Erotomania and Recommendations for Treatment

Abstract

The aim of this paper is to help clinicians better understand how erotomania originates in order to facilitate treatment and make it more effective. Data sources are the narratives of six women who spoke in detail about the beginnings of their delusional beliefs and about the nature of the evidence that convinced them that their beliefs were well-founded. In every case, low self-esteem and emotional arousal preceded the emergence of the delusion. Misperceptions and misattributions appeared responsible for keeping the delusion alive. Despite external disconfirmation, social isolation protected the delusional beliefs from revision and extinction. The erotomanic delusion provided a sense of well-being that probably contributed to its maintenance. As well, a delusion-induced boost in well-being delayed help-seeking. Recommendations for treatment include staged interventions, first establishing a therapeutic alliance with a focus on understanding the psychological factors contributing to the origin and maintenance of the delusion. The next stage is the provision of social support and strategies directed at the restoration of self-esteem. The third stage is the gradual introduction of techniques to correct cognitive biases. Medication and risk management form an integral part of overall management. Objective evidence for the effectiveness of this approach is, however, not yet available.

De Clérambault’s syndrome revisited: a case report of Erotomania in a male

“…Although presenting a course of illness typical of Seeman's (1978) [9] recurrent group, he presents a profile more typical of the fixed group. Mr. X. finds himself unattractive and is sexually inexperienced, never had a serious relationship and leads a rather isolated life, much like most descriptions of patients with Erotomania [14]. Also, he is incredibly close and dependent of his mother, which is also typical according to some authors [12].…”

“…We can conclude that it seems reasonable to retain the operative concept of Erotomania as a subtype of Persistent Delusional Disorder/Delusional Disorder, since cases fitting the classical descriptions of the syndrome have been reported, and the diagnosis of Erotomania has particular implications in case management, treatment and prognosisrisperidone under 6 mg/day is the first line treatment, to diminish the intensity of the delusions and for behavioral control but, sometimes, the only effective treatment is separation from the love object and risk management, since the patient may become really bothersome and intrusive in the object's life [14]. Also, missing this diagnosis may culminate in violent situations that may have legal implications, since these patients, especially if male, can present for the first time with violent behavior.…”

“…In general, the love object is of the opposite sex, but there have been reports of homosexual female and male cases [1,2]. The patient presenting with Erotomania is typically unattractive and sexually inexperienced, never had a meaningful relationship and leads a lonely life (but this is not always the case, as noted above) [14]. Most authors describe a unsatisfactory relationship of the patients with their mothers, while some describe very close and dependent relationships with their parents, sometimes never separating from them, and with the mother being the most important influence [1,2,12].…”

Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management

“…A therapist not recognizing the role the delusion serves can lead to tragic consequences. One of our patients, for instance, after treatment with antipsychotic medication, realized that her conviction of being loved was unreal and, as a consequence, attempted suicide [44].…”

“…Yet another example is the secondary gain inherent in erotomania, the conviction by a lonely isolated person of being loved by someone of importance [44]. A therapist not recognizing the role the delusion serves can lead to tragic consequences.…”