Aetiology

Psychological, especially psychodynamic, theories of jealousy have failed to distinguish between normal and pathological forms. Freud (16> suggested that delusional jealousy was the result of an unconscious homosexual wish externalized onto the heterosexual partner and the theme of 'latent' homosexuality is again invoked, but with little supportive evidence. Injured narcissism is another recurring speculative theme. Psychological investigations, in general, have raised many questions but provided us with no convincing answers about aetiology.

Inherited temperamental factors may be important(z5> but most cases of delusional jealousy do not have a family history of the condition itself. In the jealousy subtype of delusional disorder, it may be fair to postulate a brain abnormality which can express itself over time or when provoked by chronic substance abuse or the effects of brain injury.

Of course, provocative or misunderstood behaviour by the partner may provide a context for the delusion but is never sufficient to account for the illness itself. Course and prognosis

The condition may appear gradually or suddenly, but even when the onset seems rapid there may have been a previous period of rumination and perplexity of varying duration which probably represents the experiencing of delusional mood or Wahnstimmung. When the delusion crystallizes the perplexity vanishes and the patient is then totally sure of his belief.

Delusional jealousy is typical in being chronic and often lifelong. Without treatment the prognosis is poor and the danger to the victim is ever present. Most patients refuse to accept psychiatric treatment and unfortunately may only receive it following incarceration for a violent crime.

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