Othello Syndrome

What is Othello syndrome?

Othello syndrome (also known as delusional jealousy, erotic jealousy syndrome, morbid jealousy or Othello psychosis) is a psychiatric/psychological disorder. The affected person suffers from delusions of infidelity of their partner or spouse. This syndrome usually affects males, but it can also affect females. Read about other psychiatric disorders: Tourette syndrome, Peter Pan syndrome.

Othello syndrome was first named by English psychiatrist John Todd in 1955. He was also first to name the Alice in Wonderland syndrome ^[1].

Causes

The exact cause of Othello syndrome is unknown. It can appear by itself or sometimes in the course of other mental conditions, like schizophrenia, alcoholism or drug abuse ( mostly cocaine) ^[1]. Othello syndrome has been also associated with neurological disorders, such as:

• Brain trauma
• Stroke
• Brain tumors
• Neurodegenerative disorders
• Encephalitis (also read about Kluver Bucy syndrome)
• Multiple sclerosis
• Hydrocephalus
• Endocrine disorders

In fact, research suggests that Othello syndrome is mostly caused by neurological disorders, much rarely by psychiatric disorders or addiction problems.

Reports have suggested that the right frontal lobe is responsible for developing Othello syndrome, but also thalamus and left frontal lobe has been suggested as the neuroanatomical correlate ^[2].

Symptoms

The main symptom of Othello syndrome is delusional belief that the partner or spouse is cheating. The affected person presents with obsessive behavior to prove their partners infidelity. They start to accuse and interrogate their partner, search for evidence and test their partner’s fidelity. Sometimes the affected person starts to stalk their partners.

This syndrome can be very dangerous, not only because it can disrupt the relationship, but because it can lead to homicide and suicide ^[3].

In psychiatry, morbid jealousy is associated with the following features:

• Underlying mental disorder that emerges before the onset of jealousy or at the same time
• Features of the underlying disorder are also present with the jealousy
• The course of morbid jealousy is closely related to the underlying disorder
• Jealousy has no basis in reality^[4]

Psychopathological forms

One of the forms of Othello syndrome are delusions about the partner’s infidelity. Delusions are:

• Thoughts of the individual
• Egosyntonic
• Regarded as true
• Patient does not resist them

The affected person might believe that they are being poisoned or their partner is giving them substances to decrease sexuality. Also the patient might believe that their partner has given them sexually transmitted disease. Sometimes the patients believe that while they are sleeping, their partner is engaging in sexual activity with a third party ^[4,6].

Also read about Capgras syndrome.

Another form of Othello syndrome is obsessional jealousy. Obsessions are:

• The affected person’s own thoughts
• Egodystonic
• Acknowledged by the patient to be senseless
• Patient resists them

Patients with jealous obsessions recognize that they are without foundation and they are ashamed of these thoughts. Still the patient suffers from intrusive and excessive jealous thoughts which can be followed by compulsive behaviors, like checking on their partner all the time ^[4,6].

Overvalued ideas are another form of Othello syndrome. Overvalued ideas are:

• Individuals personal thoughts
• Egosyndtonic
• Not reasonable
• Not resisted by the patient

The patient believes that their idea of partner’s jealousy is absolutely correct, even though there is no reasoning for it. This idea becomes the most important thing for the patient and they begin to investigate their partner’s fidelity, even if it is disrupting their own and their partner’s life.

Borderline personality organization is a condition that is potentially predisposing in all forms of Othello syndrome. It is characterized by:

• Negative self-image
• Feeling unworthy
• Identity diffusion- lack of “sense of self”
• Anxiety about rejection, especially in close relationships
• Perception of unfaithfulness in partner
• Instability, anger, jealousy^[4]

Types

Symptomatic jealousy

Symptomatic jealousy emerges from an underlying mental disorder and is linked to the course of this disorder. The jealousy can be reasonably associated with this disorder. Usually symptomatic jealousy emerges together with conditions like:

• Schizophrenia
• Delusional disorder
• Affective psychosis
• Neurotic disorder
• Toxic or organic brain disorders, such as alcoholism that can also cause Wernicke-Kosakoff syndrome
• Dementia

Reactive jealousy

• Provocation that is reasonably related to fears about partner’s fidelity
• State, that makes the patient sensitive towards such provocations:
  • Poor self-esteem, over-sensitivity, vulnerability
  • Mental disorder, such as depression
  • Past experience of infidelity and abandonment
• Exaggerated psychological and behavioral response
• Jealousy is the result of provoking situation and subsequent situation developments^[5]

Diagnosis

Assessment

The assessment of Othello syndrome requires a wide ranging approach. One of the most important factors is thorough taking of the patient’s history. Also, both partners should be interviewed. If the assessment is done correctly, it can be possible to distinguish between delusional, obsessional or overvalued idea. This plays a role in determining the risk. Psychiatric history should include:

• Affective and psychotic disorders
• Threatened or perpetrated violence
• Quality of the relationship
• Family status
• Substance abuse

Mental state examination

• Form of morbid jealousy
• Associated psychological pathologies
• Possible organic disorder

It is important to assess the risk for both partners. The risk assessment should include:

• Suicide
• Domestic violence
• Interpersonal violence (for example, towards the suspected object third party)
• Risk to children^[4]

Treatment

The treatment of Othello syndrome should include both medications and psychosocial treatments. The basic principles of treating this syndrome are to treat the mental disorder and manage the risk.

Medication:

• Antipsychotic medication
• Selective serotonin reuptake inhibitors

Psychosocial treatment

• Treatment of substance abuse
• Cognitive-behavioral treatment-mostly effective if obsession is the prominent feature
• Couples therapy
• Dynamic psychotherapy-if personality disorders with borderline personality or paranoid personality are present
• Child protection
• Hospital admission-usually when there is risk to the patient and their partners
• Geographical separation of the partners is used if the treatment is not working. Geographical separation can cease the morbid jealousy ^[4,5].

Prognosis

The biggest problem in treating morbid jealousy is the adherence to the treatment. One of the most important factors is the patient’s own motivation to accept the pharmacotherapy and psychotherapy. The patient often does not have insight into the disorder ^[6]. Prognosis also depends on the underlying conditions, such as dementia. Those patients who have an underlying psychotic disorder have a poorer prognosis. It is possible that the morbid jealousy will recur ^[4].

References

1. General information for patients: http://www.medicinenet.com/script/main/art.asp?articlekey=25111
2. Causes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144984/
3. Symptoms: http://jaapl.org/content/jaapl/26/4/607.full.pdf
4. Forms of Othello syndrome: http://apt.rcpsych.org/content/10/3/207
5. Types of Othello syndrome: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2990838/
6. Prognosis: http://www.hdbp.org/psychiatria_danubina/pdf/dnb_vol25_no3/dnb_vol25_no3_334.pdf