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Ask the Mental Health Expert Archives 2001-2004

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Erotomania

Q. I'm a social worker on a forensic rehabilitation unit at a psychiatric hospital. We are currently following a client who is diagnosed with Erotomania/deClerambeault's Syndrome. Can you tell me where I can get good information about this disorder? What might be suggested as possible treatment and what outcomes might be expected from such treatment?

A. Erotomania or de Clerambault's Syndrome is usually defined as a delusional syndrome in which the patient--generally a woman--is convinced that an exalted person is in love with her. This person is typically of higher social status than the patient; a famous public figure; or in some way, inaccessible to the patient. Some patients with this condition become abusive toward, or make complaints about, the love object (the person desired). De Clerambault described this as "hope followed by resentment".

That your patient is in a forensic unit suggests that--he?--has acted out in some threatening way toward the desired person--but I can only guess from your description. The diagnosis of de Clerambault's Syndrome has been held up to very skeptical scrutiny in recent years, and some psychiatrists doubt it is a disorder in its own right--rather, many such patients turn out to have paranoid schizophrenia or bipolar disorder. For references on this, see SF Signer, J Psychiatry Neurosci 1991;16:81-90; and Ellis & Mellsop, Br J Psychiatry 1985;146:90-93.

Indeed, Ellis & Mellsop consider the term de Clerambault's Syndrome to be mainly of historical interest. Thus, the very first thing I would do in such a case is re-examine the entire diagnosis, perhaps by getting some neuropsychiatric testing done, and getting a very careful family history of psychiatric illness. It may be worth considering either an antipsychotic agent and/or a mood stabilizer, depending on what you come up with. It is also possible, in my experience, that some individuals with this diagnosis turn out to have severe, narcissistic personality disorders, perhaps with antisocial features. (This may show up on the MMPI or Millon Personality Inventory). They, unfortunately, are quite tough to treat with any kind of therapy--and may sometimes require an introduction to the legal system, as in court-mandated treatment, probation, etc.

Hard to say what the outcome would be in your patient's case, but I would hold out the most hope if the diagnosis turned out to be one in the mood disorders category, followed by schizophrenia.

October 2001

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