Erotomania disorder was described for the first time in 1921 by Clérambault. Erotomania or Clérambault syndrome is the delusional conviction of being loved. Far from the obsession with unrequited love, it is a form of paranoid psychosis of the category of passionate delusions where the hatred of the other is, by a reversal of subjective positions, disguised as an “illusory conviction of being love “. In the same way, as in the delusion of persecution where the patient is persuaded to be the object of imaginary malevolence, the erotomaniac is persuaded to be the object of a loving love, just as delirious, on the part of others.
The erotomaniac is persuaded to be secretly the object of someone’s desire, but it is through a delusional intellectual construct that supports his initial conviction, typically from telepathy, gestures to meaning. a secret known only to him, messages coded and broadcast in the media that he alone can decipher or simply looks that only he understands. He does not always like this person, but he is sure to be loved. It may be someone around him or her as a prominent figure who does not even know the existence of the erotomaniac, but a person who embodies in his eyes a superior social position, a nurse, a postman, a television presenter or his spouse, a politician, etc.
Usually, the patient returns to his “admirer” the affection he assumes by writing, phoning, and giving him gifts. Even when his advances are rejected by their addressee, the erotomaniac cannot understand the refusal that is opposed to him. He imagines this refusal as a ploy to hide from the rest of the world their forbidden “connection”. 
I – General Characteristics of Erotomania Disorder
The School of Psychiatry in France has established in the last century classification of mental disorders that are chronic psychoses and delusions. She defines erotomania as a form of paranoid psychosis belonging to the category of passionate delusions.
1 – Erotomania Disorder: Paranoid Delirium
Erotomania disorder belongs to paranoid delusions. These are chronic delirious states characterized by:
– A systematization of delirium: the construction of delirium follows a certain coherence. Associated with the absolute and unshakable conviction of the patient, it can lead to the adhesion of a third party.
– An interpretive mechanism of delusion: the subject correctly perceives the reality, but attributes to it a wrong meaning.
Good to know: the membership of a third party means that a third person is likely to judge the plausible story as delusional.
Paranoid delusions are well developed in people who previously had a paranoid personality disorder with:
– hypertrophy of the self: the subject overestimates his capacities and his importance;
– the falsity of judgment: delirium is accompanied by a total absence of self-criticism;
– mistrust: others are perceived as malicious or even hostile;
– psychorigidity: the subject is locked in a system of values that he refuses to question.
Good to know: in Freudian psychoanalysis, the ego designates an entity of thought that arranges the conditions of satisfaction of its impulses taking into account the requirements of the real.
2 – Erotomania: Passionate Delirium
Erotomania disorder is a passionate delirium among others. The characteristics of these delusions are:
– a brutal beginning, initiated by a delusional interpretation or intuition;
– a construction “in the sector”: delirium touches a specific sector of the psychic, affective or relational life of the subject and remains focused on its object.
Good to know: among the passionate delusions, there are also delusions of jealousy and demand. They all have in common to be inspired by passion, hence their name.
*** The triggers of passionate delirium
The passionate delirium of the erotomaniac necessarily originates in a word or behavior at the initiative of the person object of the unrequited love. This person, involuntarily, addresses the erotomaniac in such a way that the latter interprets the words or acts of his interlocutor as proof of very intense love. It is, therefore, the victim who, in the spirit of the erotomaniac, is at the origin of the illusory love story. Thus persuaded to be loved, the erotomaniac implements the means to perpetuate the link and make effective the fantasized love story, lasting and one-way, which necessarily results in a failure with more or less important consequences.
3 – Erotomania Disorder, a Disorder of Sexuality Characterized
Erotomania disorder is a real pathology of a psychiatric order. This disorder of sexuality is translated by the intimate conviction, wrongly, to be loved. The erotomaniac is often a woman. As for the person object of the one-way love, it is generally a person whose social or professional functions are considered in the common spirit as superior: a teacher, a doctor, a lawyer, or even a public figure – politician in particular – or a celebrity – known writer, fashionable singer…
More than a passing passion of a teenager for her favorite star, which she displays the portrait on the walls of her room, erotomania is a real mental illness whose consequences – which suffers the erotomaniac but also the loved one – are not negligible.
II – Specificities of Erotomania Disorder
Some elements are specific to erotomania disorder:
– The object of delirium (the person being loved) is a personality or a socially recognized or envied person, who often does not know the erotomaniac.
– Delirium is born in the intuition that it manifests its affection for the erotomaniac by telepathy, by means of secret messages, looks, or indirectly through the media.
The course of delirium is then variable, but the most frequent follows three phases:
1 – Hope
Erotomaniac sends emotional signs to the object of their delirium. The latter does not answer or reject it. Erotomaniac hopes that he will declare himself openly and interpret the refusals as a ploy to hide this love from the rest of the world. This phase can go as far as harassment.
*** The hope phase of the erotomania episode
For a long time, erotomania pushes the sufferer to multiply the attempts of love exchanges with the loved one. Sending couriers, insistent presence by her side in everyday life, acts of love, the erotomaniac multiplies the connections through behaviors that can quickly be likened to harassment. In the absence of a return, the erotomaniac keeps hope and finds explanations: the victim prefers to remain discreet about his love, it is an erotic game that it sets up … But after a while, the time or the categorical manifestation of the loved one lead to spite, the second stage of the cycle of erotomania.
2 – The Spite
Once, the hope is disappointed, the erotomaniac falls most often into depression and isolation. He may develop aggressive or suicidal behavior.
3 – The Grudge
Aggression turns to the beloved and can lead to a passionate crime.
*** Grudge, a destructive feeling
Once the last phase of frustration, in which the erotomaniac realizes that love is not shared, he feels a deep disappointment that leads him to grudge. He is angry with the other for making him believe that he was in love and feels the need to take revenge. His behavior can then be violent: physical aggression, threats, or material destruction.
III – Attempt to Understand an Erotomaniac…
A doctor at Sainte-Anne Hospital for 15 years, Dr. Dalle followed a dozen erotomania patients for several years. Beyond the clichés, he gives us his vision of this real disease.
*** Very variable manifestations
Present at all the dedications of her favorite writer; Sylvie is more than a fan. After much complimenting his work, the flattered author thanks her with a few kind words. Light words that Sylvie immediately interprets as a true declaration of love, certain signs, certain gestures, and certain words cannot deceive her. From this initial illusion, Sylvie will not stop writing to the author of the inflamed letters; wait for him during all these public appearances, to send him his apartment keys. The polite refusals or rebuffs of the author will do nothing; they will soon be interpreted as the result of a plot to silence this imaginary idyll. “Beyond this aspect of café-theater, erotomania is finally revealed in the light of a scandal, which will involve the police and then the care,” says Dr. Benoit Dalle.
According to some psychiatrists, erotomania disorder follows the cycle of “hope, spite, resentment, aggression” towards the beloved object, suddenly hated. For Dr. Dalle, these attacks are the result of an extreme minority and although he himself was the victim of one of these patients, he is convinced that erotomania is less dangerous for the loved one only for the patient. Suicidal thoughts are more common than attempts at aggression.
*** The delusional illusion of being loved
Described for the first time in the early 20th century, erotomania disorder was considered the delusional and lasting illusion of being loved. Since then, a fairly similar definition of this psychological disorder has been incorporated into the American Bible of all psychiatrists, the famous “Diagnostic and Statistical Manual of Mental Disorders“.
Reflecting a certain form of paranoid delusion, erotomania is essentially a women’s affair. The erotomaniac exists only for the object of her amorous desire, to which she attributes the initiative of this love. In the mind of the erotomaniac, it is the other who has chosen to love him: “He was the first to fall in love, the first to make advances. persuaded that the object of his love does everything to hide this passion by benefiting from the help of all his entourage. The extremely fertile imagination of the patient allows him to interpret any sign as confirming his thesis “tells, Dr. Benoit Dalle. His delirium affects only this sphere of desire, the person is also not affected by any mental deficiency.
Another characteristic feature of this disorder is its sustainability. Nothing to do indeed with “erotomaniac moments”, as can live some teenagers persuaded for example that such singer or such star particularly watched them or made them a sign during a concert for example. “The real erotomania can last for years, even a complete life, and I remember the case of a patient whose passion had survived the death of the object of her passion,” says Dr. Dalle. But if at first glance, this delusion can seduce by its romantic aspect (the desire is essentially platonic), it can transform the lives of the loved one into real hell!
*** Mysterious causes…
This disease is not drifted from normal passion but the delusional delusion of being loved. What are the causes? As with many of these delusional disorders, experts can only make assumptions.
The most obvious is the lack of affection during childhood. Given the predominance of this disease in women, we have often thought of emotional deficiencies, mainly of the father. But for Dr. Dalle, this version is not necessarily the most obvious: “It is often the feminine component that is sought in the beloved, so the emotional deficiency that causes this delusional disorder could ultimately be maternal…”.
When erotomania causes threatening disorders, hospitalization is performed. Management may depend on the degree of “delirium” but good results have been obtained by psychotherapeutic treatments.
Main drawback: the possible development of erotomania during the treatment vis-à-vis the therapist … Dr. Dalle was the cost before recommending systematic treatment by a therapeutic group: “The erotomaniac desires a heart to constant heart with the object of his love and does not take into account the others. Therefore, he is not in need of care and does not want to leave this delusional duo. The therapist must introduce a third in this story, including at the level of care “.
With his experience, Dr. Dalle takes a critical look at the current situation: “Today, the situation of hospital psychiatry no longer allows for the long-term follow-up of such patients, so the treatment is essentially medicated: antipsychotics, neuroleptics … Chemical solutions that only act on the symptoms but do not solve the problem …”.
IV – How to React to an Erotomaniac?
Erotomania is a risky sexuality disorder for the person object of obsessive love. Insofar as erotomania is pathological, it is useless to attempt to deal with it alone. The victim, on the other hand, has to go to the right people and surround himself well.
At first, it can be resorted to justice, to protect against violent overflows of the erotomaniac. In a second step, it is possible to consider directing the erotomania to competent psychiatric health services.
V – Treatment Solutions for Erotomania Disorder and Supported
Erotomania is detrimental to the person who suffers from it, on a personal level – depression following the stage of spite – and in terms of justice – measures of removal from him or even incarceration in case of serious the loved one.
Under these conditions, it is urgent to undertake medical treatment: solutions based on psychotherapy or drug treatments exist to help erotomania.
*** Erotomania Disorder: what support?
In the management of erotomania disorder, the main difficulty will be to make the patient adhere to the care since he is not able to criticize his delirium:
– Recourse to hospitalization is only indicated in certain cases:
* anxious or depressive decompensation, suicidal risk;
* hetero-aggressiveness: the use of hospitalization under constraints, called “at the request of a representative of the State” is necessary.
– The drug treatment is based on:
* Minimally effective antipsychotics, such as Risperdal®, Solian®, or Zyprexa®;
* antidepressants: they are indicated in case of characterized depressive episodes;
* benzodiazepines: they are sometimes used to calm the anxious manifestations.
– Psychotherapy has not demonstrated its effectiveness in this type of delusion.
Note: when hospitalization is necessary, hospitalization called “at the request of a third party” is contraindicated, because the erotomaniac might return his aggression against the third.