Differential diagnosis

The illness must be distinguished from the following:

• actual marital or sexual problems, including spousal infidelity

• mental handicap, where a simple-minded person may develop a 'crush' and be unable to understand that the other person does not reciprocate, or else enters into a sexual relationship and cannot cope with the partner's motives and behaviours

• schizophrenia, especially of the paranoid type

• major mood disorder with delusions, either depressive or manic

• personality disorder, especially of the paranoid, antisocial, borderline, histrionic, and narcissistic types

• obsessive-compulsive disorder

• substance abuse (which may complicate any of the other differential diagnoses)

• organic brain disorders, including dementias and some epileptic disorders

• sexual dysfunction may lead to fears that a normal partner is seeking satisfaction elsewhere.

It should be noted that an important part of the diagnostic process, an accurate collateral history, may be impossible to obtain in cases of delusional jealousy because of the victim's fears.

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