Season 4 Of ‘You’ Shines A Light On Erotomania—Here's What It Really Is
If you've been following the psychological thriller series You, you know it follows a bookstore manager who falls in love and develops an extreme obsession with different women. The latest season finally gives main character Joe Goldberg’s condition a name—erotomania.
It's a delusional disorder in which someone has an unfounded belief that a person of a perceived higher social status (like a famous musician or actor) is in love with them. This condition is also De Clérambault syndrome, which was coined in 1885 by French psychiatrist G.G. De Clerambault in 1885 after observing a woman who thought a man of higher social and/or professional status was in love with her.
Erotomania is rare, with a lifetime prevalence of 0.2 percent, says Gauri Khurana, MD, MPH, a psychiatrist in New York City and a clinical instructor at Yale University School of Medicine. And contrary to what's portrayed in the hit Netflix show, it's a lot more common in women than in men, per a recent BMJ Psychiatry case report.
But what You does get right is that, just like Penn Badgley's character, "[people with erotomania] generally go out of their way to make contact with the object of their affections, such as stalking,” Dr. Khurana says. “Often, the two [individuals] have never met in real life, or it was such a fleeting interaction that it should not warrant that level of obsession.”
Meet the expert: Gauri Khurana, MD, MPH, is a psychiatrist in New York City and a clinical instructor at Yale University School of Medicine.
Erotomania can also be viewed as an addiction to people, Dr. Khurana notes. It can sometimes evolve into violence when a person with erotomania pursues the object of their obsession.
What causes erotomania?
Erotomania often results from abandonment in one's early years, and could most likely be considered complex trauma, says Dr. Khurana. People with erotomania often have unresolved trauma and a poor sense of self, or they may be codependent, introverted, inexperienced sexually, or isolated.
“I often see this in patients who have a diagnosis of borderline personality disorder, which I also consider to be a progression of developmental trauma, but the idea remains that if I am able to treat the trauma, the delusion will recede,” she says.
While erotomania can occur on its own, it’s usually linked to another mental health condition, such as schizophrenia or bipolar disorder. It can last for weeks or years, and it often can morph from one person to another with the same obsessive, love-focused thread of delusion, says Dr. Khurana. For example, someone may think someone else is flirting with them when they are not, and they can become more convinced of the idea over time, especially if they spend a lot of time alone.
“Loving someone and belonging isn't something that they feel is possible or safe for them, and that is incredibly painful,” Dr. Khurana explains. “It is actually too much pain for their mind to handle, so the person begins to inhabit their fantasy world (the erotomanic delusion), which is the only realm in which they'll ever feel truly loved, safe, and happy.”
How do you know if you have erotomania?
The primary symptom of erotomania is the absolute belief that another person is in love with them. “People with erotomania often believe that the target of their affection is sending them secret messages back that affirm their love,”Dr. Khurana says. “For example, I had a patient who thought that DJ Khaled was communicating his love for her [based on] the time that he posted his Instagram messages. She thought he was posting them at eight because that was the hour that she was born.”
Behaviors linked to erotomania include persistent efforts to make contact through stalking, written communication, and other harassing behaviors. However, these actions are rare and most mental health professionals will never encounter such patients, Dr. Khurana notes.
In order to make an erotomania diagnosis, these delusions must involve possible, even if unlikely, events. “The delusion must only apply to their love life, with every other aspect of the affected person’s life being functional and normal,” she explains. "Other mental health disorders must be ruled out. And if low moods, depression, or hypomania or mania is also present, then the duration of the delusion must be longer than the mood episode.”
What are the stages of erotomania?
De Clérambault characterized the following stages of erotomania, according to Dr. Khurana:
“The last phase is considered to be the most important. After hoping that the object openly declares their love and by insistently pursuing them, the subject starts feeling humiliated,” she says. “This feeling of humiliation can trigger the affected person to seek retaliation and hurt their target.”
How do you treat erotomania?
There is no standard treatment for erotomania; rather, it varies depending on the specifics of the patient, Dr. Khurana says. However, standard treatment for delusions includes antipsychotic medications to help patients regain a sense of reality.
“Therapists have also published case studies that also include therapy, family therapy, other kinds of medication, and electro-convulsive therapy,” she says.
How do you deal with a person with erotomania?
If you think you may be dealing with person with erotomania person, Dr. Khurana recommends doing your best to maintain boundaries, stay neutral, and modulate your vocal tone so as to not encourage or worsen delusion.
If possible, you can also enlist others to help point out inconsistencies and direct the affected person toward help, like their family members, close friends, and others in their support network—and reach out to their therapist or psychiatrist.
Finally, if you know you won’t be putting your safety at risk, you can also attempt to help with crisis management, like by getting the affected person to a hospital for immediate help, especially when their delusion is bordering on dangerous activities, such as stalking or trying to hurt someone.
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