What Is Erotomania?
A delusion that provides insight into the brain regions that control love.
Posted Feb 08, 2020
What parts of our brain are involved in love? We can gain insights about this from a fascinating delusion that can occur in the context of brain injury or disease: erotomania.
Erotomania, also known as De Clérambault’s syndrome (after the French psychiatrist who first described it), is the sudden belief that someone of higher social status has fallen passionately in love with you, and that you are deeply in love with them. It typically manifests in middle-aged women with psychiatric illnesses such as schizophrenia or bipolar disorder, but there are rare reports of it occurring after an acquired brain injury or in people with dementia. For Margaret, it was the first symptom of a much more sinister problem.
Margaret was 65 years old. She had two children and had lived alone since her divorce. Her medical history included a transient ischaemic attack — a brief and temporary interruption of blood flow to the brain. These are often a warning sign that you are at risk of having a stroke. She had been a heavy smoker, working through up to 40 cigarettes a day, but had quit five years before she developed the psychiatric and neurological problems that brought her to the attention of the authors of her case study.
Over a period of six months, Margaret became increasingly obsessed with a deceased American singer of the 1930s and 40s, Dick Haymes, who was famous for his love ballads and his marriage to actress Rita Hayworth. Margaret bought every CD and DVD she could find that featured Haymes, and his music was a constant soundtrack to her life, broadcasting across her entire house from devices in all rooms. Despite being told he was dead, she insisted the singer was alive and believed he was living next door to her and was in love with her. She said she "loved him to bits" and on one occasion she waited for hours outside her flat, anticipating his arrival.
Margaret’s daughter discovered she had not been eating or sleeping properly, and a neighbour told her he had seen Margaret wandering the streets late at night. She took Margaret to the doctor. She was sent for an MRI brain scan which revealed chronic small vessel ischaemia — brain changes related to a lack of oxygen to the small blood vessels in the brain, often found in heavy smokers — and atrophy, or shrinking, of the front portion of the temporal lobes.
She also had a brain scan called a SPECT (single photon emission computed tomography), which measures glucose metabolism. It showed hypoperfusion, or reduced metabolism, in the left frontal and temporal regions. This means that those brain regions were not functioning properly. These brain areas control a vast array of functions that essentially make us who we are — and they are also considered part of the sexual and love neural networks. Her neurological condition had left Margaret unable to interpret one of our most complex social behaviours — love.
Margaret was prescribed antipsychotic medication and her erotomania resolved, but other symptoms started to appear. Her speech became slurred and soft, her tongue twitched intermittently and she had difficulty swallowing. The muscles in her hands wasted away, and she had to abandon knitting, her favourite hobby, as she couldn’t hold onto the needles anymore. She lost weight and her legs became weak.
Eighteen months after she had been seen for her erotomania, she was sent for an urgent neurological review. During her appointment, she was impulsive and demonstrated "utilisation behaviour" — or a tendency to use any object placed in her vicinity, like a baby grabbing at toys on their highchair table. This is indicative of severe frontal lobe dysfunction. She grabbed the neurologist’s pen from his desk and started writing on his notepad, and leaned forward and reached for the glasses that protruded from his shirt pocket.
After a series of investigations, she received a diagnosis of motor neurone disease with frontotemporal dementia. Motor neurone disease was initially thought only to affect nerve cells controlling the muscles, but it is now known that it can also cause changes to cognition and behaviour in up to half of people who are diagnosed with the condition. In some cases like Margaret’s — an estimated 5-15 percent of those diagnosed — these changes will be severe enough to warrant a diagnosis of behavioural-variant frontotemporal dementia as well.
In Margaret’s case, erotomania was the first sign of the changes that were occurring in her brain, as a result of a tragic neurodegenerative condition. This shows that changes in our brain can alter our experience of love. We do not fully understand the complexities of love; likewise, there is still so much more to learn about love in the brain.
This is an adapted excerpt from Sex in the Brain: How your brain controls your sex life (NewSouth Publishing, 2019 & Columbia University Press, 2020)
el Gaddal, Y.Y. (1989). De Clérambault’s syndrome (erotomania) in organic delusional syndrome. British Journal of Psychiatry, 154(5), 714–716.
Olojugba, C., de Silva, R., Kartsounis, L.D., Royan, L., & Carter, J. (2007). De Clerambault’s syndrome (erotomania) as a presenting feature of fronto-temporal dementia and motor neurone disease (FTD-MND). Behavioural Neurology, 18(3), 193–195.