Jealousy: a clinicaf and cognitive perspective

Y G. Papakostas
Department of Psychiatry, Athens University Medical School, Eginition Hospital

Although a favorable topic of philosophy and literature from the ancient times, only recently has
jealousy passed the door of psychiatric interest. However, the scarce progress obtained so far from
such an endeavor, is indicative of the difficulties in "nosologizing" or "pathologizing" some cases of
jealousy. Since - with the exception of delusional jealousy - formal criteria have not been established, in
this article an effort is undertaken to differentiate between nonmorbid and morbid jealousy as well as to
further delineate the various sub-types of the later. Regarding the morbid type, and based on the
presence or absence of insight (and rational thought), clinically jealousy can be conceptualized as
covering a spectrum, on the one hand cases with intact insight ("phobic-obsessive" type jealousy) and
the delusional type on the other. In between lie cases with no insight (difference from the "phobicobsessive" type jealousy), but also without overt delusions (difference from the delusional type
jealousy). These cases - probably representing the bulk of the morbid spectrum of jealousy and the
object of our discussion to follow - are characterized by a peculiar type of thinking pattern, namely
overvalued ideation, a concept hard to operationalize. It is probable that many descriptions in the
classical literature fall into this type of morbid jealousy. Although not yet identified, speculations about
the factors contributing to the aetiopathology and clinical picture are described, along with the cognitive
conceptualization of this type of morbid jealousy that is characterized by overvalued ideas. The
cognitive conceptualization suggests the presence of specific dysfunctional schemata in an inert form
that if activated by a stressful event, can make the individual vulnerable towards this disorder. After
their activation, a biased, predominantly top- down style of processing information prevails leading to a
negative content of the stream of thought and to the clinical picture of morbid jealousy. The ctinical
picture of a typical case is presented followed by its analysis in cognitive terms. Finally, some
suggestions regarding treatment -the elicitation ("maieutiki") and testing ("elenchos") of the overvalued
ideation of jealousy- are offered. This approach, although promising, has not been yet empirically tested
in a systematic way, hence its merits are still unknown.
Key words: jealousy, morbid, pathos, overvalued ideas, cognitive.
Y.G: Papakostas, Assoc. Professor of Psychiatry, Eginition Hospital, Vas. Sophias 74, 11528 Athens,
Greece