Erotomanic stalking in evolutionary perspective

Induced erotomania by online romance fraud - a novel form of de Clérambault's syndrome

BACKGROUND

Although the impact of internet usage on mental health is extensively documented, there is a notable scarcity of reports in the literature concerning internet-induced erotomania. Erotomania is a rare and likely underdiagnosed delusional disorder. It is characterized by an irrational belief held by the affected persons that someone of higher socioeconomic status harbor romantic feelings toward them. Here, we describe the psychopathology of erotomanic delusion induced by online romantic fraud in a female patient. Employing this case as a focal point, we illuminate novel aspects of erotomania that warrant attention and examination.

CASE PRESENTATION

We present a compelling case involving a 70-year-old married Caucasian woman diagnosed with medically controlled persistent depressive disorder for several years. The intricacies of her condition became evident as she became deeply engrossed in online profiles featuring the image of a renowned musician, inadvertently falling victim to an online romantic fraud. Subsequently, this distressing experience triggered the emergence of erotomanic delusions and a suicide attempt. The patient's history reveals an array of medical conditions and stressful life events, contributing to her vulnerability. The diagnosis of erotomanic delusional disorder, dysthymia, and mild cognitive impairment with cerebral vascular background was established. Treatment involved her previous antidepressant with low-dose risperidone, alongside supportive individual and group therapy. Her delusion showed remission four weeks later, prompting her discharge for outpatient follow-up. Although she retained some false beliefs, the intensity of the symptoms had notably diminished and her functionality improved.

CONCLUSION

This case underscores the complex interplay between mental health, online activities, and the consequences of delusions, including suicidal thoughts, shedding light on the need for a comprehensive approach in addressing such challenging psychiatric scenarios.

De Clérambault's syndrome revisited: a case report of Erotomania in a male

BACKGROUND

Erotomania, also known as "de Clérambault's Syndrome", is a psychiatric syndrome characterized by the delusional belief that one is loved by another person of, generally of a higher social status. Erotomania has always been a target of attempts of conceptualization, and the utility of regarding Erotomania as an independent syndrome has been questioned to this day. Erotomania has a much higher prevalence in the female sex, and male Erotomania is a rare and probably underdiagnosed condition. Male Erotomania is only more prevalent in forensic samples, since male sex is one of the risk factors for violent behavior in this disorder. In this article, we aim to describe an uncommon case of Erotomania occurring in a male, hoping to add to literature and to reflect on the implications of the occurrence of Erotomania in men. By discussing the case in light of the different described clinical pictures, proposed diagnostic criteria and classifications, we also aim to contribute to the ongoing attempt to conceptualize this syndrome and to understand the pertinence of considering it an independent nosological entity.

CASE PRESENTATION

We describe a case of Erotomania in a middle-aged Caucasian Portuguese male, with consecutive erotic delusions, followed by a classic turn to a persecutory delusion. The patient was admitted as an inpatient in a psychiatry unit and he was medicated with risperidone 3 mg and diazepam 3 mg daily. His persecutory delusion remitted a 4 days later, he gained insight and was discharged to follow-up as an outpatient. He retains his erotic delusional beliefs, but these are less intense, and has not presented further aggressive behavior.

CONCLUSIONS

We can conclude that it seems reasonable to retain the operative concept of Erotomania as a subtype of Persistent Delusional Disorder/Delusional Disorder, since cases fitting the classical descriptions of the syndrome have been reported, including the presented case. The diagnosis of Erotomania has implications in case management, treatment and prognosis, and missing it, especially in men, may culminate in violent situations that can have legal implications. The developed diagnostic criteria and classifications seem to retain use and should be kept in mind, in the sense that they facilitate making an important diagnosis.

Towards a compendium of the psychopathologies of love

Adults are commonly preoccupied with their love lives and in psychotherapy they often express frustrations with themselves and their partners. Ironically, patients' preoccupations with the processes of love have not created many professional deliberations on the nature of love and mechanisms of its subversion. This essay describes the converging influences that may explain the professional avoidance of love. It then describes the reasons to try to create a compendium of clinically apparent impediments to loving. The pathologies of love are divided into three categories: (1) characteristics that impede the formation of a sexual adult attachment; (2) patterns that diminish the index person's lovability to the partner; (3) processes that deteriorate the index person's ability to continue to love the partner. The compendium seems to present several important utilities. It clarifies the pathogenesis of some mental suffering. It defines a distinct, more relevant focus to psychotherapy. It makes clear that a better understanding of love's subtle processes of evolution is needed. It invites further refinement of both healthy and problematic love processes.

Stalking by females

The aim of this review was to study "female stalking" in the sense of the specific traits characterizing the phenomenon of stalking behaviour committed by women. The main medical databases were searched (Medline, Social Science Research Network, Apa Psyc Net), and 67 articles were selected, reporting studies conducted in clinical populations, case series, reports, reviews, retrospective studies and original articles. We outline a variety of different tactics adopted by female stalkers and a lesser propensity to pass on to physical violence. Nevertheless, female stalkers are more frequently affected by erotomania, and this condition generally increases the risk of violence. If there have previously been intimate relations between the stalker and her victim, this will increase the risk of violence. In a significant proportion of female stalkers, the behavior is carried out in the occupational setting, especially in the field of psychotherapy, where the male-female ratio is reversed. No significant differences emerged between the motivations of heterosexual or homosexual stalkers. In the category of crimes of harassment committed by women, stalking, at least in Italy, seems to be among the most prominent.

Female same gender stalking: a brief review of the literature and case report

The authors analyze a rare case of female same gender stalking that came to their observation as forensic psychiatry experts. Despite previously only heterosexual experiences, the woman, who was 30 in 2002, had three intimate same gender relationships in succession from 2002 to 2009: she broke off with each woman in order to take up with another. When she separated from the third woman she began violent persecutory behavior against her, in the form of harassment coming under the heading of stalking, and was reported to the authorities. In treatment with SSRI since 2003 for an anxiety disorder with panic episodes, she had been taking the drugs irregularly during the stalking period. At the end of the third relationship, after she had violently attacked her girlfriend she was advised by her family to present to a Hospital center in Northern Italy. There, she was diagnosed with a "Narcissistic Paranoid Personality Disorder", and it was hypothesized that the SSRI she was taking could have induced hypo/manic episodes and disinhibition in the woman, who had previously been heterosexual. At this hospital, mood stabilizers were prescribed. The defending lawyer therefore applied for a forensic psychiatry assessment, claiming that the persecutory behavior against the third girlfriend was induced by taking SSRI. In Italy the penal code specifies the recognition of abolished or diminished liability for crimes if a correlation between the mental disease and the crime can be demonstrated, if the disease was in course at the time of the crime, and if the motives behind the crime and the disease can be shown to be linked. In short, if the crime can be shown to be a symptom of the disease. But the forensic psychiatry assessment demonstrated that despite the presence of some factors of a psychopathological nature, the motives underlying the harassment were attributable to the woman's existential history and personality structure rather than to psychopathological causes. She was therefore judged guilty of the crime of stalking and a plea for a reduced sentence was granted. In this case, the gender of the stalker and victim seemed to be irrelevant.

Neuropsychological research in delusional disorder: a comprehensive review

In recent decades, there has been a growing interest in the field of delusions, and different aspects of delusional disorder (DD) have been investigated. However, DD is still one of the most underresearched psychiatric disorders. In this paper, we review the literature on DD and most of the theoretical approaches proposed to explain the development and maintenance of delusions. DD research is infrequent, and delusions in this disorder have been scarcely investigated. We aim to establish the state of the art of delusions research to date and point to the shortage of neuropsychological studies in patients with DD. We also justify the need for future research into the neuropsychological correlates of DD as measured in patients with this disorder given that most previous research has mainly focused on other psychotic conditions.

The evolution of misbelief

From an evolutionary standpoint, a default presumption is that true beliefs are adaptive and misbeliefs maladaptive. But if humans are biologically engineered to appraise the world accurately and to form true beliefs, how are we to explain the routine exceptions to this rule? How can we account for mistaken beliefs, bizarre delusions, and instances of self-deception? We explore this question in some detail. We begin by articulating a distinction between two general types of misbelief: those resulting from a breakdown in the normal functioning of the belief formation system (e.g., delusions) and those arising in the normal course of that system's operations (e.g., beliefs based on incomplete or inaccurate information). The former are instances of biological dysfunction or pathology, reflecting “culpable” limitations of evolutionary design. Although the latter category includes undesirable (but tolerable) by-products of “forgivably” limited design, our quarry is a contentious subclass of this category: misbeliefs best conceived as design features. Such misbeliefs, unlike occasional lucky falsehoods, would have been systematically adaptive in the evolutionary past. Such misbeliefs, furthermore, would not be reducible to judicious – but doxastically1noncommittal – action policies. Finally, such misbeliefs would have been adaptive in themselves, constituting more than mere by-products of adaptively biased misbelief-producing systems. We explore a range of potential candidates for evolved misbelief, and conclude that, of those surveyed, onlypositive illusionsmeet our criteria.

The epidemiology and characteristics of stalking

PURPOSE OF REVIEW

This article summarizes major results in the field of epidemiology and characteristics of stalking, as published in literature between 2003 and October 2005.

RECENT FINDINGS

Although stalking had been only recently conceptualized, it soon became evident that it represents a significant social and medical problem. Community-based studies on the prevalence of stalking are scarce and predominantly from English-speaking countries. All epidemiological studies, however, revealed that stalking is a widespread phenomenon with lifetime prevalence rates of stalking victimization ranging 12-16% among women and 4-7% among men. With regard to the impact of stalking, studies suggest that stalking can cause serious economic, social, medical and psychiatric consequences. Growing evidence suggests that serious violence and even homicide may occur in the context of stalking, and research on risk assessment has yielded an improved understanding of risk factors. Research on therapy of stalkers and stalking victims is still at its beginning; however, there are some preliminary reports with encouraging results.

SUMMARY

Although there are research activities in the main fields, many basic questions still remain to be adequately addressed. Increased social and political awareness and expanded research funding are obligatory prerequisites to realize sound and well designed studies.

Erotomania : epidemiology and management

Erotomania is generally classified as a delusional disorder in contemporary classification systems (DSM-IV and ICD-10). The incidence of erotomania is not known, but that of delusional disorder in general has been reported as approximately 15 cases per 100,000 of the population per year, with a female : male ratio of 3 : 1. Both primary and secondary types of erotomania have been identified, the latter being associated with evidence of an aetiologically significant organic or psychiatric condition. The aetiology of primary erotomania is not yet fully understood, but neuroimaging, genetic studies and findings from evolutionary psychopathology hold considerable promise for a deeper and broader understanding of this condition. The initial management of secondary erotomania focuses on treating the underlying organic or psychiatric illness. The management of primary and secondary erotomania involves a combination of pharmacological treatments, psychosocial interventions and risk management strategies. In the past, the antipsychotic medication pimozide was commonly used, at least in certain countries (such as the US and Canada), despite a paucity of systematic studies of its use in this disorder. In recent years, there have been reports of positive therapeutic outcomes with atypical antipsychotics (risperidone, clozapine), which, as a result of their improved tolerability over older agents such as pimozide, will hopefully enhance patient acceptability and, thereby, improve clinical outcome. Despite this advance, there is still a strong need for controlled clinical trials of therapeutic strategies for primary erotomania and related syndromes.