Erotomania – He Loves Me, He Couldn’t Possibly Love Me Not

Posted by on 04 16 13 in Love Addiction News | Comments Off on Erotomania – He Loves Me, He Couldn’t Possibly Love Me Not

Not exactly a disease or a disorder, and not necessarily a symptom of other disorders, erotomania is somewhat complex to define. To do so, we need to take a closer look at how mental disorders are classified and diagnosed.

In the popular media, diagnostic labels get tossed about like confetti: the terms psychopath, sociopath, psycho (short for psychotic), maniac, schizo, etc., are used without any particular rigor or specificity. In addition, among the different mental health practitioners, there may be subtle or significant differences in how such terms are used. Strict adherence to the diagnostic criteria in the Diagnostic and Statistical Manual (DSM) offers a common language, but over the course of a professional’s career, the DSM may be revised several times such that the criteria or even the existence of a disorder may change. For practitioners schooled in diagnosis prior to the rise in the DSM’s hegemony, the use of DSM terms and criteria may feel awkward or irrelevant.

Where does this leave us in terms of trying to understand erotomania? Basically, erotomania is a delusional belief by Person A that Person B is in love with him or her. If diagnostic criteria are met, then erotomania could be understood as a specific subtype of delusional disorder. However, this delusional belief could also occur within the context of other psychiatric disorders such as schizophrenia or bipolar disorder with psychotic features. It could also exist as a “stand alone” delusion, occurring without any other diagnostic criteria being met. But most commonly, delusional disorder is the diagnosis a person exhibiting this delusion would be diagnosed, unless additional symptoms were present.

Delusional Disorder

To diagnose a delusional disorder, the following conditions must be met:

  • The delusions must be considered “non-bizarre,” meaning that they involve events and people that are within the realm of possible (i.e., they do not involve aliens or the ability to breathe underwater, etc.).
  • The delusions must be present for at least one month.
  • Diagnostic criteria for schizophrenia have never been met.
  • In all other areas of life, functioning is normal. That is, the delusion only impacts the areas of life in which it is relevant. For example, a person could perform well as a parent, providing appropriate and loving care to his or her children but encounter difficulty at work if the delusion was work-related.
  • If low moods or manic episodes co-exist with delusional episodes, the delusional episode must outlast the mood episode. That is, mood changes should be brief and not meet diagnostic criteria for any mood disorder.
  • No better diagnosis or explanation for the delusion exists: diagnostic criteria for psychotic disorders, schizophrenia, and bipolar disorder with psychotic features are not met, and no substance has been ingested that could better account for the delusion. Several medical conditions present with delusions, and it is important to rule out physical illness before diagnosing a delusional disorder.

There are a number of subtypes of delusional disorders, of which erotomania is one. Other include grandiose, somatic, persecutory, jealous, mixed and unspecified. This delusion can come on suddenly with no prior history of mental illness.

Typical behaviors involved with erotomania include becoming obsessed with the person who is believed to be in love with the sufferer. The delusion focuses on a person of higher social status or importance: a famous person or a high ranking person at work.  While the pursuit often involves letter-writing, e-mails, gifts and telephone calls, it can escalate to surveillance and stalking. Typically for those with this disorder, denials of love and/or contact are interpreted as encoded messages of love and devotion, thus deepening the delusional belief. Interestingly, statistics indicate that this delusional belief affects more women than men, but more men than women end up in contact with law enforcement due to their obsessive and delusional behavior. In some cases, the erotomanic form of delusional disorder can become dangerous. Some people with this disorder do escalate to the point of violence, stalking and harming the object of their obsession. The disorder itself is rare, and this extreme form of it much more rare.

Treatment for Delusional Disorder

Medication combined with psychotherapy is the standard treatment approach for this disorder. Hospitalization may be necessary if the person has become dangerous to himself or others. Antipsychotic medications are often used, with additional medications for any underlying depression or anxiety added if necessary. Therapy may focus on management of symptoms; learning to treat the delusion like a craving or unwanted thought, for example. Some therapists use an addiction model, helping those struggling with erotomania to “quit” their obsession. Others favor a psychodynamic approach, exploring early childhood experiences. In general, regardless of treatment modality, recovery rates are fair, with about 50 percent of those followed in one study showing no symptoms at long term follow up points.