s important to mention that the behavioral effects of bipolar disorder depend on whether a person has manic or depressive episodes. For instance, the manic episode may include behaviors such as excitement, impulsiveness, and agitation. A depressive episode may cause behaviors such as loss of interest and social withdrawal.

3. Brain tumors

A brain tumor is defined as the growth of abnormal cells in brain tissues. The tumor can be benign (noncancerous) or malignant (cancerous). According to the Mayo Clinic, brain tumors occur due to mutations in the DNA of cells in the brain. These mutations lead to abnormal growth, during which cells divide rapidly. A paper by S.H. Lisanby et al. from the January 1998 issue of Seminars in Clinical Neuropsychiatry revealed that brain tumors can induce psychotic symptoms similar to those of schizophrenia. According to a review from the September 2015 issue of World Journal of Psychiatry published by S. Madhusoodanan et al., psychotic symptoms were found in 22% of brain tumors. In these cases, the tumor was located in the pituitary gland and temporal lobe mostly.

The physical effects of brain tumors depend on their location, but they may include headaches, nausea and/or vomiting, vision problems, difficulty with balance, loss of sensation or movement in the arm/leg, fatigue, and hearing problems. Other physical effects of brain tumors are seizures and generalized pain.

Behavioral effects of brain tumors are communication difficulties, personality changes such as becoming more anxious and irritable, difficulty making decisions, intense emotional outbursts, disinhibition, apathy, and mood swings. Keep in mind behavioral effects of brain tumors also depend on the location of the abnormal growth.

4. Drug or alcohol addiction

Drug or alcohol addiction is a mental disorder where a person has a compulsive need to keep drinking alcohol or using drugs despite the problems they cause. Even when a person attempts to stop, their strong cravings and withdrawal symptoms usually make the efforts unsuccessful. Physical addiction can also cause delusions, including erotomania. People may develop delusions due to taking too much of a certain substance, but they can also occur during the withdrawal process. That happens because drug or alcohol addiction acts directly on the brain and may influence a person’s perception of reality.

Physical effects of drug or alcohol addiction include a higher risk of lung or heart disease, liver and kidney damage, weight changes, increased risk of heart attack, stroke, and cancer, and a weakened immune system. Other physical effects of addiction include neglected appearance, gastrointestinal issues, and increased risk of STDs.

Behavioral effects of drug or alcohol addiction include risky or unethical behaviors, lying to conceal addiction, conflicts with family and friends, stealing money or other personal belongings from other people to get drugs, and irritability. Other behavioral effects of addiction include engaging in risky sexual activities, impaired performance at work or school, and social withdrawal. A person with drug or alcohol addiction may also avoid old friends and start socializing with other people who also abuse drugs and alcohol.

5. Dementia (this is rare)

Dementia is a term that refers to loss of memory, language, and cognitive abilities that can be severe enough to interfere with daily life. It is not a single disease, but an umbrella term that includes conditions including Alzheimer’s disease, vascular dementia, Lewy body dementia, mixed dementia, and Parkinson’s disease.

Erotomania in dementia is rare but possible. Dementia may contribute to delusions due to changes in brain structure and function. At the same time, people with dementia have gaps in memory that they try to fill with their own conclusions. They are usually suspicious and don’t trust others or their explanations. For that reason, it is particularly difficult to point out to a person with dementia that their delusion is a false belief.

Physical effects of dementia include weight gain, bladder and bowel incontinence, stiff muscles, lack of sleep, higher risk of cardiovascular disease, impaired kidney function, worsening of the immune system, and diabetes.

Behavioral effects of dementia include restlessness, repetition of actions and words, disinterest in everyday activities, aggressiveness, becoming clingy, hiding, hoarding, losing things, losing inhibitions, and social withdrawal.

Who is affected by erotomania?

Women are generally affected by erotomania. This type of delusion usually affects females in middle to late adulthood. It may affect sexually inexperienced people who have never had a serious relationship. People with a history of delusional disorder in the family may be more affected by erotomania.

What are the risk factors for erotomania?

Risk factors for erotomania are similar to those of delusional disorder. Since the exact causes of erotomania are unclear, it’s also difficult to identify factors that increase a person’s susceptibility to this type of delusion. A combination of biological, psychological, and social or environmental factors is involved. The most significant risk factors for erotomania are listed below:

• Being a woman
• History of major stress or trauma
• History of emotional neglect
• Personal or family history of psychotic disorders and other mental illnesses including bipolar disorder
• Being sexually inexperienced
• Feeling lonely
• Heavy social media use
• Low self-esteem
• Feeling rejected
• Difficulty with socialization
• Shy
• Being dependent on others

How is erotomania diagnosed?

Erotomania is diagnosed following a physical exam and psychiatric evaluation. However, diagnosing erotomania can be quite challenging because it’s a rare condition, Medical News Today explained. There are psychiatrists who have never seen erotomania in clinical practice and are unable to recognize symptoms in patients.

A physical exam serves to reveal whether the symptoms are associated with a specific health problem. For that purpose, a doctor may order blood tests, urine tests, and imaging tests. These tests provide a more detailed insight into a patient’s health and also demonstrate whether they used drugs or not.

When a physical exam doesn’t show the presence of any problem, a doctor refers a patient for psychiatric evaluation. The process of evaluation is simple and it includes questions about delusional beliefs, thoughts, emotions, and behavior. In addition to getting answers from patients, psychiatrists may interview their family members. That way they can get more information about someone’s behavior.

To establish an accurate diagnosis, a psychiatrist may use DSM-5 to check whether the patient’s symptoms meet diagnostic criteria and, if they do, the psychiatrist will diagnose the specific condition such as delusional disorder, erotomania subtype, or schizophrenia. They may also use ICD-10 to check for diagnostic criteria.

The psychiatrist will diagnose delusional disorder when a patient has one or more delusions for at least one month and they can’t be explained by other conditions such as schizophrenia.

During the diagnostic process, the psychiatrist needs to ensure a patient indeed has delusions. That means their delusions need to focus on events that are unrealistic or unlikely to happen and a patient firmly believes in them despite no evidence for doing so. Delusions affect one specific issue, in this case, it’s associated with love, whereas other aspects of life keep functioning relatively normally.

How to prevent erotomania?

It is impossible to prevent erotomania. Due to the rarity of this condition, the causes are largely unclear. For that reason, there is no prevention method that would help a person avoid erotomania entirely. While prevention isn’t possible, effective management is achievable. A person with erotomania can avoid complications and engage in risky behaviors when they manage their condition. Professional help in the form of therapy is an excellent choice. By coping with trauma the right way, they can protect their mental health in the long run.

What are the treatments for erotomania?

Treatments for erotomania are the same as for other types of delusions. Unfortunately, it can be difficult to treat erotomania just like other delusions. A person with delusion doesn’t see anything wrong with them. They refuse to accept their version of reality is false. To them, there is no issue, the other person really is in love with them, which is why it’s difficult to commit and stick to the treatment. In cases when a person with erotomania agrees to receive treatment to get better, usually in an attempt to solve other mental illnesses such as depression, they need a well-tailored program. The treatments for erotomania are listed below:

• Psychotherapy: the integral component of treatment for erotomania. The primary objective is to help patients adopt healthier thinking patterns to positively influence their thoughts and behaviors. Cognitive-behavioral therapy (CBT) is the most common type of talk therapy in the treatment of persons with erotomania. The biggest objective of CBT is to help identify irrational or negative thought patterns because they lead to unhealthy emotions and behaviors. As a person identifies negative thoughts, they start learning to replace them with more rational or realistic alternatives, which positively influence their emotions and behavior patterns. A study by Prof. Anne Desnoyers Hurley at University of New Hampshire and published in 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. Within three years, the patient with erotomania returned to the previous functioning without symptoms. Cognitive-behavioral therapy works because it helps a person understand their thoughts and how they influence their emotions and behaviors. Patients also get homework to do between two sessions. Homework usually consists of practicing skills they learned during the session. There is no specific number of sessions that works for everyone with erotomania. While CBT is time-limited to 6-20 sessions in most cases, people with more severe symptoms may need more than that. First sessions may last around 60 minutes while the duration of subsequent appointments is 30-45 minutes.
• Medications: the doctor may prescribe antipsychotic medications to reduce the severity of the delusion. The exact medications for the treatment of erotomania depend on the severity of erotomania. The most important thing is to make sure the medications are most suitable for the specific needs of each patient. Besides antipsychotics, a patient may receive a prescription for antidepressants and anti-anxiety medications. Like with other types of delusion, medications are never the only form of treatment for erotomania. They only work to reduce symptoms. Medications don’t focus on resolving the problems that caused these delusions. That’s why they are usually combined with therapy.
• 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 because 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 only, whereas persons with the most severe symptoms need a longer stay.

Does erotomania have a cure?

No, erotomania doesn’t have a cure that would eliminate this type of delusion entirely. Successful management is achievable, though. For example, the abovementioned paper from BMC Psychiatry (Maria Teresa Tavares Rodrigues Tomaz Valdas and Lucilla Eduarda Abrantes Bravo, October 2020) described a rare case of a man with erotomania. The treatment helped reduce symptoms such as aggressiveness, but he continued to have delusions. The good news is that the delusional beliefs of three women being in love with him became less intense with treatment.

While it’s impossible to cure erotomania entirely, proper treatment can help improve a person’s quality of life. As a person receives treatment such as therapy, they learn skills that help improve their everyday functioning. The reduction of delusions is different for everyone, but as seen above, some patients may not have symptoms that affect them on a daily basis.

The most important thing is to stick to the treatment and acknowledge professional help and support are necessary. For people with erotomania, this is a challenging task, which is why a strong support system involving their family and friends could help.