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Erotic delusions - De Clerambault's syndrome

Author: RxPG, Posted on Monday, January 12 @ 01:31:14 IST by RxPG  

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Psychiatry

Erotic delusions - De Clerambault's syndrome

 

A 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:

 

AIPGE 2004
A 30-year old unmarried woman from a low socio-economic status family

believes that a rich boy staying in her neighborhood is in deep love with her.

The boy clearly denies his love towards this lady. Still the lady insists that his

denial is a secret affirmation of his love towards her. She makes desperate

attempts to meet the boy despite resistance from her family. She also develops

sadness at times when her effort to meet the boy does not materialize. She is

able to maintain her daily routine. She however, remains preoccupied with the

thoughs of this boy. She is likely to be suffering from:

1.Delusional disorder

2.Depression

3.Mania

4.Schizophrenia

 

The answer is ‘1. Delusional Disorder’

 

We are presenting a brief tutorial over this interesting syndrome.



De 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 purpose.

patients 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.

In 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.

The 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.

Many 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.

 

 A Case Study for this syndrome:

 

An unhappily married female aged 26 years suddenly developed an

ardent 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

had '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

pushed 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

present. Dr P.................. in fact, cannot be married; I do not know that she has

been called to act a comedy which leads me completely indifferent.

'No 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

stronger, more powerful and more able to reason for me; I shall never be finally complete until I can live with him always' .

 

And here is the Times of India Article:

 

It's 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.''

Sorry 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!''

Vinay 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.

Psychiatrist 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.''

Till 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.

Medically 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).

This 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.

Behaviour Patterns
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.

What 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.

Treatment Options
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.

Antipsychotic 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.

Yes, 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.




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