Pathological jealousy

Last updated February 29, 2024

Pathological jealousy, also known as morbid jealousy, Othello syndrome, or delusional jealousy, is a psychological disorder in which a person is preoccupied with the thought that their spouse or sexual partner is being unfaithful without having any real proof,^[1] along with socially unacceptable or abnormal behaviour related to these thoughts.^[1] The most common cited forms of psychopathology in morbid jealousy are delusions and obsessions. It is considered a subtype of delusional disorder.^[1]

Definition

This disorder occurs when a person typically makes repeated accusations that their spouse or sexual partner is being unfaithful, based on insignificant, minimal, or no evidence, often citing seemingly normal or everyday events or material to back up their claims.^[2]

Unlike many other delusional disorders, people who suffer from this disorder have a strong association with stalking, cyberstalking, sabotage, or even violence. It can be found in the context of schizophrenia and delusional disorder, such as bipolar disorder, but is also associated with alcoholism and sexual dysfunction, and has been reported after neurological illness (i.e., Parkinson's).^[3]^[4]

The name "Othello Syndrome" comes from the character in Shakespeare's play Othello , who murders his wife as a result of a false belief that she has been unfaithful. Some psychologists and psychiatrists have asserted that Othello was deceived rather than deluded about Desdemona's alleged infidelity, and thus did not have ‘the Othello Syndrome’.^[5]

Psychiatric history

Presenting difficulties: neurotic or psychotic jealousy
Past psychiatric history: neurotic or psychotic disorders, deliberate self-harm, and attempted suicide
Family history: mental illness, including pathological jealousy
Relationship history: incorporating both the current and previous relationships, and taking account of the quality of the relationships and the difficulties experienced
Forensic history: previous and pending charges and convictions, as well as deviant behavior which was not reported or did not result in a charge or conviction (including aggressive behavior and stalking)
Medical history: organic causes which may be responsible for the morbid jealousy (i.e., Parkinson's)^[1]

Forms

Obsessions: the individual's own thoughts are egodystonic; they are acknowledged to be senseless, and usually resisted. Jealous thoughts are experienced as intrusive and excessive, and compulsive behavior such as checking up on their partner may follow. Egodystonicity (the distress caused by thoughts that are unwanted and viewed as contrary to conscious wishes) generally varies a large amount between patients and “a continuum from obsessional to delusional, which morbid jealousy has been suggested” (Insel & Akiskal 1986).
Extreme obsessions: much time is taken up by jealous concerns, and there is a great difficulty in putting the concerns out of the mind. Impairment of the relationship, limitation of the partner's freedom, and checking on the partner's behavior may occur. Although a distinction was occasionally difficult to make, the categories of ‘psychotic’ (delusional) and ‘neurotic’ jealousy contained similar proportions (each between one-third and one-half).^[1]
Delusions: the individual's own thoughts are egosyntonic; they are regarded as true, and not resisted.^[1] Some authors compare morbid jealousy to a delusional state (e.g., Enoch & Trethowan, 1979). Beliefs may include the morbidly jealous subjects' suspicion that: 1. he or she is being poisoned or given some substance(s) to decrease sexual potency by the partner, 2. that the partner has contracted a sexually transmitted disease from a third party 3. that the partner is engaging in sexual intercourse with a third party while the subject sleeps.^[6]
Overvalued ideas: One symptom may on some instances be viewed as overvaluing an idea, which is defined as “an acceptable, comprehensible idea pursued by the patient beyond the bounds of reason. The idea is not resisted and, although it is not a delusion, the patient characteristically attaches utmost importance to investigating and maintaining the partner’s fidelity at great personal disadvantage and to the distress of the partner”. Overvalued ideas are characterized by being existent in the individual's own thoughts, being egosyntonic; meaning that the ideas project the behaviors, values, and feelings that are aligned with the desires and aims of the individual's ego, or consistent with the individual's ideal self-image, the ideas are also amenable to reason but are not resisted.^[7]

Causes

Psychological

There are many psychological causes that go along with morbid jealousy. Some people equate morbid jealousy with a delusional state. “Delusions of infidelity exist without any other psychopathology and may be considered to be morbid jealousy in its ‘purest’ form” (Kingham and Gordon). For morbid jealousy to occur one's memories are subconsciously changed, and their partner's actions are misinterpreted as well to the extent that the person is absolutely convinced of betrayal from the partner. It is thought that even some brain disorders might eventually lead to delusions of betrayal. It has also been recorded by Cobb (1979) “that morbid jealousy may be present with all types of cerebral insult or injury.”^[8] "It has been suggested that morbid jealousy may potentially arise in response to reduced sexual function”. Cobb (1979) drew attention to the elderly man whose waning sexual powers were insufficient to satisfy a younger wife.

Mullen (1990) considered morbid jealousy to be associated with four features:^{[ full citation needed ]}

An underlying mental disorder emerges before or with the jealousy
The features of the underlying disorder coexist with the jealousy
The course of morbid jealousy closely relates to that of the underlying disorder
The jealousy has no basis in reality

Personality

People who are very insecure, or even fearful, are more likely to become anxious, or question their partner's commitment to them. “Insecure attachment style correlates strongly with borderline personality disorder” (Kingham and Gordon).

Environmental

Some people even believe that someone who is morbidly jealous might suspect that he or she is being drugged or given some kind of substance that might decrease their sexual potency, or they might even be under the impression that their significant other has somehow received a sexually transmitted disease from another person while the subject is unaware.^[9]

Epidemiology

There is no known prevalence of morbid jealousy; currently there is no community survey tracking its existence in individuals. As of 1979, it was considered to be a rare occurrence.^[10] Still, many counselors encounter cases of morbid jealousy. Some clinicians may never be able to treat this condition due to other dominating psychopathologies present within the jealous person that call for more attention.^{[ citation needed ]}

Men and women differ dramatically when it comes to morbid jealousy. Men who suffer from morbid jealousy are more likely than women to use violence, and also are more likely to harm or kill with their hands rather than a blunt object. Women on the other hand, when using violence, tend to use a blunt object or knife.^[11] Men focus on the rival's status and resources when it comes to the threat of jealousy they fear. Women tend to become more jealous of a potential threat on their rival's youth and physical attractiveness.^[12]

Triggers

For men the strongest trigger is sexual infidelity, and with women the strongest trigger is emotional infidelity. If partner-related violence does not stop infidelity from happening, the male mate will sometimes resort to suicide instead. The final resort to stopping infidelity inside of morbid jealousy is to commit partner murder. Women are much less likely to kill their partner, unless it is in self-defense. Morbid jealousy can occur in a number of conditions such as chronic alcoholism, addiction to substances other than alcohol (i.e., cocaine, amphetamines., organic brain disorders (i.e., Parkinson's, Huntington's), schizophrenia, neurosis, affective disturbances, or personality disorders.^[13]

Associated drug and alcohol use

Alcohol and drug misuse has a well-recognized association with morbid jealousy. “In two studies, morbid jealousy was present in 27% and 34% respectively of men recruited from alcohol treatment services” (Shrestha et al., 1985; Michael et al., 1995). Amphetamine and cocaine increase the possibility of a delusion of infidelity that can continue after intoxication stops. (Shepherd, 1961).

Assessment

In an attempt to counsel or treat the morbid jealousy of an individual, proper and thorough assessment must be employed. This approach is broad in nature, but necessary so as to provide adequate information that will aid in the possible reparation of a dynamic containing a morbidly jealous person. To begin, a careful history should be taken of both partners if possible; separate and together. It is imperative that a full and detailed psychiatric history and mental state examination be recorded for the jealous partner; doing so may enable one to distinguish whether the jealousy is obsessional or delusional in nature. It is also possible that the jealousy may be the result of a thought that has been given too much importance. Considering that jealousy is a very delicate issue, any reference made to it should be approached carefully and with tact. It must be kept in mind that the jealous individual may be displacing blame for their issues onto their partner and their alleged infidelity as opposed to their own behavior. If there is any history of relevant or related mental illness and substance misuse it should be noted as it may possibly be a contributing or aiding factor. In order to get the best grasp on the issues and begin positive progression, multiple interviews should be held to assess the marital relationship.^[14]

After completing the assessment, it is best to deliver information about risk with both individuals in the relationship. Due to confidentiality, the patient should give consent for this information to be shared unless there is a risk to another individual and it is serious and immediate. This is the only case in which confidentiality is invalid. The professional should ensure that all necessary steps are taken to guarantee the safety of a potential victim, keeping in mind that it is possible that authorities may have to be alerted regarding the matter. If the professional has reason to believe that there is a high risk of harm to themselves or another person, the individual who is morbidly jealous should be admitted to a hospital as soon as possible to prevent any negative outcomes for any parties involved.^[14]

Management

Morbid jealousy encompasses various psychiatric states and the best way to approach treatment depends on the symptoms that are observed in the individual. Therefore, prognosis and outcomes vary from person to person and depends on the situation and the complexities of the interpersonal relationships being observed. Also, other issues that may exacerbate the negative aspects of the environment created by jealous behavior need to be addressed in order to begin reparations. For example, if alcoholism plays a role in the behavior of the morbidly jealous individual, treatment of their addiction can positively affect their progress in trying to change their jealous nature. While psychotherapy can be an effective method of treating morbidly jealous persons, it is not sufficient when the nature of their illness is more serious.^[15] It is not possible to say that there is one form of treatment that is superior over all those that are currently available.^[16] Even though this may be true, cognitive behavioral therapy is the treatment that has proven to be most effective.^[17]

Medical

Treatment of the primary psychiatric condition
Antipsychotic medication
Antidepressant medication

Psychological

Psycho education for the affected person and the partner
Behavioral therapy
Cognitive therapy
Individual psychotherapy
Insight-riented psychotherapies
Family therapy
Couple therapy

Social

Geographical separation of the partners
Social work involvement for child protection issues
Alcohol and substance misuse treatment^[13]

Risks associated

Confirmatory behaviors

When suspicions of the partner's fidelity arise, they quickly become all that is thought about. Certain behaviors, such as interrogation of the partner, repeated telephone calls to work and surprise visits, stalking behavior, setting up recording devices in the home or work, or hiring a private detective to follow the partner, are all common in trying to determine if there is truly infidelity or if it is just perceived. Individuals who are jealous may take drastic measures, such as searching the partner's clothing and belongings, looking through diaries and other communication methods (email, text messaging), or examining bed sheets, undergarments, and even genitalia for evidence of sexual activity.^{[ citation needed ]}

Harm to self

Suicidal thoughts are common in morbid jealousy, especially because of its association with depression and substance abuse.

Risk to others

Violence can occur in any relationship tainted with jealousy, either normal or morbid jealousy. In a study of jealousy by Mullen & Martin in 1994, 15% of both men and women reported that at some time they had been “subjected to physical violence at the hands of a jealous partner.” Culturally, jealousy may be even used to “justify violence towards partners.” Victims in a homicide case are most likely to be current or ex-partners in both female and male perpetrators. When a partner repeatedly denies infidelity, this may provoke anger and extreme violence. On the other hand, the partner that is suffering may give up and give a false confession, which in turn most likely will provoke rage in the jealous individual. In the U.S. a sample was taken of 20 participants with delusional jealousy.^[18] 19 were male and the researchers found that 12 had threatened to kill their spouse because of their perceived infidelity. Of the 12 males, all actually attacked their spouse. Out of the 20, a weapon was used by three of them, and 12 had harmed their spouse. The one female participant also attacked her spouse. A presence of paranoid delusions and hallucinations of injury to the spouse were most often associated with violence. This suggests that individuals who suffer from delusional jealousy who partake in violence may be solely driven by psychotic phenomena. A higher risk of assault was associated with alcohol consumption.

Risk to children

Children who live in a household with a parent who suffers from morbid jealousy may suffer emotional and/or physical abuse as a direct result of the actions made by the parent. Children may also accidentally overhear arguments or witness physical violence between their parents. They could even be potentially accidentally injured during assaults. The morbidly jealous parent may employ a child or more than one to spy on the other parent. It is not out of the question for a child to witness a homicide or suicide where their parent is the victim.^{[ citation needed ]}

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

Erotomania, also known as de Clérambault's syndrome, is a relatively uncommon paranoid condition that is characterized by an individual's delusions of another person being infatuated with them. It is listed in the DSM-5 as a subtype of a delusional disorder. Commonly, the onset of erotomania is sudden, and the course is chronic.

Jealousy generally refers to the thoughts or feelings of insecurity, fear, and concern over a relative lack of possessions or safety.

Hypersexuality is a term used for a presumed mental disorder which causes unwanted or excessive sexual arousal, causing people to engage in or think about sexual activity to a point of distress or impairment. It is controversial whether it should be included as a clinical diagnosis used by mental healthcare professionals. Nymphomania and satyriasis were terms previously used for the condition in women and men, respectively.

Delusional disorder, traditionally synonymous with paranoia, is a mental illness in which a person has delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that could occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.

Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, another close family member, or pet has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), the French psychiatrist who first described the disorder.

Infidelity is a violation of a couple's emotional and/or sexual exclusivity that commonly results in feelings of anger, sexual jealousy, and rivalry.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in the DSM 5, published in 2013. The disorder is no longer listed in the 11th revision of the International Classification of Diseases (ICD-11).

Intermetamorphosis is a delusional misidentification syndrome, related to agnosia. The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality. The disorder is usually comorbid with neurological disorders or mental disorders. The disorder was first described in 1932 by Paul Courbon (1879–1958), a French psychiatrist. Intermetamorphosis is rare, although issues with diagnostics and comorbidity may lead to under-reporting.

The syndrome of subjective doubles is a rare delusional misidentification syndrome in which a person experiences the delusion that they have a double or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own. The syndrome is also called the syndrome of doubles of the self, delusion of subjective doubles, or simply subjective doubles. Sometimes, the patient is under the impression that there is more than one double. A double may be projected onto any person, from a stranger to a family member.

Sexual jealousy is a special form of jealousy in sexual relationships, based on suspected or imminent sexual infidelity. The concept is studied in the field of evolutionary psychology.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

Suicide risk assessment is a process of estimating the likelihood for a person to attempt or die by suicide. The goal of a thorough risk assessment is to learn about the circumstances of an individual person with regard to suicide, including warning signs, risk factors, and protective factors. Risk for suicide is re-evaluated throughout the course of care to assess the patient's response to personal situational changes and clinical interventions. Accurate and defensible risk assessment requires a clinician to integrate a clinical judgment with the latest evidence-based practice, although accurate prediction of low base rate events, such as suicide, is inherently difficult and prone to false positives.

Olfactory reference syndrome (ORS) is a psychiatric condition in which there is a persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals. People with this condition often misinterpret others' behaviors, e.g. sniffing, touching their nose or opening a window, as being referential to an unpleasant body odor which in reality is non-existent and cannot be detected by other people.

Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric disorders, including two-thirds of patients in a manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, frequently as a comorbid condition in narcissistic personality disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. Around 10% of healthy people experience grandiose thoughts at some point in their lives but do not meet full criteria for a diagnosis of GD.

Obsessional jealousy is jealousy that is characterized by intrusive and excessive thoughts, and may be accompanied by compulsive checking of the partner. It is not classified as a mental disorder in the psychiatric manuals DSM or ICD, but it is mentioned as an example of how obsessive compulsive disorder can present itself.

Relational transgressions occur when people violate implicit or explicit relational rules. These transgressions include a wide variety of behaviors. The boundaries of relational transgressions are permeable. Betrayal for example, is often used as a synonym for a relational transgression. In some instances, betrayal can be defined as a rule violation that is traumatic to a relationship, and in other instances as destructive conflict or reference to infidelity.

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

References

1 2 3 4 5 6 Kingham, Michael; Gordon, Harvey (2004-05-01). "Aspects of morbid jealousy". Advances in Psychiatric Treatment. 10 (3): 207–215. doi: 10.1192/apt.10.3.207 . ISSN 2056-4678.
↑ "jealousy: Topics by Science.gov". www.science.gov.
↑ Michael, A.; Mirza, S.; Mirza, K. A.; Babu, V. S.; Vithayathil, E. (November 21, 1995). "Morbid jealousy in alcoholism". The British Journal of Psychiatry: The Journal of Mental Science. 167 (5): 668–672. doi:10.1192/bjp.167.5.668. PMID 8564326. S2CID 32699779 – via PubMed.
↑ Kataoka, Hiroshi; Sugie, Kazuma (March 7, 2018). "Delusional Jealousy (Othello Syndrome) in 67 Patients with Parkinson's Disease". Frontiers in Neurology. 9: 129. doi: 10.3389/fneur.2018.00129 . PMC 5845894 . PMID 29563893.
↑ Crichton, P. Did Othello have 'the Othello Syndrome? Journal of Forensic Psychiatry & Psychology. 1996;7(1):161-9.
↑ Kingham, Michael; Gordon, Harvey (May 22, 2004). "Aspects of morbid jealousy". Advances in Psychiatric Treatment. 10 (3): 207–215. doi: 10.1192/apt.10.3.207 .
↑ "Pathological Jealousy: Its Symptoms and Definition". 24 October 2012.
↑ Cobb, J (1979). "Morbid jealousy". British Journal of Hospital Medicine. 21 (5): 511–518. PMID 573647.
↑ Kingham, M. and Gordon, H. Advances in psychiatric treatment. Aspects of morbid jealous. http://apt.rcpsych.org/content/10/3/207.full.pdf+html
↑ Enoch, M.D (1979). Uncommon Psychiatric Syndromes. Bristol: John Wright. pp. 25–40.
↑ Easton, Judith, and Todd Shackelford. Morbid Jealousy and Sex Differences in Partner-Directed Violence. Human Nature 20.3 (2009): 342-350. Academic Search Premier. EBSCO. Web. 27 Oct. 2011.
↑ Easton, J.A.; Schipper, L.D.; Shackelford, T.K. (2007). "Morbid Jealousy from an Evolutionary Psychological Perspective". Evolution and Human Behavior. 28 (6): 399–402. doi:10.1016/j.evolhumbehav.2007.05.005.
1 2 Morbid Jealousy: The Green Eyed Monster. http://www.ijpm.org/Mod5.pdf Archived 2015-05-01 at the Wayback Machine
1 2 Kingham, Michael; Gordon, Harvey (2004). "Aspects of morbid jealousy". Advances in Psychiatric Treatment. 10 (3): 207–215. doi: 10.1192/apt.10.3.207 .
↑ Shephard, Michael (1961). "Morbid Jealousy: Some clinical and social aspects of a psychiatric symptom". Journal of Mental Science. 107 (449): 687–753. doi:10.1192/bjp.107.449.687.
↑ DeSteno, D. A.; Valdesolo, P.; Barlett, M. Y. (2006). "Jealousy and the threatened self: Getting to the heart of the green eyed monster". Journal of Personality and Social Psychology. 91 (4): 626–641. doi:10.1037/0022-3514.91.4.626. PMID 17014289.
↑ Kellett, Stephen; Totterdell, Peter (2013). "Taming the green-eyed monster: Temporal responsively to cognitive behavioural and cognitive analytic therapy for morbid jealousy". Psychology & Psychotherapy: Theory, Research & Practice. 86 (1): 52–69. doi:10.1111/j.2044-8341.2011.02045.x. PMID 23386555.
↑ Arturo, Silva, J.; Ferrari, Michelle M.; Leong, Gregory B.; Penny, Gary (1998). "The dangerousness of persons with delusional jealousy". Journal of American Academy of Psychiatry Law. 26 (4): 607–623.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Sources

Enoch, D. & Ball, H. (2001) The Othello Syndrome. In Enoch, D. & Ball, H. Uncommon psychiatric syndromes (fourth edition) pp50–73. London: Arnold. ISBN 0-340-76388-4