De Clerambault Syndrome
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Erotomania, also known as de Clérambault's Syndrome, named after French
psychiatrist A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders. Psychiatrists are physicians and evaluate patients to determine whether their sy ...
Gaëtan Gatian de Clérambault Gaëtan Henri Alfred Edouard Léon Marie Gatian de Clérambault (2 July 1872 – 17 November 1934) was a French psychiatrist. Career De Clérambault gained his thesis in 1899, later becoming an assistant physician at the special infirmary ...
, is listed in the
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
as a subtype of a
delusional disorder Delusional disorder is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect.American Psychiatric Association. (2013). ''Diagnosti ...
. It is a relatively uncommon
paranoid Paranoia is an instinct or thought process that is believed to be heavily influenced by anxiety or fear, often to the point of delusion and irrationality. Paranoid thinking typically includes persecutory beliefs, or beliefs of conspiracy c ...
condition that is characterized by an individual's delusions of another person being infatuated with them. This disorder is most often seen (though not exclusively) in female patients who are shy, dependent and sexually inexperienced. The object of the delusion is typically a male who is unattainable due to high social or financial status, marriage or uninterest. The object of obsession may also be imaginary, deceased or someone the patient has never met.
Delusions of reference Ideas of reference and delusions of reference describe the phenomenon of an individual experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the ...
are common, as the erotomanic individual often perceives that they are being sent messages from the secret admirer through innocuous events such as seeing license plates from specific states, but has no proof. Commonly, the onset of erotomania is sudden, and the course is chronic.


Presentation

Erotomania is more common in women, but men are more likely to exhibit violent and
stalker Stalking is unwanted and/or repeated surveillance by an individual or group toward another person. Stalking behaviors are interrelated to harassment and intimidation and may include following the victim in person or monitoring them. The term ...
-like behaviors. The core symptom of the disorder is that the individual holds an unshakable belief that another person is secretly in love with them. In some cases, the person with the condition may believe several people at once are "secret admirers". Most commonly, the individual has delusions of being loved by an unattainable person who is usually an acquaintance or someone the person has never met. They may also experience other types of delusions concurrently with erotomania, such as delusions of reference, wherein the perceived admirer secretly communicates their love by subtle methods such as body posture, arrangement of household objects, colors, license plates on cars from specific states, and other seemingly innocuous acts (or, if the person is a public figure, through clues in the media). Some delusions may be extreme such as the conception, birth, and kidnapping of children that never existed. The delusional objects may be replaced by others over time, and some may be chronic in fixed forms. Denial is characteristic with this disorder as the patients do not accept the fact that their object of delusion may be married, unavailable, or uninterested. The phantom lover may also be imaginary or deceased. Erotomania has two forms: primary and secondary. Primary erotomania is also commonly referred to as de Clerambault's syndrome and Old Maid's Insanity and it exists alone without
comorbidities In medicine, comorbidity - from Latin morbus ("sickness"), co ("together"), -ity (as if - several sicknesses together) - is the presence of one or more additional conditions often co-occurring (that is, concomitant or concurrent) with a primary ...
, has a sudden onset and a chronic outcome. The secondary form is found along with mental disorders like paranoid schizophrenia, often includes
persecutory delusions Persecution is the systematic mistreatment of an individual or group by another individual or group. The most common forms are religious persecution, racism, and political persecution, though there is naturally some overlap between these terms ...
,
hallucination A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
s, and grandiose ideas, and has a more gradual onset. Patients with a "fixed" condition are more seriously ill with constant delusions and are less responsive to treatment. These individuals are usually timid, dependent women that are often sexually inexperienced. In those with a more mild, recurrent condition, delusions are shorter-lived and the disorder can exist undetected by others for years. Problematic behaviors include actions like calling, sending letters and gifts, making unannounced house visits and other persistent stalking behaviors.


Cause

Erotomania may 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 may also be precipitated by alcoholism and the use of antidepressants. There may be a potential genetic component involved as family histories of first degree relatives with histories of psychiatric disorders are common.
Sigmund Freud Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
explained erotomania as a defense mechanism to ward off homosexual impulses which can lead to strong feelings of paranoia, denial, displacement and projection. Similarly, it has been explained as a way to cope with severe loneliness or ego deficit following a major loss. Erotomania may also be linked to unsatiated urges dealing with homosexuality or narcissism. Some research shows brain abnormalities occurring in patients with erotomania such as heightened temporal lobe asymmetry and greater volumes of lateral ventricles than those with no mental disorders.


Treatment

Prognosis differs from person to person, and the ideal treatment is not completely understood. Treatment for this disorder gains the best results when tailored specifically for each individual. To date, the mainline pharmacological treatments have been pimozide (a typical antipsychotic which was also approved for treating Tourette's Syndrome), and atypical antipsychotics like risperidone and clozapine. Non-pharmacologic treatments that have shown some degree of efficacy are electroconvulsive therapy (ECT), supportive psychotherapy, family and environment therapy, rehousing, risk management and treating underlying disorders in cases of secondary erotomania. ECT may provide temporary remission of delusional beliefs; antipsychotics help attenuate delusions and reduce agitation or associated dangerous behaviors, and SSRIs may be used to treat secondary depression. In delusional disorder there is some evidence that pimozide has superior efficacy compared with other antipsychotics. Psychosocial psychiatric interventions can enhance the quality of life through allowing some social functioning, and treating comorbid disorders is a priority for secondary erotomania. Family therapy, adjustment of socio-environmental factors, and replacing delusions with something positive may be beneficial to all. In most cases, harsh confrontation should be avoided. Structured risk assessment helps to manage risky behaviors in those individuals more likely to engage in actions that include violence, stalking, and crime. For particularly troublesome cases, neuroleptics and enforced separation may be moderately effective.


History

Early references to the condition can be found in the work of
Hippocrates Hippocrates of Kos (; grc-gre, Ἱπποκράτης ὁ Κῷος, Hippokrátēs ho Kôios; ), also known as Hippocrates II, was a Greek physician of the classical period who is considered one of the most outstanding figures in the history of ...
, Freud (1911), G.G. de Clérambault (1942),
Erasistratus Erasistratus (; grc-gre, Ἐρασίστρατος; c. 304 – c. 250 BC) was a Greek anatomist and royal physician under Seleucus I Nicator of Syria. Along with fellow physician Herophilus, he founded a school of anatomy in Alexandria, where the ...
,
Plutarch Plutarch (; grc-gre, Πλούταρχος, ''Ploútarchos''; ; – after AD 119) was a Greek Middle Platonist philosopher, historian, biographer, essayist, and priest at the Temple of Apollo in Delphi. He is known primarily for his ''P ...
and
Galen Aelius Galenus or Claudius Galenus ( el, Κλαύδιος Γαληνός; September 129 – c. AD 216), often Anglicized as Galen () or Galen of Pergamon, was a Greek physician, surgeon and philosopher in the Roman Empire. Considered to be one of ...
. Parisian physician, Bartholomy Pardoux (1545-1611) covered the topics of nymphomania and erotomania. In 1623, erotomania was referred to in a treatise by Jacques Ferrand (Maladie d'amour ou Mélancolie érotique) and has been called "erotic paranoia" and "erotic self-referent delusion" until the common usage of the terms erotomania and de Clérambault's syndrome. In 1971 and 1977, M.V. Seeman referred to the disorder as "phantom lover syndrome" and "psychotic erotic transference reaction and delusional loving". Emil Kraepelin and Bernard also wrote of erotomania and more recently, Winokur, Kendler, and Munro have contributed to knowledge on the disorder. G. E. Berrios and N. Kennedy outlined in 'Erotomania: a conceptual history' (2002) several periods of history through which the definition of erotomania has changed considerably: *Classical times – early eighteenth century: General disease caused by unrequited love *Early eighteenth-beginning of nineteenth century: Practise of excess physical love (akin to
nymphomania Hypersexuality is extremely frequent or suddenly increased libido. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania and satyriasis were terms previously used for the c ...
or
satyriasis Hypersexuality is extremely frequent or suddenly increased libido. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania and satyriasis were terms previously used for the c ...
) *Early nineteenth century – beginning twentieth century: Unrequited love as a form of mental disease *Early twentieth century – present: Delusional belief of "being loved by someone else" In one case, erotomania was reported in a patient who had undergone surgery for a ruptured
cerebral aneurysm An intracranial aneurysm, also known as a brain aneurysm, is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. Aneurysms in the posterior circul ...
.


Well-known cases

In his paper that described the syndrome, de Clérambault referenced a patient he had counselled who was obsessed with British monarch
George V George V (George Frederick Ernest Albert; 3 June 1865 – 20 January 1936) was King of the United Kingdom and the British Dominions, and Emperor of India, from 6 May 1910 until Death and state funeral of George V, his death in 1936. Born duri ...
. She had stood outside
Buckingham Palace Buckingham Palace () is a London royal residence and the administrative headquarters of the monarch of the United Kingdom. Located in the City of Westminster, the palace is often at the centre of state occasions and royal hospitality. It ...
for hours at a time, believing that the king was communicating his desire for her by moving the curtains. Parallels were drawn between this and a 2011 case where the body of a homeless American man was found on a secluded island in St James Park, within sight of Buckingham Palace. The man had sent hundreds of "strange and offensive" packages to
Queen Elizabeth II Elizabeth II (Elizabeth Alexandra Mary; 21 April 1926 – 8 September 2022) was Queen of the United Kingdom and other Commonwealth realms from 6 February 1952 until Death and state funeral of Elizabeth II, her death in 2022. She was queen ...
over the previous fifteen years. The attempted assassination of United States president
Ronald Reagan Ronald Wilson Reagan ( ; February 6, 1911June 5, 2004) was an American politician, actor, and union leader who served as the 40th president of the United States from 1981 to 1989. He also served as the 33rd governor of California from 1967 ...
by
John Hinckley Jr. John Warnock Hinckley Jr. (born May 29, 1955) is an American man who attempted to assassinate U.S. President Ronald Reagan in Washington, D.C. on March 30, 1981, two months after Reagan's first inauguration. Using a .22 caliber revolver, Hinck ...
has been reported to have been driven by an erotomaniac fixation on actress
Jodie Foster Alicia Christian "Jodie" Foster (born November 19, 1962) is an American actress and filmmaker. She is the recipient of numerous accolades, including two Academy Awards, three British Academy Film Awards, three Golden Globe Awards, and the ho ...
, whom Hinckley was attempting to impress. Late-night TV entertainer
David Letterman David Michael Letterman (born April 12, 1947) is an American television host, comedian, writer and producer. He hosted late night television talk shows for 33 years, beginning with the February 1, 1982 debut of ''Late Night with David Letterman' ...
and former astronaut
Story Musgrave Franklin Story Musgrave (born August 19, 1935) is an American physician and a retired NASA astronaut. He is a public speaker and consultant to both Disney's Imagineering group and Applied Minds in California. In 1996, he became only the second as ...
were both stalked by Margaret Mary Ray, who had erotomania. Michael David Barrett allegedly had erotomania, stalking ESPN correspondent
Erin Andrews Erin Jill Andrews (born May 4, 1978) is an American sportscaster, television personality, and actress. She rose to prominence as a correspondent on the American cable sports channel ESPN after joining the network in 2004. She later joined Fox Sp ...
across the country, trying to see her and taking lewd videos. Many cases of obsession or stalking can be linked to erotomania but do not always necessarily go hand in hand.


In media

* ''
Nurse Betty ''Nurse Betty'' is a 2000 American black comedy film directed by Neil LaBute and starring Renée Zellweger as the title character, a small town, Kansas housewife-waitress who suffers a nervous breakdown after witnessing her husband's torture mur ...
'' (2000) * A main character in
Orange Is the New Black ''Orange Is the New Black'' (sometimes abbreviated to ''OITNB'') is an American comedy-drama streaming television series created by Jenji Kohan for Netflix. The series is based on Piper Kerman's memoir '' Orange Is the New Black: My Year in a Wo ...
, Lorna Morello, exhibits erotomanic behavior towards a man to whom she deludedly believes herself to be engaged * '' He Loves Me... He Loves Me Not'' (2002) * A 2011 episode (Series 5, Episode 3) of the British TV series ''Lewis'' features a character with erotomania, referred to in the show as de Clérambault's syndrome * Enduring Love (1997) * Criminal Minds Season 1, Episode 5: ''Broken Mirror''. * ''
Doc Martin ''Doc Martin'' is a British medical comedy drama television series starring Martin Clunes as Doctor Martin Ellingham. It was created by Dominic Minghella after the character of Dr Martin Bamford in the 2000 comedy film '' Saving Grace''. The ...
'' Season 6, Episode 3: ''The Tameness of a Wolf'' * Law & Order Season 3, Episode 18: “Animal Instinct” * A 2019 episode (Series 1, Episode 2) of the British-Austrian series Vienna Blood features a character who displays symptoms of de Clérambault's syndrome (although correctly not described as such, since the programme is set in 1907, 14 years before de Clérambault himself described the syndrome)


See also


Further reading

* * * Frank Bruni, Behind the Jokes, a Life Of Pain and Delusion; For Letterman Stalker, Mental Illness Was Family Curse and Scarring Legacy, New York Times, November 22, 1998 * Foster, David & Levinson, Arlene. Suicide on a railroad track ends a celebrity-stalker's inner agony Archived 2011-06-14 at the Wayback Machine., Associated Press, October 11, 1998 * * Helen K. Gediman (14 December 2016). Stalker, Hacker, Voyeur, Spy: A Psychoanalytic Study of Erotomania, Voyeurism, Surveillance, and Invasions of Privacy. Karnac Books. pp. 21–34. .


References


Notes


Bibliography

* * *Helen K. Gediman (14 December 2016). Stalker, Hacker, Voyeur, Spy: A Psychoanalytic Study of Erotomania, Voyeurism, Surveillance, and Invasions of Privacy. Karnac Books. pp. 21–34. . * * *McDonnell, Margaux, and Mike McPadden. "9 Stalkers That Make Us Glad We're Not Famous." CrimeFeed, 12 Nov. 2013, crimefeed.com/2013/10/9-stalkers-that-make-us-glad-were-not-famous/. * * * {{Authority control Psychosis Delusional disorders Love Stalking Psychopathological syndromes Delusions