Pathological jealousy, also known as morbid jealousy, is a

psychological disorder A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

characterized by a pervasive preoccupation with the belief that one's spouse or romantic partner is being unfaithful, despite the absence of any real or substantiated evidence. The condition encompasses two primary clinical subtypes: obsessional jealousy and

delusional jealousy Pathological jealousy, also known as morbid jealousy, is a psychological disorder characterized by a pervasive preoccupation with the belief that one's spouse or romantic partner is being unfaithful, despite the absence of any real or substantiat ...

, the latter also referred to as

Othello syndrome Pathological jealousy, also known as morbid jealousy, is a psychological disorder characterized by a pervasive preoccupation with the belief that one's spouse or romantic partner is being unfaithful, despite the absence of any real or substantiate ...

. Obsessive jealousy is generally classified as a subtype of obsessive-compulsive disorder, reflecting recurrent, intrusive thoughts and compulsive behaviors related to concerns about infidelity. In contrast, delusional jealousy is recognized as a subtype of

delusional disorder 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. Ameri ...

, involving fixed, false beliefs concerning a partner’s infidelity that are resistant to reason or contrary evidence.

Delusional jealousy

This disorder is characterised by persistent suspicions of a partner’s infidelity that are not supported by the evidence. Individuals affected by the condition may misinterpret neutral behaviour as indications of unfaithfulness, which further reinforces their perceptions. Some studies have suggested that the disorder may co-occur with other conditions,including psychiatric disorders such as

schizophrenia Schizophrenia () is a mental disorder characterized variously by hallucinations (typically, Auditory hallucination#Schizophrenia, hearing voices), delusions, thought disorder, disorganized thinking and behavior, and Reduced affect display, f ...

and

, as well as mood disorders such as

bipolar disorder Bipolar disorder (BD), previously known as manic depression, is a mental disorder characterized by periods of Depression (mood), depression and periods of abnormally elevated Mood (psychology), mood that each last from days to weeks, and in ...

. It has also been associated with certain behaviours, including

stalking Stalking is unwanted and/or repeated surveillance or contact by an individual or group toward another person. Stalking behaviors are interrelated to harassment and intimidation and may include following the victim in person or monitorin ...

cyberstalking Cyberstalking is the use of the Internet or other electronic means to stalk or harass an individual, group, or organization. It may include false accusations, defamation, slander and libel. It may also include monitoring, identity theft, thr ...

sabotage Sabotage is a deliberate action aimed at weakening a polity, government, effort, or organization through subversion, obstruction, demoralization (warfare), demoralization, destabilization, divide and rule, division, social disruption, disrupti ...

alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...

sexual dysfunction Sexual dysfunction is difficulty experienced by an individual or partners during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm. The World Health Organization defines sexual dysfunction ...

, and neurological disorders such as

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...

. Pathological jealousy is generally identified through clinical assessment and is recognised as a possible feature of certain psychiatric conditions. According to the ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), it may be observed in disorders such as obsessive-compulsive obsessive-compulsive disorder and

. While it is not classified as a distinct diagnostic category, pathological jealousy is often viewed as a manifestation of underlying mental health issues. The term "Othello Syndrome" is derived from the central character in

Shakespeare William Shakespeare ( 23 April 1564 – 23 April 1616) was an English playwright, poet and actor. He is widely regarded as the greatest writer in the English language and the world's pre-eminent dramatist. He is often called England's natio ...

’s tragedy ''

Othello ''The Tragedy of Othello, the Moor of Venice'', often shortened to ''Othello'' (), is a tragedy written by William Shakespeare around 1603. Set in Venice and Cyprus, the play depicts the Moorish military commander Othello as he is manipulat ...

''. In the play, Othello kills his wife Desdemona in the mistaken belief that she has been unfaithful to him. However, some scholars and experts have pointed out that Othello's actions resulted from manipulation and misinformation, which did not exhibit the clinical features of delusional disorder.Crichton, P. Did Othello have 'the Othello Syndrome? ''Journal of Forensic Psychiatry & Psychology''. 1996;7(1):161-9.

Psychiatric history

Clinical assessment of pathological jealousy requires a comprehensive assessment of the psychiatric history, encompassing the following areas: :* Presenting difficulties: neurotic or psychotic

jealousy Jealousy generally refers to the thoughts or feelings of Emotional insecurity, insecurity, fear, and concern over a relative lack of possessions or safety. Jealousy can consist of one or more emotions such as anger, resentment, inadequacy, he ...

:* Past psychiatric history: neurotic or

psychotic disorders In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or incoh ...

, deliberate

self-harm Self-harm refers to intentional behaviors that cause harm to oneself. This is most commonly regarded as direct injury of one's own skin tissues, usually without suicidal intention. Other terms such as cutting, self-abuse, self-injury, and s ...

, and attempted

suicide Suicide is the act of intentionally causing one's own death. Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...

:* Family history:

mental illness A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is ...

, 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 (''e.g.'', Parkinson's)

Forms

*Obsessions: in individuals with pathological jealousy, obsessive jealous thoughts are often experienced as

egodystonic In psychoanalysis, egosyntonic behaviors, values, and feelings are in harmony with or acceptable to the needs and goals of the ego, or consistent with one's ideal self-image. Egodystonic (or ''ego alien'') behaviors are the opposite, referring to ...

; i.e., contrary to the individual's values or wishes. These thoughts are often perceived as irrational and intrusive and may lead to the emergence of

compulsive behavior Compulsive behavior (or compulsion) is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. Compulsive behaviors are a need to reduce apprehension caused by internal ...

such as checking up on their partner may follow. Some research suggests that pathological jealousy may lie on a continuum from obsessional to

delusional A delusion is a 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 ...

thinking. Due to individual differences, there may also be significant differences in the degree of self-affliction experienced by the patient *Extreme obsessions: the individual may spend a significant amount of time ruminating on jealous and difficult to shift his or her focus. This preoccupation may lead to excessive behaviour, such as restricting the freedom of the partner. 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). *Delusions: egosyntonic thoughts refer to ideas or behaviours that individuals perceive as true, reasonable, and consistent with their personal values or identity, and therefore are not resisted. Some authors compare morbid jealousy to a delusional state. 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. *Overvalued ideas: overvalued ideas are characterised by a reasonably comprehensible thought of the patient that goes beyond the bounds of rationality in a particular situation. The idea itself is not irrational, but the patient's lack of resistance may lead to excessive behaviours, such as investigations to maintain a partner's loyalty. This kind of highly evaluative behaviour towards ideas can have negative consequences for both parties in the relationship. Overvalued ideas are characterized by being existent in the individual's own thoughts, and being egosyntonic; this means that patients may act on these ideas because they are consistent with the individual's ego, or consistent with the individual's ideal

self-image Self-image is the mental picture, generally of a kind that is quite resistant to change, that depicts not only details that are potentially available to an objective investigation by others (height, weight, hair color, etc.), but also items that ...

, the ideas are also amenable to reason but are not resisted, even if they may have irrational consequences.

Causes

Psychological

Morbid jealousy has been associated with a range of psychological factors. In some cases, it is conceptualized as a delusional state. According to Kingham and Gordon, “Delusions of

infidelity Infidelity (synonyms include non-consensual non-monogamy, cheating, straying, adultery, being unfaithful, two-timing, or having an affair) is a violation of a couple's emotional or sexual exclusivity that commonly results in feelings of anger, se ...

exist without any other

psychopathology Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes Abnormal psychology, abnormal cognition, maladaptive behavior, and experiences which differ according to social norms ...

and may be considered to be morbid jealousy in its ‘purest’ form.” The condition is often characterized by distorted memory processing and misinterpretation of a partner’s behavior, leading to a fixed conviction of betrayal despite the absence of objective evidence. Certain

brain disorder Central nervous system diseases or central nervous system disorders are a group of neurological disorders that affect the structure or function of the brain or spinal cord, which collectively form the central nervous system (CNS). These disorders ...

s have also been implicated in the development of delusional beliefs related to infidelity. Cobb (1979) noted that “morbid jealousy may be present with all types of cerebral insult or injury,” suggesting a neurological basis for some cases. Furthermore, it has been proposed that diminished sexual function may serve as a contributing factor in the emergence of morbid jealousy. Cobb highlighted instances involving elderly men whose declining sexual capacity was perceived as inadequate by significantly younger partners, potentially giving rise to pathological suspicion and jealousy. Mullen (1990) considered morbid jealousy to be associated with four features: * 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 Borderline personality disorder (BPD) is a personality disorder characterized by a pervasive, long-term pattern of significant interpersonal relationship instability, an acute fear of Abandonment (emotional), abandonment, and intense emotiona ...

” (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.Kingham, M. and Gordon, H. Advances in psychiatric treatment. Aspects of morbid jealous. http://apt.rcpsych.org/content/10/3/207.full.pdf+html

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. Still, many counselors encounter cases of morbid jealousy. Some clinicians may not at first be able to treat this condition due to other dominating psychopathologies present within the jealous person that call for priority attention. 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. 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 based on their rival's youth and physical attractiveness.

Triggers

Research indicates that for men, sexual infidelity is typically the most significant trigger of morbid jealousy, whereas for women, emotional infidelity tends to elicit a stronger response. In cases where partner-related violence does not deter infidelity, some male individuals may resort to

as a final response. In extreme circumstances, morbid jealousy may culminate in partner homicide as a means of attempting to prevent further infidelity. Statistically, women are considerably less likely to commit such acts, with most cases occurring in the context of self-defense. Morbid jealousy has been observed in association with a range of medical and psychiatric conditions, including chronic alcoholism, substance dependence (such as cocaine and amphetamines), and various organic brain disorders (e.g.,

Huntington's disease Huntington's disease (HD), also known as Huntington's chorea, is an incurable neurodegenerative disease that is mostly Genetic disorder#Autosomal dominant, inherited. It typically presents as a triad of progressive psychiatric, cognitive, and ...

). It is also linked to psychiatric conditions such as

, neuroses,

mood disorder A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where the main underlying characteristic is a disturbance in the person's mood. The classification is in the ''Diagnostic ...

s, and

personality disorder Personality disorders (PD) are a class of mental health conditions characterized by enduring maladaptive patterns of behavior, cognition, and inner experience, exhibited across many contexts and deviating from those accepted by the culture. ...

s.Morbid Jealousy: The Green Eyed Monster. http://www.ijpm.org/Mod5.pdf

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. 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.

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 Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...

can be an effective method of treating morbidly jealous persons, it is not sufficient when the nature of their illness is more serious. It is not possible to say that there is one form of treatment that is superior over all those that are currently available. Even though this may be true,

cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD, and anxiety disorders. Cognitive behavioral therapy focuses on challenging and chang ...

is the treatment that has proven to be most effective. Medical *Treatment of the primary psychiatric condition * Antipsychotic medication *

Antidepressant medication Antidepressants are a class of medications used to treat major depressive disorder, anxiety disorders, chronic pain, and addiction. Common side effects of antidepressants include dry mouth, weight gain, dizziness, headaches, akathisia, sex ...

Psychological *Psycho education for the affected person and the partner *

Behavioral therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...

Cognitive therapy Cognitive therapy (CT) is a psychotherapeutic approach developed by American psychiatrist Aaron T. Beck, which aims to change unhelpful or inaccurate thought patterns. CT is one therapeutic approach within the larger group of cognitive behavio ...

*Individual psychotherapy *Insight-riented psychotherapies *

Family therapy Family therapy (also referred to as family counseling, family systems therapy, marriage and family therapy, couple and family therapy) is a branch of psychotherapy focused on families and couples in intimate relationships to nurture change and ...

* Couple therapy Social *Geographical separation of the partners *Social work involvement for child protection issues *Alcohol and substance misuse treatment

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.

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. 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.

References

Sources

* Enoch, D. & Ball, H. (2001) The Othello Syndrome. In Enoch, D. & Ball, H. ''Uncommon psychiatric syndromes (fourth edition)'' pp50–73. London: Arnold.