Othello Syndrome

Introduction & Characterization

The Othello syndrome was named by the English psychiatrist John Todd (1914-1987) in a paper he published with K. Dewhurst entitled "The Othello Syndrome: a study in the psychopathology of sexual jealousy" (Journal of Nervous and Mental Disorder, 1955). 

The eponym “Othello syndrome” originates from Shakespeare’s tragedy in which the protagonist’s jealousy over his wife’s supposed infidelity ultimately leads him to commit spousal homicide. It refers to a content-specific delusion characterized by the fixed false belief that one’s partner has been or is being unfaithful. Men are diagnosed with Othello syndrome more often than women. Patients with Othello syndrome ascribe personal meaning to benign events, misinterpreting the behavior of others to provide confirmatory evidence for their delusions. Delusional jealousy is also known as erotic jealousy syndrome, morbid jealousy, Othello psychosis, or sexual jealousy.


Othello syndrome or morbid jealousy describes a range of irrational thoughts and emotions, together with associated unacceptable or extreme behaviour, in which the dominant theme is a preoccupation with a partner’s sexual unfaithfulness based on unfounded evidence. It is noteworthy that individuals may suffer from morbid jealousy even when their partner is being unfaithful, provided that the evidence that they cite for unfaithfulness is incorrect and the response to such evidence on the part of the accuser is excessive or irrational. Healthy people become jealous only in response to firm evidence, are prepared to modify their beliefs and reactions as new information becomes available, and perceive a single rival. In contrast, morbidly jealous individuals interpret conclusive evidence of infidelity from irrelevant occurrences, refuse to change their beliefs even in the face of conflicting information, and tend to accuse the partner of infidelity with many others.

The most common symptoms of Othello syndrome:

• recurrent accusations of infidelity,
• searches for evidence,
• repeated interrogation of the partner,
• tests of partner's fidelity,
• stalking

Risks Associated with Othello Syndrome

Confirmatory behaviours
Once suspicions regarding the partner’s fidelity are established, they quickly become preoccupying. Overt behaviours to investigate suspicions and preoccupations are common and evident to all involved. They include interrogation of the partner, repeated telephone calls to work and surprise visits, stalking behaviour, or hiring a private detective to follow the partner. Jealous individuals may search the partner’s clothes and possessions, scrutinise diaries and correspondence, and examine bed linen, underclothes and even genitalia for evidence of sexual activity. They may hide recording equipment to detect clandestine liaisons, and some go to extreme lengths, including violence, to extract a confession from their partner.

The accused partner is assumed to be guilty until evidence of innocence is found, but this cannot materialise. Heroic efforts to prove innocence or disprove guilt must fail, as irrational preoccupations cannot be refuted rationally.


Harm to self
Suicidal ideation is not uncommon in morbid jealousy, given the association with depression and substance misuse. Aggressive challenging of the partner may be followed by intense remorse during which suicidal action may occur. In a UK population, it was found that 20% of morbidly jealous individuals had made suicide attempts. Where jealousy gives rise to fatal violence against the partner, this may be followed by suicide.

Risk to others
Violence may occur in any relationship marred by jealousy, although the risk may be greater in morbid jealousy. Culturally, jealousy may be used to justify violence towards partners, and in some courts of law it can even be used as the basis of a provocation defence. Victims of homicide are most likely to be current or ex-partners; this is true for both male and female perpetrators.

Repeated denials of infidelity may provoke extreme anger and violence. Alternatively, the long-suffering partner, plagued by repeated cross-examination and accusations of infidelity, may yield and give a false confession, provoking a violent rage in the jealous individual.

Accusations may be made and violence directed towards a third party believed to be the partner’s lover, the ‘paramour’.


Risk to children
Children in the household may suffer emotional and physical abuse as a result of the actions of a morbidly jealous parent. They may witness arguments and physical violence between their parents or be injured accidentally during assaults. They may be employed by the morbidly jealous partner to spy on a parent. They may even see a homicide or suicide in which a parent is the victim.

Other risks
Partners of morbidly jealous people may develop mental disorder, including anxiety and depression, or may turn to substance misuse.Vauhkonen (1968) described two cases in which jealousy became apparent only after the partner had made suicide attempts in response to persistent unreasonable accusations. Rarely, partners may respond violently themselves to repeated confrontations.

Management of Othello Syndrome with Psychotherapy

For most patients with delusional disorder, some form of supportive therapy is helpful. The goals of supportive therapy include facilitating treatment adherence and providing education about the illness and its treatment. Educational and social interventions can include social skills training (eg, not discussing delusional beliefs in social settings) and minimizing risk factors that may increase symptoms, including sensory impairment, isolation, stress, and precipitants of violence. Providing realistic guidance and assistance in dealing with problems stemming from the delusional system may be very helpful.

Cognitive therapeutic approaches may be useful for some patients and this is best studied in persecutory type. The therapist helps the patient to identify maladaptive thoughts by means of Socratic questioning and behavioral experiments and then replaces them with alternative, more adaptive beliefs and attributions. Discussion of the unrealistic nature of delusional beliefs should be done gently and only after rapport with the patient has been established.

A recent study evaluated the effectiveness of cognitive-behavioral therapy (CBT) versus attention placebo control (APC) as a means to treat delusions in delusional disorder. Using the Maudsley Assessment of Delusions Schedule (MADS), the study found that both APC and CBT improved belief and mood parameters associated with delusions. However, CBT produced more of an impact when compared to APC on strength of conviction, affect relating to belief, and positive actions of beliefs, suggesting CBT as a successful means of treating delusional disorder.

Another technique that may be applicable to a wider population of persons with delusional disorder is behavioral principles and social skills training to provide the individual with effective means of "feeling in control" and less subject to viewing others' efforts to harm him/her as allowing "them" to be controlling. Social skills training focuses on promoting interpersonal competence, confidence (with successful use of more competent social skills) and comfort in interacting with those who the individual feels are judging and having harmful intent toward him/her. Taking control and initiative can dissipate the feeling of loss of control that feeds into and reinforces the delusions.