delusions - De Clerambault's syndrome
recent question in All India PG Entrance Exam (AIPGE 2004) makes this topic a
contentious topic. Despite this syndrome having an interesting and rare name, it
was not asked directly, so the question was a bit easy to attempt. Luckily The
times of India carried a feature on it also. So our condolences are there for
people who don’t read that newspaper! The question is:
A 30-year old unmarried woman from a low socio-economic status family
that a rich boy staying in her neighborhood is in deep love with her.
boy clearly denies his love towards this lady. Still the lady insists that his
is a secret affirmation of his love towards her. She makes desperate
to meet the boy despite resistance from her family. She also develops
at times when her effort to meet the boy does not materialize. She is
to maintain her daily routine. She however, remains preoccupied with the
of this boy. She is likely to be suffering from:
answer is ‘1. Delusional Disorder’
are presenting a brief tutorial over this interesting syndrome.
Clerambault (1921) proposed that a distinction should be made between paranoid
delusions and delusions of passion. The latter differed in their
pathogenesis and in being accompanied by excitement. They had a sense of
in this category whether they display erotomania, litigious behaviour, or morbid
jealousy all have a precise aim in view from the onset of the illness, which
brings the will into play from the beginning. This constitutes a distinguishing
feature of the illness. This distinction is of historical interest only, as it
is not made nowadays. However, the syndrome of erotomania is still known as De
Clerambault's syndrome. It is a-rare disorder. Although erotomania is usually
a disorder of women, Taylor et at. (1983) have reported four cases in a series
of 112 men charged with violent offences.
erotomania, the subject, usually a single woman, believes that an exalted person
is in love with her. The supposed lover is usually inaccessible, as he is
already married, or famous as an entertainer or public figure. According to De
Clerambault, the infatuated woman believes that it is the supposed lover who
first fell in love with her, and that he is more in love than she. She derives
satisfaction and pride from this belief. She is convinced that the supposed
lover cannot be a happy or complete person without her.
patient often believes that the supposed lover is unable to reveal his love for
various reasons that he has withheld from her, and that he has difficulties in
approaching her, has indirect conversations with her, and has to behave in a
paradoxical and contradictory way. The woman may be a considerable nuisance to
the supposed lover, who may complain to the police and the courts. Sometimes the
patient's delusion remains unshakeable, and she invents explanations for the
other person's paradoxical behaviour. She may be extremely tenacious and
impervious to reality. Other patients turn from a delusion of love to a delusion
of persecution. They become abusive and make public complaints about the
supposed lover. This was described by De Clerambault as two phases - hope
followed by resentment.
patients with erotic delusions are suffering from paranoid schizophrenia. Sometimes
there is insufficient evidence to make a final diagnosis at the time, and they
can be classified as delusional disorder erotomanic type in DSM-IV.
Case Study for this syndrome:
unhappily married female aged 26 years suddenly developed an
passion for a married doctor who attended her abortion. She constantly pestered
him with telephone cans and almost daily messages, and frequently visited his
home. She showed no concern whatsoever for her own daughter, and would talk of
nothing but 'him', alleging that he
'reciprocated several times with an ardour even more pronounced than her own' .
She maintained that when she first met Dr 'P', 'I felt changed into another
person until then I had not lived'. Thereafter she ceased to live alone and was
convinced that everybody when they talk to me, inevitably ends by speaking about
him'. Finally the doctor's wife literally
her out of the door but threats and scenes only increased her love. 'He acts
like that only because, for reasons I am not yet able to understand, he is
compelled to assume attitudes entirely to the contrary to his feelings, because
he does not want others to understand his real passionate love: in fact, I have
noticed that he has shown himself more aggressive to me verbally when that
woman, who passes for his wife, is
Dr P.................. in fact,
cannot be married; I do not know that she has
called to act a comedy which leads me completely indifferent.
person or circumstance will be able to separate us, not even death, because this
exists solely for those who love by the body; I will be united to him eternally
because I love with my mind, as he loves me. He is part of me in so far as he
integrates my personality; nevertheless he is much
more powerful and more able to reason for me; I shall never be finally complete
until I can live with him always' .
here is the Times of India Article:
just another day for Nidhi. She reaches office at 9:30 am sharp and waits. At a
quarter to 10, her heart starts pounding. At 10 to 10, she starts getting
nervous. At 10, out comes the mirror from her bag; Nidhi adjusts her hair and
waits for Vinay to walk in. Vinay is her boss, a highly successful CEO. The CEO
smiles and Nidhi's heart skips a beat. And her belief grows stronger. ''He loves
me so much, he doesn't even look at anyone else in office,'' is what she says to
herself. Nidhi confides in a friend: ''Vinay is madly in love with me. It's
because of his wife that we aren't together.''
for the interruption, but what Nidhi imagines is far from true. When Vinay gets
to hear of the rumour in office, he's hopping mad. ''I never thought my casual
good-mornings and goodbyes would lead Nidhi to think this way. Actually, our
families know each other so, maybe, I'm a little more warm towards her, but
never have I given her the impression that I love her!''
is not at fault. And, probably, neither is Nidhi - she suffers from the De
Clerambault's Syndrome, a condition in which a woman entertains the delusion
that a certain man is in love with her. Usually, it is a man of a higher social
status whom she is acquainted with.
Sanjay Chugh, recalls a case involving an aspiring actress who was offered words
of acknowledgement by an established writer. Unfortunately, the actress'
overactive mind came to the conclusion that love was in the air. Only, the
writer had no clue as to what this was all about. ''Things got out of hand when
this actress started making obscene calls to the writer and told her parents
about a relationship which did not exist,'' elaborates Chugh, ''But after a few
sessions of therapy, she woke up to reality.''
recently De Clerumbault's syndrome was regarded as a female disorder (with male
victims). However, now it is established that even males suffer from it.
speaking it is classified as a delusional (paranoid) disorder. Delusional
disorders are a form of psychosis in which a person has paranoid delusions which
are often long-lasting, and do not have an obvious physical or medical causes
(e.g. head injuries).
type of stalker has real potential for violence when their "love" is
persistently unrequited by the object of their affection. The patient usually
becomes aware of the victim through various forms of the media (cinema, TV,
radio, newspapers, etc.) and establishes a delusional fantasy in which they have
a special or unique relationship with the victim. These fantasies can be of an
extreme sexual nature - sometimes reflected in the way the stalker attempts to
communicate with the victim.
While communication is one-way, the stalker believes the victim is communicating
with them using a secret code that only they know the meaning of. Due to the
nature of this type of stalker most victims will be the rich and famous. In some
cases the victim may simply look like someone famous.
makes the stalker dangerous is their tendency to objectify their victims. This
means they will view a victim not as a human-being, but as an object that they
alone must possess and control.
Given the nature of the problem, people with paranoid delusions are often very
suspicious about receiving treatment. Often they don't believe anything is wrong
with them and asking them to get some help via a doctor or a hospital may only
serve to complicate their paranoid delusions and make things worse. Thus, a
great deal of care should be taken. Even so, sometimes this does not work and
the person may have to be admitted into hospital against their will.
Medication, also known as neuroleptics, is mainly used in the treatment of
disorders where there is an element of psychosis. Psychotherapies such as
Cognitive-Behavioural Therapy (CBT) are also used to resolve the problem.
the Clerumbault's Syndrome is no case of love's labour lost. Rather, it is an
unfortunate situation created by the victim's low self-esteem. Ironically, if
love is all about an affair to remember, a mismatch of emotions is all about a
tragedy of errors.