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Love, delusion and delusional disorders
Erotomania is a rare psychiatric condition characterised by the persistent delusion (fixed, false belief) that one is loved from afar by another person. The condition has a long history in psychiatry and has been known as de Clérambault's syndrome and old maid's insanity. More recently, erotomania has been reclassified as a form of 'delusional disorder' in the International Statistical Classification of Diseases (ICD-10). 1
The purpose of this paper is to provide a background to the concept of erotomania in psychiatry; discuss a possible case of erotomania in which the woman's apparent delusions centred on the economist John Maynard Keynes (1883-1946); examine the treatment of erotomania in selected literary and romantic fiction, exploring why delusions of love appear to have generated a specific, definable, recurring syndrome; and suggest that various combinations of longing, disappointment, shame and narcissism can lie at the heart of the complex psychopathology of at least some cases of erotomania. It is also possible that lesser forms of delusional exaggeration of true love might exist in many stable relationships, and might even be essential for the continued existence of some such relationships in the long term.
What is erotomania?
Erotomania is a form of delusional disorder, a diagnosis that has waxed and waned over the course of the history of psychiatry. In the latter part of the 1900s, delusional disorder was not commonly described in the psychiatric literature, although there was persistent interest in certain subtypes, including primary erotomania and pathological jealousy. 2 The recent re-emergence of delusional disorder as an acceptable diagnostic category coincides in significant part with the development of effective antipsychotic medication in the 1950s and 1960s. 3
Today, it is recognised that erotomania is a relatively rare condition, 4 and much recent consideration has focused on the disorder's relationship with stalking, especially in the context of high-profile stalking cases in the USA. 2 Erotomania is, however, an interesting condition to explore for many other reasons too, not least because it demonstrates some more general debates in psychiatry, especially in relation to the role of new pharmacological agents in the management of psychiatric illness and the relationship between psychiatry, risk and the popular press. 5 6
From earliest times, references to erotomania...