Electroconvulsive therapy in erotomanic delusion: a path to belief updating

Erotomania is a rare delusional disorder marked by the persistent, unfounded belief that another person is in love with the affected individual. While antipsychotic medications may alleviate the intensity of delusions, the core belief often persists, leading to significant emotional distress and potential behavioral risks. The aim of this study was to illustrate the potential therapeutic role of electroconvulsive therapy (ECT) in the treatment of chronic, treatment-resistant erotomania.

We present a case report of a patient with a lifelong erotomanic delusion, centered on the same individual, which persisted unchanged despite multiple pharmacological treatments. The patient underwent a course of ECT, and clinical observations were documented throughout the treatment process. In addition to symptom monitoring, we explored the cognitive mechanisms potentially involved in the therapeutic response, with particular attention to belief updating and cognitive flexibility.

ECT led to a marked reduction in the patient's conviction regarding the erotomanic delusion, alongside improvements in emotional regulation and daily functioning. These changes appeared to be sustained over time. The treatment was well tolerated, with no significant adverse effects reported.

This case suggests that ECT may be a viable option for patients with severe, treatment resistant erotomania. Beyond symptomatic relief, ECT may facilitate the recalibration of maladaptive beliefs by enhancing cognitive flexibility, supporting the view that belief updating mechanisms play a key role in the resolution of persistent delusions. Further studies are needed to systematically evaluate ECT's efficacy in delusional disorders.