TLDR: A case study reveals a 70-year-old woman developed erotomanic delusions and attempted suicide following online romance fraud.
Highlights:
- 70-year-old woman with persistent depressive disorder.
- Victim of online romance fraud involving a renowned musician’s image.
- Developed erotomanic delusions and attempted suicide.
- Treatment included antidepressants, low-dose risperidone, and therapy.
- Significant symptom remission after four weeks of treatment.
Source: BMC Psychiatry (2024)
Internet-Induced Erotomania?
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 characterized by the irrational belief that someone of higher socioeconomic status harbors romantic feelings toward the affected person.
A recent case report describes the psychopathology of erotomanic delusion induced by online romantic fraud in a female patient, highlighting novel aspects of erotomania that warrant attention and examination.
Case Report: Online Romance Fraud-Induced Erotomania in 70-Year-Old Female
A 70-year-old married Caucasian woman, with a history of persistent depressive disorder controlled by medication, was admitted to a psychiatric department after a suicide attempt.
Her condition worsened after engaging in an online romantic relationship with a fraudster posing as a renowned musician.
Patient History
The patient, a retired cook, resides with her husband and reported feeling neglected by her family throughout her life.
Her childhood and adolescence were uneventful, but she perceived familial neglect, exacerbated by her mother’s depression and dementia.
Marrying a military officer at 17, her husband became her sole relationship.
Over the past three decades, cumulative organ diseases have contributed to a depressive mood, decreased work capacity, and heightened isolation.
Despite residing near her son and grandchildren, loneliness persisted due to infrequent visits, and her husband’s social engagement.
- Medical history: Bilateral deep vein thrombosis, diabetes mellitus with polyneuropathy, hypercholesterolemia, spondylosis, lumbar spondylarthrosis, osteoporosis, lumboischialgia, vertebrobasilar syndrome, and tinnitus.
- Medications: She took 50 mg of sertraline and 0.25 mg of alprazolam daily for dysthymia and anxiety, maintaining a compensated psychiatric status since the age of 55. No prior psychotic symptoms were noted.
Erotomania Onset
The patient’s involvement began innocently, expressing admiration for a musician’s work through positive comments on various online social profiles.
Over time, her feelings intensified, perceiving the musician as talented, elegant, and sexually attractive.
She persuaded her husband to attend the musician’s live concert, hoping for a personal encounter.
Subsequently, she engaged in frequent, confidential chats on profiles that were deceptively using the musician’s image (fraud) and received positive and encouraging messages.
The conversations became increasingly personal, with the patient divulging significant amounts of personal information.
Signs of Online Romance Fraud
- Personalized Attention: The fraudster, posing as the musician, sent numerous messages praising the patient, which created a deep emotional connection and made her feel rejuvenated.
- Requests for Money: As the online relationship deepened, the fraudster began requesting significant sums of money, citing various reasons such as charitable causes or covering their phone bills.
- Increased Secrecy & Isolation: The patient’s involvement in the online relationship led her to become more secretive, and she started isolating herself from her husband and family.
- Escalating Conflicts: The financial requests and the patient’s belief in the fraudulent relationship led to escalating conflicts within her marriage. Her husband, concerned about the inconsistencies and dangers of the perceived relationship, filed a police report, resulting in the temporary cessation of fraudulent profiles.
- Continued Deception: Despite the initial intervention, the fraudster resumed communication through a new profile, continuing to manipulate the patient and further straining her marital relationship.
Symptoms of Erotomania
- Delusional Belief: The patient developed an irrational belief that the musician was romantically interested in her. She felt that the musician’s supposed love for her was genuine and reciprocated.
- Suicidal Thoughts & Attempt: The fear of losing the perceived relationship and the ongoing conflicts with her husband led to a suicide attempt by benzodiazepine ingestion.
- Persistent Delusions: Despite treatment, the patient retained some false beliefs about the romantic relationship, though the intensity of her symptoms diminished over time.
Diagnosis & Treatment
- Diagnosis: The patient was diagnosed with erotomanic delusional disorder, dysthymia, and mild cognitive impairment with a cerebral vascular background.
- Treatment: The treatment involved continuing her previous antidepressant (sertraline 50 mg/day) and adding low-dose risperidone (2 mg/day), along with supportive individual and group therapy. Cognitive-behavioral therapy focused on processing the emotional trauma of deception and loss, while couple-counseling helped resolve marital conflicts.
Outcome: ~4 weeks into treatment, the patient showed significant improvement in her symptoms. Her dysthymia and anxiety resolved, and her psychotic symptoms improved. She was discharged for outpatient follow-up, with recommendations for continued psychopharmacological and supportive treatment.
What causes erotomania?
Erotomania, also known as de Clérambault’s syndrome, is a rare delusional disorder characterized by the irrational belief that someone of higher socioeconomic status is romantically interested in the affected individual.
The exact causes of erotomania are not fully understood, but several contributing factors have been identified:
- Psychodynamic Factors: Psychodynamic theories suggest that erotomania arises from unmet needs for love and affection, often rooted in early developmental experiences. Narcissistic injuries and deficits in ego function may also play a role.
- Neurophysiological Factors: Deficits in visuospatial functioning, lesions in the limbic system (particularly the temporal lobes), associative deficits, and impairments in cognitive flexibility and frontal-subcortical functioning have been implicated in erotomania.
- Genetic & Neurochemical Factors: A genetic predisposition has been suggested, with studies indicating potential familial aggregation. Neurochemical imbalances, particularly involving dopamine and serotonin, may also contribute to the disorder.
- Environmental & Psychological Factors: Stress, trauma, and life events, such as the loss of a loved one, isolation, and significant changes in life circumstances, can trigger or exacerbate erotomanic delusions.
How common is erotomania?
Erotomania is considered a rare psychiatric condition, and its exact prevalence is not well-documented.
However, it is recognized as a subtype of delusional disorder in both the ICD-11 and DSM-5-TR. Some key points about its prevalence include:
- General Population: Delusional disorder, in general, has an estimated prevalence of approximately 15 cases per 100,000 people per year.
- Sex Differences: Historically, erotomania was believed to be more common in women, but more recent reports indicate that it can affect both genders, with some studies suggesting a higher prevalence in men within forensic samples.
- Age & Cultural Factors: Erotomania can manifest from adolescence to old age and is not restricted to any specific age group, race, culture, or socioeconomic status.
What are warning signs of erotomania?
Recognizing the warning signs of erotomania is crucial for early intervention and treatment.
Common signs include:
- Delusions: The central feature of erotomania is a fixed, false belief that another person, usually of higher social or professional standing, is in love with the individual.
- Lack of Reciprocal Contact: The delusional belief persists despite minimal or no contact with the perceived love interest.
- Persistent Pursuit: The affected individual may engage in persistent attempts to contact or communicate with the object of their delusion, often through letters, emails, or social media.
- Emotional Reactions: Intense emotional reactions, such as euphoria when perceiving signs of reciprocation or anger and resentment when perceiving rejection or obstacles, are common.
- Changes in Behavior: The individual may exhibit changes in behavior, such as neglecting daily responsibilities, obsessively checking for messages, or making significant lifestyle changes to attract the attention of the perceived love interest.
- Social Isolation: The delusion often leads to social withdrawal and isolation, as the individual becomes preoccupied with their fantasy relationship.
- Legal Issues: In some cases, the persistent pursuit of the perceived love interest can lead to stalking or other legal issues.
Who is most susceptible to erotomania? (Demographics)
Certain demographic groups may be more susceptible to developing erotomania due to various factors:
- Women: Historically, erotomania was thought to be more prevalent in women, though recent findings indicate that men are also affected.
- Mental Health Disorders: Those with pre-existing psychiatric conditions, such as schizophrenia, bipolar disorder, major depressive disorder, and dementia, are at higher risk.
- Socially Isolated: People who are socially isolated, have few social contacts, or have a history of unsatisfactory relationships are more vulnerable.
- Elderly: Older adults, particularly those experiencing cognitive decline or chronic physical illnesses, may be more susceptible.
- Low Socioeconomic Status: Individuals with lower socioeconomic status may be at increased risk due to higher levels of stress and fewer resources for coping with psychological distress.
Conclusion: Internet-Induced Erotomania & Mental Health
This case highlights the susceptibility of individuals with mental disorders to developing erotomanic delusions in the context of online romance fraud.
The findings underscore the importance of monitoring the online activity of at-risk patients and implementing comprehensive, multidimensional approaches in treatment.
Mental health professionals must focus on early recognition, patient education, and supportive therapeutic relationships to mitigate the impact of such delusions and improve patient outcomes.
More research is needed to understand the complex relationship between online fraud and the development of erotomania.
References
- Study: Induced erotomania by online romance fraud – a novel form of de Clérambault’s syndrome (2024)
- Authors: Nasri Alotti et al.
