Fantasizing about being in a relationship is something most people may have done, at some point in their lives. A colleague or a stranger at a bar sending “signals” or casually “flirting” feels rather common in the canon of dating and desire. But there’s another form of aspiration that is rather uncommon: when someone believes, against all odds, that they are indeed dating someone whom they may never have even met. In fact, it’s a tell-tale sign of a rare condition called erotomania.

Erotomania is included in the fifth Diagnostic and Statistical Manual, or the DSM-5, as a sub-type of delusional disorder. The condition is characterized by delusions of infatuation, and even love. In the French movies He Loves Me…He Loves Me Not (2002) and Anna M. (2007), the female protagonists are struggling with erotomania and believe that a cardiologist and an orthopedic surgeon, respectively, reciprocate their passion. Their objects of affection, however, aren’t interested in them romantically. A similar story plays out in the Daniel Craig-starrer Enduring Love (2004), where Craig’s character becomes the object of another man’s erotomanic delusion. Basically, an erotomaniac is convinced that a celebrity — or, anyone else with a higher social standing than themselves — is in love with them.

Erotomania is also known as “de Clérambault’s Syndrome,” named after the French psychiatrist Gaëtan Gatian de Clérambault, who brought the disorder to light in 1885. Among the many patients of erotomania he studied, there was Léa-Anna B., who believed George V (the former monarch of the U.K.) was in love with her. She perceived a different world, “…he watched over her with secret emissaries under various disguises, and that all of London knew of their affair and wanted it to succeed. She often expressed grandiose plans concerning him. She spent large sums of money to travel to England, prowling around royal residences, often in a state of ardent anticipation.”

Just like her, many erotomaniacs believe their imaginary lovers are communicating with them indirectly and using subtle, secret hints — like the information embedded in license plates, clues in media appearances, postures and body language, colors of clothing, the list is endless. In other words, an erotomaniac’s mind thinks what they want it to.

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Besides the delusion of covert messaging, symptoms of erotomania also include an unhealthy obsession with one’s object of interest — involving stalking, among other means of establishing direct contact. This can become dangerous quickly — if an erotomanic individual is slapped with a restraining order, for instance, they may be convinced it’s a sign from their lover to be more aggressive in their advances toward them. Despite all evidence to the contrary, an erotomaniac’s belief in the affection of the person they’re in an imaginary relationship with remains unshakeable.

To the person experiencing erotomanic delusions, the narrative in their head becomes their truth. “You may also experience jealousy and suspicion that the other person is being unfaithful to you… Also, a loss of interest in most activities, other than that person,” explained Brian Wind, a clinical psychologist.

The exact cause of erotomania — as a primary disorder — remains unknown. However, experts believe the condition can be genetic — a family history of delusional disorders may make one more likely to experience erotomania. But other reasons that can increase one’s vulnerability to the condition include poor mental health — in the form of low self-esteem, social isolation, a strong sense of being rejected, and difficulty understanding the perspectives of others.

As a secondary disorder — one where it manifests as a symptom of another condition — erotomania may accompany schizophrenia and bipolar disorder. Addiction to certain drugs and alcohol, or regular use of antidepressants, can trigger the condition too.

Unfortunately, once erotomania sets in, the condition can be chronic — as suggested by more than 30-year-long case studies on people living with it. However, antipsychotic medication — in combination with psychotherapy — can effectively treat the condition in many cases.

As Wind notes, “Treatment for erotomania often has successful outcomes — as long as any co-occurring mental health conditions are also treated.”

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The belief, so far, has been that erotomania was more common in women in comparison to men, but research is beginning to question that; it’s possible that people across genders are similarly affected by the disorder. But, in the past, the condition has been used as a means to discredit women’s stories. This was the case with Anita Hill, who had accused Clarence Thomas, a man in a powerful position, of sexual harassment. To question the validity of Hill’s allegations, an expert was brought in to suggest she suffers from erotomania.

Looking back at the case and reviewing the claim, a 2016 article on SheKnows stated, “It seems highly unlikely, if not an outright ridiculous and sexist accusation. To us, accusing Hill of having extreme delusional fantasies about Thomas is just another way to dismiss a woman for being too emotional or simply crazy. It is an attempt to damage the reputation and emotional stability of all women. It is also an attempt to protect men and their position of status at any cost.”

Meanwhile, it is also suggested that irrespective of the prevalence of the condition among different genders, men remain the most likely to engage in violent, stalker-ish behavior. The real-life account of John Hinckley, Jr. fits this description. Having fallen in love with actor Jodie Foster after watching her in Taxi Driver (1976), he stalked her for months, and then, attempted to assassinate former U.S. President Ronald Reagan in 1981 in a bid to impress her.

Erotomania, then, presents an interesting example of how medical diagnoses have been weaponized to cast aspersions on female experiences — much like hysteria was. In Shakespeare’s Hamlet, interestingly, the character of Ophelia was deemed to be afflicted with both hysteria and erotomania. An article by American literary critic, Elaine Showalter notes, “…feminism offered a new perspective on Ophelia’s madness as protest and rebellion. For many feminist theorists, the madwoman was a heroine who rebels against gender stereotypes and the social order, at [an] enormous cost.” Hill, too, had dared to question the status quo by questioning the predatory behavior of a man in a powerful position, rather than simply accepting it as “something that happens.”

Historically, women have been crucified for questioning patriarchal norms and daring to have a mind of their own. Mental health, which is heavily stigmatized as it is, has served as yet another means to ostracize free-willed women by questioning their very sanity. Unfortunately, in the process, the medical history of erotomania, a very real condition, has become embedded with sexism.