[not verified in body] Delusions of reference are common, as the erotomanic individual often perceives that they are being sent messages from the secret admirer through innocuous events such as seeing license plates from specific regions.

They may also experience other types of delusions concurrently with erotomania, such as delusions of reference, wherein the perceived admirer secretly communicates their love by subtle methods such as body posture, arrangement of household objects, colors, numbers, license plates on cars from specific states and other seemingly innocuous acts‍—‍or, if the person is a public figure, through clues in the media such as coded social media posts and meaningful clothing choices.

Primary erotomania is also commonly referred to as de Clerambault's syndrome and old maid's insanity[5] and it exists alone without comorbidities, has a sudden onset and a chronic outcome.

[4] The secondary form is found along with mental disorders like paranoid schizophrenia, often includes persecutory delusions, hallucinations, and grandiose ideas, and has a more gradual onset.

Sigmund Freud explained erotomania as a defense mechanism to ward off homosexual impulses which can lead to strong feelings of paranoia, denial, displacement and projection.

[5] Some research shows brain abnormalities occurring in patients with erotomania such as heightened temporal lobe asymmetry and greater volumes of lateral ventricles than those with no mental disorders.

[5] ECT may provide temporary remission of delusional beliefs; antipsychotics help attenuate delusions and reduce agitation or associated dangerous behaviors, and SSRIs may be used to treat secondary depression.

Psychosocial psychiatric interventions can enhance the quality of life through allowing some social functioning, and treating comorbid disorders is a priority for secondary erotomania.

[2] Early references to the condition can be found in the work of Hippocrates, Freud (1911), French psychiatrist Gaëtan Gatian de Clérambault (1942),[4] Erasistratus, Plutarch and Galen.

[8] In his paper that described the syndrome, de Clérambault referenced a patient he had counselled who was obsessed with British monarch George V.[9][failed verification] She had stood outside Buckingham Palace for hours at a time, believing that the king was communicating his desire for her by moving the curtains.

[9] Parallels were drawn between this and a 2011 case where the body of a homeless American man was found on a secluded island in St James Park, within sight of Buckingham Palace.