Treatment of the somatic subtype

Treatment is discussed later in this chapter in the section on overall treatment aspects. Delusional disorder: jealousy subtype™'71)

This is sometimes known as the Othello syndrome, but the term is not recommended as it lacks specificity. The phenomenon of jealousy

Jealousy can arise in various contexts, but here we shall deal with sexual jealousy. This is a virtually universal human emotion, especially when a rival is attempting to lure away someone's sexual partner. Males and females are equally prone to jealousy but may express it differently; Mullen and Martin (I2> suggest that men are mainly concerned with losing the partner whereas women worry about the effect of infidelity on the ongoing relationship.

Broadly there are three levels of jealousy. Normal jealousy is understandable in terms of the situation and the individual's perception of it, and its expression can range from pique to severe rage. How it is expressed is largely related to temperament; some people habitually vent anger with slight provocation and others usually bottle up their feelings. On the whole, men tend to act out their jealous anger more physically.

Neurotic jealousy occurs where the mood and its mode of expression are relatively normal but owing to non-psychotic psychiatric illness, including personality disorder, the reaction is impulsive and excessive. Although the individual is reacting to an overvalued idea rather than a delusion, this type of jealousy can be irrational and quite persistent, and may be expressed dangerously.

Psychotic jealousy, such as occurs in delusional disorder, is characterized by a fixed delusional belief which cannot be swayed by reasoned argument or presentation of contrary evidence. This is the most alarming type since there is no dissuasion and there is an inexorability about the way that the individual accuses, controls and even stalks the victim. Since the accusations are usually untrue, the latter is bewildered by them, but occasions do arise when a partner actually has been unfaithful and it is then very difficult for the observer to know at first how much of the jealousy is justified and how much is delusional. Eventually the savageness and unreasonableness of the accusations reveal themselves as undoubtedly abnormal, but meanwhile a frightened partner will have suffered enormous abuse and possibly repeated assault.

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