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Past relationships, childhood experiences cause morbid jealousy: Local study

15 Nov 2021

  • Affective factors include experiences of being cheated on or parents’ extramarital relationships
BY Ruwan Laknath Jayakody Individuals with morbid jealousy, a local study on this hitherto little-studied phenomenon found, have either experienced or are more likely to recall incidents of past experiences of being cheated on in previous relationships or childhood experiences of parents having or being accused of having extramarital relationships. This finding was made in a brief report on the “Role of negative experiences in past relationships and adverse childhood experiences in morbid jealousy”, which was researched and authored by S. Karunarathne and A. Rodrigo (attached to the Kelaniya University’s Medical Faculty’s Psychiatry Department) and N. Liyanage (attached to the National Hospital’s Colombo University Psychiatry Unit) and published in the Sri Lanka Journal of Psychiatry 8 (2) in December 2017, where they argued that this clinical information should be used in treatment, including in cognitive restructuring. “Morbid jealousy”, according to J. Cobb, involves a range of irrational thoughts and emotions along with associated unacceptable or extreme behaviour in which the dominant theme is a preoccupation (as per M. Kingham and H. Gordon’s “Aspects of morbid jealousy”, the said preoccupation could be a delusion, obsession, or overvalued idea) with a partner’s sexual unfaithfulness based on unfounded evidence.  Moreover, the diagnosis is, as per Kingham and Gordon, encountered frequently by mental health clinicians, with C. Kapugama, C. Suraweera, W. Kotalawala, V. Wijesiri, M. Dalpadatu, and R. Hanwella finding it to be common (a high prevalence of 17.1%) in the “Prevalence of morbid jealousy among inpatients in a psychiatry unit in Sri Lanka (the National Hospital’s Colombo University Psychiatry Unit)”, and D. De Silva and P. De Silva noting in “Morbid jealousy in an Asian country: A clinical exploration from Sri Lanka (the study conducted in Colombo)” that the local clinical presentation was largely similar to presentations described in the international – largely western – literature. This condition, Karunarathne et al. pointed out, is associated with significant negative consequences and has confirmatory behaviours (searching the partner’s clothes, mobile phones, and other personal belongings; surprise visits to the partner’s workplace and stalking; and in extreme circumstances becoming violent to extract a confession from the partner and being provoked to extreme anger and violence when faced with repeated denials from the partner) in common, where the focus is on the investigation of the partner’s fidelity so as to find evidence of infidelity. In such circumstances, the constantly suffering partner can even make a false confession, thus, Karunarathne et al. added, leading to increased violence. The partner may, Karunarathne et al. explained, in turn, develop mental disorders such as anxiety and depression while suicide and self-harm too are not uncommon among people suffering from morbid jealousy. On the other hand, children of a morbidly jealous parent, as Kingham and Gordon observed, may be subjected to physical and emotional abuse. Moreover, morbid jealousy is, as per Karunarathne et al., oft co-morbid with other psychiatric disorders, with alcohol use disorders being commonly associated, while G. Clanton and D.J. Kosins’s “Developmental correlates of jealousy” elaborated that the actual, supposed, or threatened loss of affection by parents will introduce the child to his/her first experience of jealousy, which may in turn make them more vulnerable to the development of jealousy later on in life (in “A new concept and finding in morbid jealousy”, J.P. Docherty and J. Ellis found three morbidly jealous men who saw their mothers engage in extramarital sexual activity during their adolescence) and E.W. Mathes’ “A cognitive theory of jealousy” opined that a previous negative experience in a relationship may play a significant role in the formation of jealousy through feelings of insecurity or inadequacy and low esteem. Therefore, Karunarathne et al. conducted a retrospective case control study, based on the case notes of all patients admitted to the Colombo North/Ragama Teaching Hospital’s Psychiatry Unit between January 2014 and February 2015. A total of 2,279 records that were included were perused manually by a consultant psychiatrist and a registrar in psychiatry. The patients with symptoms of morbid jealousy were defined as per Cobb, irrespective of their other diagnoses (the psychiatric diagnosis of individuals with morbid jealousy included mono-symptomatic delusional disorder [while delusional disorder is characterised by a single or multiple, systematised, non-bizarre delusions and affect appropriate to the delusion, the mono-symptomatic aspect commonly consists of delusional parasitosis where the patients have a fixed, false belief of being infested with parasites], schizophrenia [symptoms can include delusions, hallucinations, disorganised speech, trouble with thinking, and lack of motivation] or schizoaffective disorder [characterised primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression], depressive disorder [a persistent feeling of sadness and loss of interest], obsessive compulsive disorder [OCD – recurring, unwanted thoughts, ideas, or sensations that make them feel driven to do something repetitively], mental and behavioural disorder due to substance use, dementia [loss of memory, language, problem solving, and other thinking abilities], and unclear diagnosis) and irrespective of whether morbid jealousy was the main presenting problem or not. All remaining patient records (429) were considered as controls (patients not having morbid jealousy). Of the records of 2,708 patients (excluding the controls), the majority (1,948 – 71.9%) were male. Out of the 2,708 patients, 131 (4.8%) were identified as having symptoms of morbid jealousy, and the majority (105 – 80%) among them were male. While their age ranged between 23 and 76 years, their average age was 42.8 years. Schizophrenia or schizoaffective disorder was the most common diagnosis amongst those with morbid jealousy, followed by unclear diagnosis (according to Karunarathne et al., this highlights deficiencies in record-keeping), depressive disorder (mood disorder), mental and behavioural disorder due to substance use, dementia, mono-symptomatic delusional disorder, and OCD. Previous experiences of being cheated on were recorded in 34 (25.9%) of the 131 patients with morbid jealousy and in 256 (9.9%) of the 2,577 controls. The childhood experience of parents having or being accused of having extramarital relationships was recorded in 47 (35.9%) of the 131 cases and in 399 (15.5%) of the 2,577 controls. There was a statistically significant association found between morbid jealousy and past experiences of being cheated on and childhood experiences of parents having or being accused of having extramarital relationships (a fact borne by the case notes on patients with morbid jealousy recording such more frequently than in the case of the case notes pertaining to patients without morbid jealousy). Karunarathne et al. found that morbid jealousy is a common finding among psychiatric inpatients. In this regard, D. Bhugra explained in “Cross-cultural aspects of jealousy” that the role played by Sri Lankan culture too cannot be excluded. Karunarathne et al. venture an explanation that patients with morbid jealousy may recall such occurrences more readily, may have distorted or delusional memory about such events, or the clinicians may have explored these aspects in greater depth in patients with morbid jealousy. I.H. Gotlib and J. Joormann mentioned in “Cognition and depression: Current status and future directions” the role played by cognitive biases in the development, maintenance, relapse, and recurrence of mental illnesses, particularly in the case of depression, with J. Everaert, E.H. Koster, and N. Derakshan observing in “The combined cognitive bias hypothesis in depression” that individuals with mental illnesses have attention, interpretation, and memory-based biases for relevant negative information as they have a greater propensity to interpret information in a negative manner and a tendency to recall negative information when compared with healthy individuals (also as per F. Colombel’s “Memory bias and depression: A critical commentary”, and R. De Raedt and E.H. Koster’s “Understanding vulnerability for depression from a cognitive neuroscience perspective: A reappraisal of attentional factors and a new conceptual framework”). Everaert et al. also emphasised that these cognitive biases and memories are not mere symptoms or mood-dependent correlates of the disorder, but causal antecedents and perpetuating factors, and hence important in treatment.


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