CLERAMBAULT'S SYNDROME
Description
● Introduction:
Clérambault’s Syndrome, also called Erotomania, is a rare psychiatric condition in which a person has the delusional belief that someone, usually of higher social, professional, or financial status, is in love with them. It was first described in detail by Gaëtan Gatian de Clérambault, a French psychiatrist, in 1921.
● CASE REPORTS
45-year-old mother of two, married woman, and school assistant.
Symptoms (5–6 months) include wandering, social disengagement, poor mood, irritability, and sleep disturbances.
Recently, I stopped eating for three days due to a lack of hunger.
Delusion: the headmaster, who is erotomaniac and in love with her, ordered her to abstain from food till he met her and planned a school celebration for her birthday.
Pallor is intense, but otherwise normal.
MSE: lack of insight, poor judgement, systematised erotomanic hallucination, and dysthymic mood.
Haloperidol up to 20 mg/day was used as treatment; mood and biofunctions improved, but delusions remained.
Erotomanic type persistent delusional disorder is the diagnosis.
● Core Features:
➣Central delusion: “That person is secretly in love with me.”
➣The individual may believe the other person initiated contact, is sending hidden signals, or is hindered by external circumstances (e.g., family, work, social barriers) from openly expressing their love.
➣ Often, the supposed admirer is someone famous, powerful, married, or unattainable.
● Clinical Presentation:
➣ Delusions of being loved: persistent, fixed false belief despite evidence to the contrary.
➣ Misinterpretation of signals: Innocent gestures, comments, or media messages are reinterpreted as proof of love.
➣ Preoccupation: Excessive focus on the supposed lover, sometimes leading to repeated contact attempts.
➣ Behavioural manifestations:
• Letters, phone calls, and social media messages.
• Stalking or unwanted visits.
• Legal issues (restraining orders, harassment).
● Types:
→ Clérambault originally described two main forms:
➣ Primary Erotomania
• Occurs in isolation, without other psychotic symptoms.
• Chronic course but may lessen with age.
➣ Secondary Erotomania
• Occurs as part of another psychiatric disorder (e.g., schizophrenia, bipolar disorder, major depressive disorder with psychosis).
➣ More common than primary type.
• Associated Disorders
• Schizophrenia (especially paranoid type)
• Bipolar disorder (manic phase)
• Schizoaffective disorder
• Delusional disorder, erotomanic type (as per DSM-5 classification)
➣ Epidemiology
• Rare, but more frequently reported in women than men.
• Men with the condition are more likely to show violent or aggressive behavior toward the object of delusion.
• Onset usually in early to middle adulthood.
● Diagnosis:
• Clinical diagnosis based on psychiatric evaluation.
• Classified under Delusional Disorder, Erotomanic Type in DSM-5.
➣Must differentiate from:
•Obsessive love disorder
•Borderline personality disorder
•Obsessive–compulsive disorder (OCD)
•Normal infatuation
●Management:
➣ Pharmacological Treatment:
• Antipsychotics (e.g., risperidone, olanzapine, haloperidol).
• Mood stabilizers (if associated with bipolar disorder).
• Antidepressants (if linked with depression).
➣ Psychotherapy:
• Supportive psychotherapy (building insight, coping strategies).
• Cognitive behavioral therapy (CBT) to challenge delusional thoughts (though insight is often limited).
➣ Social & Legal Management:
• Setting boundaries and preventing harassment of the “love object.”
• Possible involvement of law enforcement or legal measures.
• Family education to support treatment adherence.
Protocol
● Challenges for Nurses:
← When caring for individuals with erotomania, nurses may encounter:
➣ Risks to safety:
• Aggression risk.
• The potential for self-harm or harm to the "love object."
• The possibility of aggressive stalker conduct.
➣ Challenge in Establishing a Therapeutic Relationship: The patient may be defensive, sceptical, or overly obsessed with their delusion; they can interpret the nurse's indifferent manner as secret "messages of love."
➣ Noncompliance with therapy; frequent relapses following treatment cessation; inadequate understanding resulting in medication refusal.
➣ Emotional Stress in Nurses: Hearing fixated, delusional conversation all the time might be frustrating. Nurses may feel powerless when rational responses are insufficient.
➣ Legal and Ethical Challenges
preserving privacy while protecting potential victims; finding a middle ground between patient rights and public safety concerns.
● Management of Nursing
➣Nursing Diagnoses (For instance)
• Disturbed mental processes associated with delusions.
• The possibility of violence (either against oneself or others).
• Reduced social engagement as a result of delusional obsession.
• Poor understanding is the reason for non-compliance.
• Low self-esteem, which is frequently concealed by grandiose delusions.
➣Interventions in Nursing
• Establish a therapeutic relationship; be impartial and consistent; and
• refrain from perpetuating the illusion by gently redirecting rather than agreeing or disagreeing.
• Communicate simply and clearly.
➣ Assure Security
• Keep an eye out for hostile or stalking conduct.
• Work together to prepare for safety with the care team.
• If the "love object" has been discovered, restrict access to it.
➣Encourage the Adherence to Medication
· Inform people about the function of medicine.
• To promote compliance, use motivational interviewing techniques.
• Keep an eye on adverse effects and offer assistance.
➣ A focus on reality
• Promote participation in practical exercises (occupational therapy, group treatment).
• Introduce reality-testing gradually, but refrain from confronting delusions head-on.
➣ Psychosocial Assistance
• Promote involvement in support groups.
• Inform family members about the disorder, its dangers, and coping mechanisms.
• Offer instruction on stress management.
➣ Ethical and Legal Care
• Properly report possible dangers.
Work within mental health laws to strike a balance between safety and rights.
→ Disturbed Thought Processes
➣ Goals / Outcomes
• Patient will show reduced preoccupation with delusion.
• Patient will identify at least one alternative coping thought.
➣ Interventions
• Establish therapeutic relationship with consistent, neutral, nonjudgmental approach.
• Do not challenge or argue about delusion → gently redirect to reality-based topics.
• Engage patient in structured activities (group therapy, occupational therapy).
→ Risk for Violence (Self or Others)
➣ Goals / Outcomes
• Patient will remain safe and not harm others.
• Patient will verbalize nonviolent coping strategies.
➣ Interventions
• Regularly assess for threats or aggression.
• Maintain safe environment (remove sharp/harmful objects, ensure observation).
• Collaborate with healthcare team for safety plan; inform authorities if needed.
• Teach relaxation and de-escalation techniques (deep breathing, guided imagery).
→ Noncompliance with Treatment
➣Goals / Outcomes
•Patient will take medications as prescribed.
•Patient/family will verbalize understanding of treatment necessity.
➣Interventions
•Provide education about role of medications in controlling symptoms.
•Use motivational interviewing to address reluctance.
•Monitor/manage side effects and encourage reporting.
•Involve family in supporting medication adherence.
Notes
Ind Psychiatry J. 2021 Oct 22;30(Suppl 1):S249–S251. doi: 10.4103/0972-6748.328821