This article describes the organic contribution to morbid jealousy. Although the true prevalence of morbid jealousy is unknown, organic factors contribute significantly to its development. We present an assortment of five case histories to highlight the importance of organic causation in this phenomenon.
The first two cases portray organic delusional disorder arising as an aftermath of cerebral infarcts. They are both associated with left sided brain lesions.
Though organic processes generally respond poorly to treatment, case 3 (patient with head injury), is unusual as it describes a young man whose symptoms resolve on recovering from the effects of a head injury.
Likewise, case 4 (patient with a meningioma) who made a complete recovery following surgery, emphasizes the need for early detection of reversible causes.
The difficulty in identifying the common substrate for a phenomenon with such a wide variety of causations is amply displayed by the abundance of theories forwarded. The blurred demarcation between normal jealousy and pathological jealousy leads to further uncertainty. The excess representation of morbid jealousy in organic conditions is not enlightened by these theories. Organic pathology, by affecting the higher centers of the brain, may remove the control over instinctual behaviour. Evidence for this is hard to establish but the evolutionary perspective of jealousy akin to that of the animal kingdom alludes to possible explanations.
The emotion of jealousy entwined with the accompanied sense that the loved one belongs to oneself is a normal human experience (Sims, 2003). It has a social value in preserving the family and an advantage in evolutionary terms of preserving one's own gene pool (Daly et al., 1982). However, jealousy which is maladaptive and dysfunctional causing disruption and distress in the relationship can be regarded as morbid (Marks and De Silva, 1991).
In marital and other long-term relationships assumptions about the exclusivity of the couple and the priority one should have for the other can lead the individual concerned to interpret certain behaviours as violations of these understandings, and to fear that they are losing their place in the partner's affection. This can give rise to jealousy (De silva, 2004). Morbid jealousy is a disorder of content of thought (Sims, 2003), and the term “delusion of jealousy” is in fact a misnomer, as it is the fidelity of the partner which is suspected (Shepherd, 1961). It may manifest in various forms such as a delusion, an overvalued idea or an obsessional thought and the underlying morbid process could be schizophrenia, depression, delusional disorder, personality disorder, alcohol abuse or organic disorders. Morbid jealousy, also known as Othello Syndrome, therefore can be regarded as a syndrome and not a disorder. It can be identified as a descriptive term.
The true prevalence of morbid jealousy is unknown. Even though Enoch and Trethowan considered it as an uncommon disorder, clinicians encounter this syndrome routinely (Michael and Harvey, 2004). Among those who suffer from it, almost 15% were found to have an organic psychosyndrome (Mullen and Maack, 1985). A wide variety of cerebral insults have been shown to be associated with it (Cobb, 1979). Association of this syndrome with head injury such as Punch-Drunk syndrome in boxers following multiple contra-coup contusions has also been described (Lishman, 1998). A recent case report suggested lesions in the right orbito-frontal cortex in development of morbid jealousy (Narumoto et al., 2006). However, this condition has also been shown in patients with non-focal cerebral conditions such as Normal Pressure Hydrocephalus (Yusim et al., 2008) and Parkinson's disease (Cobb, 1979). We present the following case histories to highlight some of the important aspects of organic causation of morbid jealousy.
