Erotomania is the delusional belief that someone is in love with you, accompanied by a fixation on signs and signals of affection that aren’t based in reality. Typically, the object of fixation is a celebrity or person of higher social status, often a stranger. While the person being focused on isn’t necessarily famous, the extensive content available online about celebrities makes them obvious targets.
What Is Erotomania?
Someone experiencing erotomania believes the object of their love is actually fixated on them, even if they’ve never met. This may lead them to believe a musician is sending hidden messages in their songs, or that their boss is professing coded affection in emails. These delusions can be all-consuming, sometimes leading to stalking or violence.
When an erotomanic’s attempt to contact the object of their desire is ignored, their behavior often increases in intensity. A famous example of this was when John Hinkley Jr. developed an obsession with actress Jodie Foster after seeing her in the movie Taxi Driver. His attempted assassination of President Ronald Reagan was part of an escalating series of events involving stalking and trying to impress Foster, who he believed returned his affections.1
Historically, erotomania has been called de Clerambault syndrome, named for the physician who first described the condition.2 Since then, it has been recognized as having similar characteristics to other types of delusional thinking. It’s also been linked to mental health diagnoses that contain symptoms of psychosis.
Erotomania as a mental health diagnosis is relatively rare and falls under the category of delusional disorder. Delusions are fixed beliefs that can’t be altered despite evidence to the contrary. When a person suffers from a delusional disorder their delusional thinking persists over time and may include delusions of other subtype categories, such as jealousy, grandiosity, or persecution. Delusions are often present in those with other significant mental health issues, such as bipolar disorder or schizophrenia.
7 Signs & Symptoms of Erotomania
An obsessive focus on a love interest, particularly one that is a stranger and/or is of a higher social status, is the hallmark of erotomania. This combined with the delusional belief that one’s love interest reciprocates and is communicating with you (often secretly) creates a dangerous departure from reality for an erotomanic person.
Seven signs and symptoms of erotomania are:1
- Obsessive thinking about a love interest who is a celebrity, person of power, and/or a stranger
- Obsessively seeking information or media content about the love interest
- Attempting to communicate with or send gifts to the love interest
- Following, harassing, or otherwise stalking the love interest
- Believing the love interest is sending messages, possibly secret or encoded, to express their affection, even when no direct communication is present
- Losing motivation for activities other than pursuing the love interest
- A “psychotic break” or psychotic episode that includes high energy, sleeplessness, pressured speech, racing thoughts, and/or delusional thinking of subcategories besides erotomania
Causes of Erotomania
Some people experience erotomania of a shorter duration, and in the absence of psychosis, these instances are more likely to be brought on by social or emotional factors and not physiological shifts in brain chemistry.
The following precipitating factors may refer to clinical or subclinical examples of erotomania:
- Social isolation
- Low self-esteem
- Loneliness
- Feeling rejected
- Difficulty with socialization cues
The following precipitating factors likely denote a more significant and possibly clinical case of erotomania:
- Psychosis brought on by drug or alcohol addiction
- Psychosis brought on by an underlying mental health condition, such as bipolar disorder or schizophrenia
- Psychosis brought on by deterioration in physical health, such as a brain tumor or dementia
- Genetic predisposition to schizophrenia spectrum or other psychotic disorders
- Classification of Erotomania As a Delusional Disorder
If erotomania is long-lasting and significant, it may be classified as a mental health disorder, even in the absence of other symptoms.3 To meet the diagnostic criteria for a delusional disorder (subcategory erotomania) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), erotomania must have been present for at least one month with other mental health disorders having been ruled out.
Treatment of Erotomania
Typically a combination of intensive psychotherapy and drug treatment is required to alleviate the symptoms of erotomanic delusions. Medication alone does not identify or examine the underlying causes of the delusion. Note that erotomania can last for months or even years. The longer it goes on unaddressed, the more difficult it may be to treat.
Therapy
Cognitive behavioral therapy (CBT) has been shown to be moderately effective in treating erotomania, particularly in conjunction with drug therapy and community support.4 Mental health therapists with CBT training will employ cognitive restructuring techniques to identify and change thoughts and behaviors. They may utilize aversion therapy or guided imagery to reduce interest in the erotomanic love object.
Although CBT is one of the most researched therapeutic modalities in terms of effectiveness, other forms of therapy are also likely to have positive results when utilized consistently and in conjunction with medication.
Important elements to include in a therapeutic intervention for erotomania are:5
- Building a strong therapeutic alliance
- Implementing risk management strategies
- Understanding the underlying factors which contributed to the delusion
- Fostering a system of social support
- Restoring self-esteem
- Gradually correcting cognitive bias
Medication
Antipsychotics are the class of drugs most commonly used to treat erotomania and other similar patterns of delusional thinking. They can help to reduce delusional thinking within hours or days but require 4-6 weeks to reach their full effect. They work by blocking dopamine receptors in the brain, typically reducing the intensity of delusional thinking (although delusions are unlikely to go away completely).
In general, antipsychotics can help manage symptoms and reduce the probability of another serious episode; however, they do not cure the underlying condition. Combining antipsychotic medication with psychotherapy is necessary to effectively manage erotomania.
There are two categories of antipsychotic medication, typical and atypical. Typical antipsychotics impact only the dopamine receptors whereas atypical antipsychotics are newer (second generation) and also affect serotonin. Atypical antipsychotics are reported in general to have fewer side effects.
Each specific antipsychotic medication has side effects that are more or less prevalent and each medication can affect patients differently. It is important to talk with your prescribing doctor about which medication might be most effective and discuss potential side effects.
Common side effects of antipsychotics include:6
- Feeling sedated (tired, foggy, sleepy, low motivation)
- Restlessness
- Dizziness
- Dry mouth
- Blurred vision
- Weight gain
- Decreased libido
- Constipation
- Nausea
- Vomiting
- Low blood pressure
- Seizures (rare)
Because it is important to first diagnose whether delusional thinking is part of a broader mental health diagnosis, antipsychotics are most likely to be prescribed for erotomania by a psychiatrist or an MD with a strong psychiatric background.
Erotomania Statistics
To provide a better understanding of erotomania, here are several relevant statistics:
- Delusional disorder of any subtype, including erotomania, is quite rare and occurs in only about 0.2% of the population7
Erotomania is one of the more rare subtypes of delusional disorder5 - Prevalence of delusional disorder is equal across genders, whereas the erotomania subtype is seen slightly more frequently in women2
- Erotomania is more likely to occur in individuals with schizophrenia or bipolar disorder than on its own1
- Although erotomania can occur in younger individuals, delusions such as this are believed to be more prevalent in older populations1)
Final Thoughts On Erotomania
Those afflicted with erotomania will often experience their thought patterns as being normal or based in reality. For this reason, if you’re a friend, family member, or colleague of someone who you believe is being impacted by erotomania, your role is crucial in getting them support. Contact the National Alliance on Mental Illness (NAMI) for resources to help you take the next steps, or look through an online directory for therapists who specialize in this disorder.
