Erotomania

Erotomania or Clerambault syndrome is a rare mental disorder listed in the DSM-5 as a subtype of delusional disorder. It is a paranoid condition A relatively uncommon disorder characterized by an individual's delusions that another person is in love with them. This disorder is most often (though not exclusively) seen in female patients who are shy, dependent, and sexually inexperienced. The target of the scam is typically a man who is unattainable due to high social or financial status, marriage, or lack of interest in him.

History

The Parisian physician, Bartholomy Pardoux (1545-1611) covered the topics of nymphomania and erotomania. And in 1623, Jacques Ferrand (Maladie d'amour ou Mélancolie érotique) referred to erotomania in a treatise. He has also been called "erotic paranoia"; and "self-referential erotic delusion" until the emergence of common use of the terms erotomania and Clérambault Syndrome. This last term arose from the extensive report on the subject published in 1921 by Gaëtan Gatian de Clérambault (1872–1934), under the title Les Psychoses Passionelles. In 1971 and 1977, MV Seeman referred to the disorder as "phantom lover syndrome" and "erotic psychotic transference reaction and delusional love". Emil Kraepelin and Bernard have also written about erotomania and, more recently, Winokur, Kendler and Munro have contributed to the understanding of the disorder.

GE Berrios and N. Kennedy described in 'Erotomania: a conceptual history' (2002) various periods in history through which the definition of erotomania has changed considerably:

• Classic times at the beginning of the centuryXVIII: general illness caused by unrequited love.
• Early centuryXVIII at the beginning of the XIX: practice of excess physical love (similar to ninfomania or satiriasis).
• Early centuryXIX at the beginning of the centuryXX.: Unrequited love as a form of mental illness.
• Early centuryXX. to the present: delusional belief of "being loved by another person."

In one case, erotomania was reported in a patient who had undergone surgery for a ruptured brain aneurysm.

Description

Erotomania occurs more frequently in women, but men are more likely to exhibit violent and harassing-type behaviors associated with it.

The central symptom of the disorder is that the sufferer has an unshakable belief that another person is secretly in love with them. In some cases, the victim may believe that several people are "secret admirers" at the same time. More frequently, the individual has delusions of being loved by an unattainable subject who is usually an acquaintance or even someone the person has never met. The victim may also experience other types of delusions at the same time as erotomania, such as delusions of reference, in which the perceived admirer secretly communicates his love through subtle methods such as body posture, arrangement of household objects, colors, the license plates of specific states, and other seemingly innocuous acts (or, if the person is a public figure, through tips in the media). Some delusions can be extreme, including details such as the conception, birth, and abduction of children who never existed. Focal objects of delusion may be replaced by others over time, or they may be chronic in fixed forms.

Denial is characteristic of this disorder, as patients do not accept the fact that their deluded object may be married, unavailable, or uninterested. The ghost lover can also be imaginary or deceased. Erotomania has two forms: primary and secondary. Primary erotomania is also commonly known as de Clerambault syndrome and exists alone, without co-morbidities, has a sudden onset and a chronic outcome.

The secondary form is found in association with mental disorders such as paranoid schizophrenia, often includes persecutory delusions, hallucinations, and grandiose ideas, and has a more gradual onset. Patients with a "fixed" they are more seriously ill with constant delusions and are less responsive to treatment. These individuals are typically shy, dependent women who are often sexually inexperienced. In those with a milder, recurring condition, the delusions are shorter-lived and the disorder may exist undetected by others for years. Behaviors Problematic include actions such as calling, sending letters and gifts, making unannounced home visits, and other persistent stalking behaviors.

Causes

Erotomania can present as a primary mental disorder or as a symptom of another psychiatric illness. With secondary erotomania, the erotomanic delusions are due to other mental disorders such as bipolar I disorder or schizophrenia. Symptoms can also be precipitated by alcoholism or the use of antidepressants.

It is speculated that there may be a potential genetic component involved as a history of first-degree relatives with a history of psychiatric disorders is common. Sigmund Freud explained erotomania as a defense mechanism to ward off homosexual impulses that can lead to strong feelings of paranoia, denial, displacement, and projection. Similarly, it has been explained as a way to deal with severe loneliness or ego deficits after a major loss. Thus, erotomania is considered to be linked to unsatisfied drives related to homosexuality or narcissism.

Some research shows brain abnormalities that occur in patients with erotomania, such as increased temporal lobe asymmetry and larger lateral ventricular volumes than those in individuals without mental disorders.

Treatment

The prognosis differs from person to person, and the ideal treatment is not fully understood. Treatment for this disorder achieves the best results when it is specifically tailored to each individual. To date, the main drug treatments have been pimozide (a typical antipsychotic that is also approved to treat Tourette syndrome), and atypical antipsychotics such as risperidone and clozapine.

Non-pharmacological treatments that have shown some degree of efficacy include electroconvulsive therapy (ECT), supportive psychotherapy, family and environmental therapy, relocation, risk management, and treatment of underlying disorders in cases of secondary erotomania. ECT can provide temporary remission of delusional beliefs; antipsychotics help attenuate delusions and reduce agitation or associated dangerous behaviors, and SSRIs can be used to treat secondary depression.

There is some evidence that pimozide has superior efficacy in delusional disorder compared with other antipsychotics. Psychosocial psychiatric interventions may improve quality of life by enabling some social functioning, and treatment of comorbid disorders is a priority for secondary erotomania.

Family therapy, adjusting for socioenvironmental factors, and replacing delusions with something positive can be beneficial for all cases. In most cases, severe confrontation should be avoided. Structured risk assessment helps manage risky behaviors in those people who are most likely to engage in actions that include violence, harassment, and crime. For particularly problematic cases, neuroleptics and forced separation may be moderately effective.