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Lovestruck: A brief look at de Clérambault’s Syndrome

In previous blogs I have looked at both love addiction and obsessional love. Since writing my blog on obsessional love and noting that it is also known as erotomania, I have received a couple of emails from clinicians saying that obsessional love is not necessarily erotomania by definition. The problem with the wider area of obsessions, compulsions and addiction more generally is that academics and clinicians have different definitions of what it is to be obsessed or addicted to something.

In clinical circles, erotomania is known as de Clérambault’s syndrome (DCS), and was named after a paper published in 1921 (Les Psychoses Passionelles) by the French psychiatrist Gaëtan de Clérambault. Those with DCS typically have a delusional belief that another person (typically someone famous, high status and/or a stranger) is in love with them. Some of the scientific literature suggests that DCS sufferers may have experienced loss of people that were emotionally close to them, and that therefore they may feel emotionally and psychologically safer by attaching themselves to people who are unattainable. Such actions prevent any further losses. In a 1983 issue of Psychological Medicine, Dr. P. Taylor and colleagues described the main components of DCS:

  • The presence of a delusion that the individual (usually described as a female) is loved by a specific man;
  • The woman has had little or no contact with the man;
  • The man is unattainable in some way, because he is already married or because he has no personal interest in her;
  • The man is perceived as watching over, protecting or following the woman;
  • Despite the erotic delusion, the woman remains chaste.

One of the reasons I am personally interested in DCS is that back in the early 1990s, my then girlfriend (who was – and still is – a clinical psychologist) was the object of affection by a DCS sufferer. The man who fell in love with my girlfriend was slightly brain damaged following a bad motorcycling accident. The accident had also left him paralyzed and had to use a wheelchair. As part of her job, my girlfriend worked with the charity Headway (a brain injury association), and it was when she was caring for this head injured and paralyzed man that he fell in love with her and believed that the feelings were reciprocal. The condition was so intense that he even booked a wedding date, sent out wedding invitations, and told all his family and friends that he was marrying my girlfriend. I even started to question my girlfriend’s fidelity because I couldn’t comprehend that someone could organize a whole wedding if nothing had ever happened between them. (Even though I was a psychologist when this happened I had never come across DCS).

The research literature on DCS suggests that the delusional behaviour is usually part of psychotic behaviour (typically schizophrenia, bipolar disorder, or borderline personality disorder) and can therefore be treated using atypical anti-psychotics (however, most DCS sufferers do not ask for help or seek treatment as they don’t believe they are doing anything wrong). According to the Wikipedia entry on DCS (and based on a paper published in a 1998 issue of the Journal of Neuropsychiatry and Clinical Neuroscience by Dr. C. Anderson and colleagues):

“During an erotomanic episode, the patient believes that a ‘secret admirer’ is declaring his or her affection to the patient, often by special glances, signals, telepathy, or messages through the media. Usually the patient then returns the perceived affection by means of letters, phone calls, gifts, and visits to the unwitting recipient. Even though these advances are unexpected and unwanted, any denial of affection by the object of this delusional love is dismissed by the patient as a ploy to conceal the forbidden love from the rest of the world”.

In a 2002 issue of the journal History of Psychiatry, Dr. German Berrios and Dr. N. Kennedy describe four convergences in the history of erotomania.

  • Convergence 1: From classical times to the early eighteenth century, erotomania was viewed as a ‘general disease caused by unrequited love’.
  • Convergence 2: During the nineteenth century, erotomania was viewed as a disease of ‘excessive physical love (nymphomania)’
  • Convergence 3: During the twentieth century, erotomania was viewed as a form of ‘mental disorder’
  • Convergence 4: Currently, erotomania is viewed as a ‘delusional belief of being loved by someone else’.

Berrios and Kennedy also note that there are differences between Anglo-Saxon and French views surrounding the meaning or coherence of “the much-abused English eponym ‘de Clérambault syndrome’. Erotomania is a construct, a mirror reflecting Western views on spiritual and physical love, sex, and gender inequality and abuse. On account of this, it is unlikely that there will ever be a final, ‘scientific’ definition rendering erotomania into a ‘natural kind’ and making it susceptible to brain localization and biological treatment”.

Empirical research suggests that women are more likely than men to suffer from DCS, and that DCS sufferers tend to have social and intimacy difficulties, and are therefore typically loners. Developmentally, they are likely to have a poor sense of self and may have suffered abuse during childhood and/or adolescence. Much of the published theorizing about erotomania is from a psychodynamic perspective or genetic/neurochemical presispositions. I’m far more eclectic in my approach to understanding human behaviour and believe that environmental, psychological, pharmacological and physiological factors most likely trigger a predisposed person into developing DCS. It’s also been speculated that learning through the media (television, radio, books, etc.) has influenced the development of DCS.

Dr. Louis Schlesinger in his 2004 book Sexual Murder: Catathymic and Compulsive Homicides writes about DCS sufferers in relation to possible stalking behaviour. He notes that: “some stalkers are unable to give up a prior intimate relationship (Zona, Sharma, and Lane, 1993). Some develop delusional beliefs about the target (Goldstein, 1987), while others develop strong obsessional thoughts about virtual strangers (Spitzberg and Cupach, 1994). Meloy (1992) and Kienlen (1998) believe that a disturbance of attachment begins in the offender’s early childhood and stalking starts when some type of loss in adulthood resurrects these early conflicts”

In some individuals, DCS can remain with the person for a long time. For instance, Dr. Harold Jordan and colleagues published a paper in a 2006 issue of the Journal of the National Medical Association. They reviewed two cases of DCS that they had followed for over 30 years making these some of the longest, single-case longitudinal studies yet reported”. They noted that DCS remains a “ubiquitous nosological psychiatric entity with uncertain prognosis”. De Clerambault’s original paper presented the case of a woman whose chronic, erotic delusion remained with her for 37 years, and the cases reported by Dr. Jordan and his colleagues also demonstrated that the delusion can remain unchanged for decades. I have yet to come across any research that estimates the prevalence of DCS among the general population but given most published papers are clinical case reports, it suggests the disorder is relatively rare.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Anderson CA, Camp J, Filley CM (1998). Erotomania after aneurismal subarachnoid hemorrhage: Case report and literature review. Journal of Neuropsychiatry and Clinical Neuroscience, 10, 330-337.

Berrios G.E. & Kennedy, N. (2002). Erotomania: a conceptual history. History of Psychiatry, 13, 381-400.

Jordan, H.W., Lockert, E.W., Johnson-Warren, M., Cabell, C., Cooke, T., Greer, W. & Howe, G. (2006). Erotomania revisited: Thirty-four years later. Journal of the National Medical Association, 98, 487-793.

Schlesinger, L.B. (2004). Sexual murder: Catathymic and compulsive homicides. London: CRC Press.

Taylor, P., Mahendra, B. & Gunn J. (1983). Erotomania in males. Psychological Medicine, 13, 645-650.

Zona, M., Sharma, K., and Lane, J. (1993). A comparative study of erotomania and obsessional subjects in a forensic sample. Journal of Forensic Sciences, 38, 894–903.

Yearning power: A beginner’s guide to obsessive love

In a previous blog, I briefly looked at to what extent love can be addictive. However, recent history has seen the rise of the term ‘obsessive love’.  Obsessive love is typically associated with unrequited love, but there are relationships in which individuals could be said to obsess over each other and relationships in which one member obsesses over their partner. According to Dr. Helen Fisher in her 2005 book Why We Love: The Nature and Chemistry of Romantic Love, some people believe that all love is obsessive as it can be characterised by feelings of exhilaration, and intrusive, obsessive thoughts about the object of one’s affection. One common view is that love and relationships are a specialized kind of mutual addiction.

It may be useful to categorise obsessive love as an addiction because the behaviour is often similar. It is possible to see the resemblance between the definitions given for obsessions and addictions. In 2003, Griffin and Tyrrell stated that “obsessions are thoughts, images or impulses that cause marked degrees of anxiety or distress”. Similarly, Stanton Peele and Archie Brodsky in their 1975 book Love and Addiction defined addiction as “a single overwhelming involvement with one thing that serves to cut a person off from life, to close him or her off to experience, to debilitate him, to make him less open, free, and positive in dealing with the world”. From this it is obvious that there is a resemblance in the fact that both can be debilitating. However, though it seems that certain aspects of obsessive love resemble a behavioural addiction, it has not been fully investigated.

Current literature uses the term ‘obsessive love’ to describe erotomania or love addiction. Obsessive love can therefore be seen as an umbrella term that covers subgroups such as erotomanics and love addicts, although no literature has been found that uses both concepts within the context of obsessive love. A common conception of obsessive love is generally that of a person being infatuated with a particular individual. However, another category includes those who feel the need to be in love generally. These are commonly known as ‘love addicts’. A more medically accepted category of obsessive love is that of erotomania.

Erotomania is a ‘rare delusional disorder’ also known as De Clerembault’s Syndrome. This type of obsessive lover develops a fixation on a person and becomes convinced that they are having a romantic relationship regardless of attempts by the recipient to convince them otherwise. Although erotomania and love addiction are dealt with as individual disorders, they share a number of characteristics. Obsessive love is seen predominantly in women although it has been realised that there are male sufferers. Also, more specifically, erotomania usually occurs in unmarried women that are isolated and lonely and have low self-esteem. However, recent studies have shown the disorder to be present in men who have a history of substance abuse or mental illness.

Obsessive lovers lack the ability to develop and are obsessed with impossible needs and unrealistic expectations. They engage in desperate hopes and unending fears. Obsessive lovers often have a past history of mental illness and/or a criminal record. Erotomania is also often associated with other mental disorders, in particular paranoid schizophrenia. Only ten percent of those that suffer erotomania do not suffer any other forms of mental illness. Typically the recipient is often higher in social status – often a boss or a celebrity. Symptoms of this form of obsessive love include delusions of passion followed by delusions of persecution. The individual creates reasons as to why the recipient cannot be with them such as their job or shyness. The person also believes that the recipient is more in love with them than vice versa.

Obsessive love can take place both in and out of a relationship. It can be a past partner, a friend, an acquaintance or even a stranger. Characteristics shared by all types of obsessive love include addictive personalities and low self-esteem. Obsessive lovers also have a tendency for violence and self-destruction. A person with such an obsession is likely to avoid change, and is typically dependent with a need for security. As this disorder is of an obsessive nature, the love the person feels is not particularly intimate. It is often the case that the love interest is the biggest thing in their life and so they dedicate lots of time to it.

Generally, the obsessed person’s life revolves around the person they are obsessed with. Whether in a relationship or not, the happiness of the obsessed is a direct result of the actions of the love object. As a result of this, the obsessed may beg to be told of how to make the other person happy so that they become the person the love object would want them to be. Obsessive lovers will go to great lengths to achieve or maintain the love of the love interest. Behaviour can become unpleasant for the recipient. Such actions include obscene phone calls, criminal damage or even physical violence and stalking. Their behaviour may necessitate the interest of the law.

This is frequently an occupational hazard for celebrities. In 1995, Madonna was stalked by Robert Hoskins. The man suffered from erotomania and believed that she was his wife. In an attempt to see his ‘wife’ he gained access to her home and assaulted a security guard. He was sentenced to ten years imprisonment. There are always fans that take their love for their idol into obsession.

Stalking is clearly a form of obsessive behaviour, and it has been found that those patients who have been stalked have described it as ‘psychological rape’. This can only further illustrate the devastating consequences of obsessive love. Stalking has even been given the clinical term ‘obsessional following’, and can be defined as the wilful, malicious and repeated following and harassing of another person. There is no single stalker profile and no two research centres can agree on what to call different types of stalkers.  The only exception is erotomania. This is the only psychiatric diagnosis routinely associated with stalking.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Bogerts, B. (2005). Delusional jealousy and obsessive love – causes and forms. MMW Fortschritte der Medizin, 147(6), 28-9.

Debbelt, P. & Assion, H.J. (2001). Paranoia erotica (de Clerambault syndrome) in affective disorder. Der Nervenarzt. 72, 879-83.

Fisher, H. (2005). Why We Love: The Nature and Chemistry of Romantic Love. New York: Henry Holt and Company.

Graziano, W.G. & Musser L.M. (1982). The joining and parting of the ways. In Duck, S (Ed.). Personal Relationships 4: Dissolving Personal Relationships (pp.75-106). London: Academic Press.

Kennedy, N., McDonough, M., Kelly, B., & Berrios, G.E. (2002). Erotomania revisited: Clinical course and treatment. Comprehensive Psychiatry, 43, 1-6.

McCann, J.T. (1998). Subtypes of stalking (obsessional following) in adolescence. Journal of Adolescence, 21, 667-75.

Meloy, J. R. (1998). The psychology of stalking: Clinical and Forensic Perspectives. New York: Academic Press.

Orion, D. (1997). I Know You Really Love Me: A Psychiatrist’s Journal of Erotomania, Stalking, and Obsessive Love. London: MacMillan Publishing Company.

Peabody, S. (1994). Addiction to love. California: Celestial Arts.

Peele, S. & Brodsky, A. (1975). Love and Addiction. New York: Taplinger.

Sinclair, H.C, and Frieze, I.H. (2000). Initial courtship behaviour and stalking: how should we draw the line? Violence and Victims. 15(1), 23-40.

Stanbury, A. & Griffiths, M.D. (2007). Obsessive love as an addiction. Psychology Review, 12(3), 2-4.

A whole in the heart: Can love really be addictive?

“You like to think that you’re immune to the stuff/It’s closer to the truth to say you can’t get enough/You know you’re gonna have to face it, you’re addicted to love”

(Robert Palmer, Addicted To Love, 1986)

“Stitched up tight, can’t break free/Love is the drug, got a hook on me/Oh, oh, catch that buzz/Love is the drug I’m thinking of/Oh, oh, can’t you see/ Love is the drug for me”

(Roxy Music, Love Is The Drug, 1975)

If evidence for love addiction was purely based on the lyrics of pop songs, there would be little doubt that love addiction exists. For those in the academic community who believe in the concept of ‘love addiction’ unsurprisingly define it as the condition in which people become addicted to the feelings of being in love.

Historically, in the psychological literature, the concept of love addiction has been around for some time. Freud’s case study of the Sergei Pankejeff (nick-named the ‘Wolf Man’ after he told Freud about a strange dream involving a tree full of white wolves), noted his “liability to compulsive attacks of falling physically in love …a compulsive falling in love that came on and passed off by sudden fits”. However, it is generally thought that Dr. Sándor Radó (the Hungarian psychoanalyst) first described the characteristics of ‘’love addicts” that used love to simultaneously increase sexual satisfaction and heighten self-esteem.

Arguably the most cited work in this area is the 1975 book Love and Addiction by Dr. Stanton Peele and Dr. Archie Brodsky. Their book suggested that some forms of love are actually forms of addiction, and tried to make the case that some forms of love addiction may be potentially more destructive and prevalent than widely recognized opiate drugs. However, Peele later said his main points had been somewhat sidelined and used for others’ own agendas. He said that the book had intended to be: ‘”a social commentary on how our society defines and patterns intimate relationships…all of this social dimension has been removed, and the attention to love addiction has been channeled in the direction of regarding it as an individual, treatable psychopathology”.

In 1981, a paper on the development of a 20-item ‘Love Addiction Scale’ by Dr. Mary Hunter and colleagues was published in the journal Psychological Reports. They said that the defining characteristics of love addiction were:

  • Wanting the partner to fill a felt void in one’s life
  • Wanting the reassurance of constancy of partner
  • Feeling that the partner is necessary to make life bearable
  • Feeling that the sole source of one’s gratification, and pleasure is one’s partner.

However, the actual paper was a one-page summary and did not actually report what the individual 20 items were. Since then, the term ‘love addiction’ has been uncritically and extensively used in popular psychology and self-help books (such as Robin Norwood’s Women Who Love Too Much, and Susan Peabody’s Addiction to Love, and John Moore’s Confusing Love with Obsession). Jim Hall claims there are at least nine types of love addict in his book The Love Addict in Love Addiction. He claims that some individuals “become painfully obsessed with avoidant and/or narcissistic relationship partners” and that others can become addicted to individuals outside of a romantic relationship.

Readers of my research in the general area of behavioural addiction will know that I use the components model of addiction to operationally define whether addictions to certain behaviours exist. If love addiction exists, I would expect to see people with the following criteria:

  • Salience: This would be when loving somebody becomes the most important activity in the person’s life and dominates their thinking (preoccupations and cognitive distortions), feelings (cravings), and behaviour (deterioration of socialized behaviour).
  • Mood modification: This would refers to the subjective experiences that people report as a consequence of being in love with someone and – if it was a genuine addiction – would be used as a coping strategy to feel better about themselves (i.e., they experience love as an arousing “buzz” or a “high” or paradoxically a tranquilizing feel of “escape” or “numbing” that helps them to cope with other more stressful things in their life).
  • Tolerance: This would be the process whereby the love they feel for someone plays an increasingly bigger and more important part in that persons’ life to achieve the former mood modifying effects.
  • Withdrawal symptoms: These would be the unpleasant feeling states and/or physical effects that occur when love is discontinued (e.g., the other person ends the relationship or the person loved dies).
  • Conflict: This would be where being in love with someone resulted in the feelings love interfering and compromising all other activity in that person’s life (e.g., job, hobbies, social friendships, etc.).
  • Relapse: Here this might refer to “getting somebody out of their system” only for all the feelings of love to return when they are in the person’s company or engage in an act (e.g., kissing) that re-kindles all the previous feelings they had for that person.

By applying these basic criteria to love, I would guess (as I have never done any empirical research on this topic) that there would be very few genuine ‘love addicts’. When people first meet and fall in love, many of the criteria above may be temporarily experienced, but this is due to the effect of novelty, and may not be particularly long lasting. There is certainly some empirical evidence by Dr. Thomas Timmreck (California State University, USA) suggesting that relationship break-ups and death of life-partners can lead to a range of symptoms that resemble withdrawal effects in more traditional addictions.

As I have said many times before in many different contexts, the difference between healthy enthusiasms and addictions is that healthy enthusiasms add to life whereas addictions take away from them. For the vast majority of people, falling in love (and being in love with somebody), is something that is life affirming and life enhancing and in no way problematic.

I recently co-authored (along with Dr Steve Sussman and Nadra Lisha, from the University of Southern California) a review paper on addiction prevalence across 11 different potentially addictive behaviours (including love addiction). We reported that one study by MacLaren and Best in 2010, provided estimates of 12% for relationship submissive/love addiction among a sample of young adults. Most studies I have read report the prevalence of love addiction at around 3% to 6%. However, most of these studies are methodologically questionable (small samples, sample bias, etc.) and are more likely to be estimating or assessing preoccupation with love rather than genuine addiction.

Despite the lack of conclusive evidence that love addiction actually exists, we can all probably think of people we know where their love for somebody has bordered on the obsessive and/or addictive. There are also clinical cases of de Clérambault’s Syndrome in which the affected person suffers from the delusion that another person (typically a stranger or very casual acquaintance, or somebody famous or of high-status), is in love with them. This type of obsessive love is often found in people with other psychological and/or psychiatric disorders such as bipolar disorders, psychoses, and schizophrenia (and as such is a different clinical entity to love addiction).

One of the problems with the concept of ‘love addiction’ is that if it does exist, there is potential crossover and confounding effects with ‘sex addiction’ particularly as they often appear to have a symbiotic relationship. Although love and sex are different entities, they can be highly intertwined. On this note I will leave you with a couple of my favourite quoatesAs actor and film director Woody Allen once said: “Love is the answer. But while you’re waiting for the answer, sex raises some pretty good questions” and “Sex alleviates tension. Love causes it”.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Griffiths, M.D.  (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.

Hunter, M.S., Nitschke, C. & Hogan, L. (1981). A scale to measure love addiction. Psychological Reports, 48, 582.

MacLaren, V.V., & Best, L.A. (2010). Multiple addictive behaviors in young adults: Student norms for the Shorter PROMIS Questionnaire. Addictive Behaviors, 35, 252-255.

Peele, S. & Brodsky, A. (1975), Love and addiction. New York: Taplinger.

Rado, S. (1928). The problem of melancholia. International Journal of Psycho-Analysis, 9, 420.

Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.

Timmreck, T.C, (1990). Overcoming the loss of a love: preventing love addiction and promoting positive emotional health. Psychological Reports, 66, 12-14.