De Clerambault's Syndrome
Synonyms: erotomania (a delusion of passion), erotomanic delusion, paranoia erotica, psychose passionelle.
A form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that an exalted person is in love with her. This condition was originally described by de Clerambault as having phase of hope followed by a phase of resentment.1
The victim of the delusion, with whom only a brief acquaintance exists, is usually older and of higher social status. The victim may well be a public figure in politics, on the screen, stage or television, or is often a doctor or a priest.
There has usually been little or virtually no contact and nothing has been done to stimulate or encourage such a belief.
The victim is at first unaware but is later likely to be embarrassed by telephone calls, letters and amorous advances.
History
Gaetan Gatian de Clerambault (1872-1934) was born near Paris and became successful in both medicine and art (many of his paintings are now in museums).
His work in psychiatry focused on hallucinations and delusions. He suggested that "mental automatism" might be responsible for experiences of hallucination.2
De Clerambault described Clerambault's syndrome in 1927 as "psychose passionelle".
Epidemiology
Age at onset is usually middle or late adulthood, and the course is variable.
Familial transmission is suspected, and co-morbidity (frequently mood disorders) may exist.
Subjects are often isolated, unemployed, and with few social contacts.
Presentation
The diagnosis of primary erotomanic delusions requires at least one month's duration of the delusion, otherwise generally normal appearance and behaviour and the exclusion of schizophrenia, mood disorder, substance-induced toxicity, and medical disease.
Typically, patients are unaware of the psychiatric nature of the condition.
Usually the supposed lover is inaccessible, e.g. a famous television performer who she only sees whilst watching the television.
The patient often believes that it is the subject of her delusion that is more in love with her than she with him, and takes great pride in this. She may feel that the subject cannot live happily without her.
The patient may believe that the subject of her delusion cannot make his feelings known because of various reasons, for example difficulties in approaching her.
This type of delusional disorder may lead to stalking or other potentially threatening and dangerous behaviour.3 The police may get involved in trying to keep her from pestering the subject, but this may be perceived as a paradoxical sign of affection.
The patient may continue to pester the subject and may develop delusions of persecution following the delusions of passion.
They may also be violent against those they believe stand in the way of their delusional love.
A thorough psychiatric evaluation is essential in diagnosis and assessment of possible co-morbidity.
Investigations Very occasionally, if a neurological problem is suspected, tests such as an EEG, MRI or CT scan may be performed.
Associated Diseases
Erotomania may be primary (no associated psychiatric problem) but is often associated with other psychiatric illness (secondary) such as paranoid schizophrenia, schizo-affective disorder, major depression, bipolar disorder or Alzheimer's disease.
Is occasionally associated with other delusions, e.g. persecutory, grandiose, jealousy or somatic.4
Other associations include epilepsy and a left frontal lobe lesion.
Management
Management of any associated disorder.
Successful management is difficult and may include psychotherapy and anti-psychotic pharmacotherapy.
Prognosis
The prognosis is variable but various treatment modalities have been shown to be successful, especially for primary erotomania and erotomania secondary to bipolar affective disorder, with subjects becoming less dangerous and engaged in less harassment of victims.5
Delusional disorder is typically a chronic condition, but with appropriate treatment, a remission of delusional symptoms occurs in up to 50% of patients.
However, because of their strong belief in the reality of their delusions and a lack of insight into their condition, individuals may never seek treatment, or may be resistant to exploring their condition in psychotherapy.