The patient yearns for another person and has the unshakeable belief that these feelings are reciprocated. The person is often socially unattainable, may be of higher social status, and can be a celebrity. There has rarely been close contact and the love object will usually be unaware of the situation, but despite this the patient believes that the other initiated the imagined relationship, often with covert signals or utterances. Many patients experience strong erotic feelings, but some insist that the relationship is platonic and that the other person is maintaining a non-sexual attitude of watchful protectiveness.
In many instances the patient makes no attempt to get in touch with the love object, perhaps writing letters or buying gifts but not sending them. When given a chance to make actual contact he or she will frequently avoid doing so and will make spurious excuses such as not wanting to offend the other person's spouse. In those cases where the patient does attempt contact, equally false reasons are presented to explain the almost inevitable rejection that results.
Since this is erotomania in the setting of delusional disorder, the illness will have the typical form of a tightly knit delusional system with preservation of relatively normal personality features and with greater or lesser ability to continue functioning in society. There is often enough insight or inhibition present for the patient to keep the delusional beliefs concealed. However, at times he or she may be profoundly angered by being 'inexplicably' rejected and may act this out, occasionally dangerously. This is more likely to occur in males.
The onset of erotomania can be gradual or apparently sudden. Hallucinations are sometimes present but are not prominent, although the patient may be encouraged by 'hearing' the other person express passionate feelings. Occasionally, the presence of tactile hallucinations leads the patient to believe that a lover has paid a visit during the night (sometimes picturesquely referred to as the 'incubus syndrome') (81
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