Glenn Wilson PhD, Gresham College, London

Glenn Wilson PhD, Gresham College, London LOVESICKNESS

CRAZY FOR YOU The symptoms of love look much like various forms of mental illness (Tallis 2005): Mania – abnormally elevated mood, inflated self-esteem, extravagant gift-giving. Depression – tearfulness, insomnia, loss of appetite & concentration. Obsessive-compulsive disorder – preoccupation, checking (text messages), hygiene rituals, hoarding valueless but resonant items.

THE AGONY OF A BROKEN HEART “My misery following the split took me by surprise. It was intense… In tears and blinded by anxious headaches, I imagined him laughing at my gullibility. My emotional pain became physical, twisting knots in my neck and shoulder muscles that left me in agony. I felt flat, foolish and tormented by the thought he had deceived me….I bored friends rigid with my forensic analysis of our relationship and its demise. I even rang a private detective with a view to recruiting his services…” (Mandy Appleyard, Femail Magazine, 31/3/11)

LOVE HURTS Romantic breakup activates brain areas similar to those with experience of pain. Kross et al (2011) studied fMRI responses of people looking at (and thinking about a lover) who had dumped them. Romantic rejection hurt to much the same degree as hot probe pressed against the arm.

UNRECIPROCATED LOVE IN THE BRAIN Rejected lovers show brain activation in areas overlapping with those for people still “in love” (at least if they have not given up on winning back their ex). These are the mesolimbic reward and forebrain motivational areas involved in kicking a drug habit. (From Fisher et al, 2010) R arrow = VTA Cross-hair = NAcc + VPall

HEART-BRAKE HOTEL Social rejection has measurable effects on the autonomic nervous system. When people are told that attractive others disliked their image there was a transient slowing of heart-rate with a delayed return to baseline (Moor et al, 2010). This was greater if the rejection was not anticipated. This approximates to “parasympathetic fainting or shock”, an “I give up” (depression) response.

THE WIDOWHOOD EFFECT The immense grief of losing a partner leads to many premature deaths. 40% of men and 26% of women die within 3 years of their partner (Boyle et al, 2010). This is beyond chance - suggesting it is possible to “die of a broken heart”. Causes of death varied: cancer, heart disease, suicide, “accident”.

COPING WITH A BROKEN HEART Recovery from a broken heart shares many aspects with overcoming a drug habit. Don’t beat yourself up – you are not to blame. Nor is your ex, so avoid recriminations. Call up your social support (family & friends) but don’t drive them away with your self-pity. Distract yourself – keep as active as possible with hobbies & work projects. Avoid old associations (photos, love letters, old haunts – unless going with someone new). Look after your health – keep fit & pamper yourself.

ATTACHMENT STYLES Styles of attachment are classified in relation to two dimensions: avoidance & anxiety. Nearly half of the variance in these dimensions is genetic, the rest down to non-shared environment. Hence parental treatment not critical. Oxytocin relates to high anxiety - may be secreted as an anxiolytic, to promote relationships by increasing willingness to take risks.

PATHOLOGICAL LOVE Sophia et al (2009) defined pathological love as uncontrollable, over-possessive caring for a partner that is recognised by the individual themselves as detrimental to other aspects of their lives (e.g., children, career). Compared with normal controls, PL people were inclined to be impulsive, reward-dependent, spiritual and low in self-esteem. They were also less secure/more anxious in attachment style and persisted in unsatisfying relationships.

FOUR-LEGGED FRIENDS Pet owners are on average more attached to their pet than their partner. Pets emit infant signals that arouse parental instincts, hence serve as child substitutes. They don’t argue, don’t leave home, they reduce stress (reduce blood pressure) and may combat widowhood effect in elderly people.

JEALOUSY Jealousy is the emotion felt when one feels threatened by a love rival. It is normal (unless taken to extreme) and functions to increase mate retention behaviours. For men this focuses on sexual penetration (fear of cuckoldry). For women emotional involvement is a bigger issue (fear of relationship loss).

JEALOUSY AND ATTACHMENT Overall, men are more concerned about sexual infidelity and women emotional betrayal. Those with secure attachment styles (whether men or women) focus more on emotional infidelity; those with dismissing styles are more distressed by sexual infidelity. Levy & Kelly ( 2009)

ATTRIBUTES OF THE RIVAL Women experience greater jealousy when their rival is attractive. Subliminal exposure to an attractive female face increases reaction to a jealousy-evoking scenario (Massar & Buunk, 2010). One male equivalent is stature (= dominance). Short men experience more jealousy than tall men (Brewer & Riley, 2009). However, they are less likely to turn to violence.

JEALOUSY AND SEX HORMONES Contraceptive pills high in synthetic oestrogen (ethinyl oestrodial) increase jealousy in women. This could affect their capacity to maintain stable pair-bonds. Progesterone is not implicated. Men with low prenatal testosterone (feminine finger ratios) show more jealousy.

STALKING Stalking = repeated, unwanted following or harassment by mail/phone. Reasons vary: refusal to recognise that a relationship is over; effort to start one with someone unavailable/out of reach (e.g., a celebrity); social incompetence; revenge; planning a sexual assault. About 8% of women, 2% of men have been stalked. Most stalkers are male and their victims female, but men are just as likely to be stalked by a woman as a man. Some are psychotic (deluded), others obsessional or personality disordered (anti-social, narcissistic, paranoid).

QUEEN VICTORIA’S STALKER One of the first celebrity stalkers was a teenage urchin called Edward Jones who habitually broke into Buckingham Palace in the hope of meeting the Queen. He was discovered lurking in her dressing room after stealing some of her underwear. The magistrate dismissed it as a “daring folly” and he became a folk hero before several repeat episodes led to his deportation.

CLUMSY COURTSHIP Some forms of stalking can be understood as incompetent courtship. Women put men through rituals requiring them to demonstrate their devotion and persistence sometimes pays off. Some men get this terribly wrong, persisting despite strong cues that their attention is unwelcome and that they will never be successful. Gwyneth Paltrow had a stalker who sent her 5 love letters a day, as well as flowers, chocolate, pizza and pornography (perhaps not the way to impress a lady but it might work with some).

INTIMATE STALKING Stalking by an ex-partner is most common & dangerous form. Usually “controlling”, psychopathic males. Particularly intrusive because they know life details & movements of victim. Children used as additional tool of intimidation. Prior relationship usually abusive, coercive & violent – so stalking is “business as usual”. May begin while relationship is intact but escalate & become more dangerous after separation. Lasts years (avge 2) - causing great disruption, distress to victim (anxiety, depression) esp. when threats of violence. Actual violence occurs in about 50% of cases (higher than non-partner stalking).

TO HAVE AND TO HIT Around 50% of murdered women are killed by an “intimate”. McFarlane et al (2002) looked at partner stalking behaviours in the year preceding an attempted/actual murder. Two-thirds had been stalked and two-thirds assaulted prior to the murder attempt. Those who had been spied on or followed were 2x as likely as other abused women to be victims of murder/attempted murder. Threats to harm the children if the women left (did not return) were associated with a 9x risk.

DE CLERAMBAULT’S SYNDROME Delusional belief that one is loved by another person. Identified by French psychiatrist in 1921. Also called “erotomania”. Most commonly a middle aged woman who believes that a known, high status male (e.g. doctor, lawyer) secretly loves her but is prevented from declaring himself (e.g., because he is married). Tenuous clues are latched onto as cryptic signals (e.g., “he is wearing a tie of my favourite colour”). May lead to stalking, harassment, even murder of the wife to clear the way.

FATAL ATTRACTION Not all erotomania is totally delusional. It may start with a fling that is followed by the woman developing an obsession for the man. Failed attempts to perpetuate the relationship turn to progressive stalking and threats to wreck the man’s life. Again, murder of the man, or other members of his family, occurs very occasionally.

“U BE DEAD” Argentinian born Maria Marchese (45) was jailed for 9 years in 2007 for wrecking the life of London psychiatrist Dr Jan Falkowski. She stalked him relentlessly, making threats both to him and his fiancee, causing the relationship to collapse. Stealing a used condom from his rubbish bin, she smeared her underwear with his semen and had him convicted of rape (later overturned). The story was dramatised in the film U Be Dead.

EROTOMANIA: CLINICAL FEATURES Extreme cases are much publicised but most erotomania is not dangerous and does not lead to stalking. Associated with other psychotic symptoms and responds to low-dose anti-psychotic drug treatment. Strong family psychiatric histories suggest that genetic factors are involved. Male erotomania is less common but often more dangerous (e.g., John Hinckley, 25, shot President Reagan in an attempt to impress Jodie Foster after seeing her in Taxi Driver).

MISFIRING ADAPTATIONS The various forms of lovesickness may be understood as evolutionary adaptations that are exaggerated or misdirected. Obsessional love comes from a mechanism for narrowing mate choice. Mania overrides inhibitions against mating. Depression is a reaction to loss in the competitive struggle (withdrawing to fight another day). Extreme jealousy and partner stalking are clumsy courtship or mate retention tactics. Female erotomania stems from the instinct to acquire a high-ranking long-term mate. Drugs may help to contain these distorted drives (e.g., SSRIs for obsession, neuroleptics for delusions) – perhaps additional to CBT.

Glenn Wilson PhD, Gresham College, London