Treatment of obsessive morbid jealousy with cognitive analytic therapy: An adjudicated hermeneutic single‐case efficacy design evaluation

Objective

The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT).

Design

An adjudicated hermeneutic single‐case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy.

Method

A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative‐versus‐sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy.

Results

The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt.

Conclusions

This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided.

Practitioner points

• The relational approach of CAT makes it a suitable therapy for morbid jealousy.
• The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns.
• It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy.

     

An inventory and update of jealousy‐evoking partner behaviours in modern society

The goal of the present study was to identify the most important jealousy‐evoking partner behaviours and to examine the extent to which these behaviours evoke jealousy. Based on the literature, a questionnaire was constructed containing 42 jealousy‐evoking partner behaviours, including a partner's extra‐dyadic involvement with someone else by means of modern communication devices, such as the Internet. A second study examined the extent to which undergraduates and a community sample experienced jealousy in response to these partner behaviours. Results showed that explicit unfaithful behaviours evoked most feelings of jealousy, followed by a partner's emotional or romantic involvement with someone else by means of modern communication devices. In general, older individuals responded with less jealousy in response to a partner's unfaithful and suspicious behaviours. Clinical implications are discussed. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• A partner's involvement with someone else by means of modern communication devices may evoke strong feelings of jealousy, in particular among women.
• An individual's age affects the extent to which he or she experiences jealousy in response to specific extra‐dyadic partner behaviours.
• In order to correctly diagnose and treat pathological jealousy, clinicians should pay attention to the extent to which partners (unintentionally) evoke and maintain feelings of jealousy.
• Identifying partner behaviours that evoke most jealousy may help couples define the boundaries of their relationship.

     

嫉妒的心理学研究进展

近年来，有关嫉妒的研究比较活跃，嫉妒已经成为人际关系，情侣之爱，人格和临床心理研究中经常涉及的概念。本文简要描述和回顾了嫉妒的基本概念，嫉妒的有关理论以及对于嫉妒和嫉妒反应的有关评定方面的研究进展情况。     

大学生自恋与嫉妒心理的关系

目的:探讨自恋与嫉妒两方面的关系。方法:随机抽取济南市172名大学生进行自恋人格问卷及大学生嫉妒量表测试。结果:大学生自恋总分、显性自恋、隐性自恋和嫉妒均不存在性别差异。显性自恋的分维度优越感、嫉妒心理的分类学业嫉妒和就业嫉妒存在显著的户籍差异(t=-2.087,2.209,2.384;P0.05)。隐性自恋的分维度易感质和嫉妒心理的分类经济嫉妒在出生顺序上存在显著差异(F=3.065,3.320;P0.05)且均为第一个出生的孩子高于独生子女及第二个出生的孩子,独生子女与第二个出生的孩子之间无差异。大学生显性自恋与嫉妒心理之间不存在显著的相关关系;大学生隐性自恋与嫉妒心理之间存在显著的相关关系(r=0.334,P0.01)。大学生隐性自恋及易感质、特权感对嫉妒心理有正向的预测作用。结论:显性自恋对嫉妒心理的影响微乎其微,隐性自恋和嫉妒心理的关系更为密切。     

A behavioral-systems approach to the treatment of marital jealousy

This paper describes a model of jealousy as an interactional rather than an individual problem and illustrates how faulty attempts to correct jealousy actually exacerbate and maintain the problem. The model integrates a systems view of molar relationship structures and sequences with a behavioral view of respondent and operant components of jealousy. The three case histories that are presented combine strategic approaches, including therapeutic directives and reframing with behavioral strategies such as cognitive restructuring, negotiation and behavioral rehearsal. How the therapist issues directives, fosters compliance, and handles the values dimension of jealousy are discussed as important considerations in the treatment of jealousy.     

Relations between different types of jealousy and self and partner perceptions of relationship quality

The present paper examines the relationships between relationship quality and three different types of jealousy, including both partners' levels of jealousy and perceptions of relationship quality. It was expected that jealousy in response to a direct threat to the relationship—that is, reactive jealousy—would be positively related to relationship quality, whereas forms of jealousy that may also be triggered in the absence of such a threat would be negatively related to relationship quality. Three studies were conducted among large community samples of heterosexual married and cohabiting couples (a total of 961 couples), using three different operationalizations of relationship quality. In all three studies both partners' levels of reactive jealousy related positively to relationship quality, whereas in all three studies, both partners' levels of anxious jealousy were negatively related to relationship quality. Findings and clinical implications are discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Delusional disorder–jealous type: how inclusive are the DSM–IV diagnostic criteria?

Delusional disorder-jealous type is a new diagnostic category in the Diagnostic and Statistical Manual for Disorders, Fourth Edition, Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) in which delusions concerning a partner's infidelity must be present. Therefore, patients who experience a jealousy disorder, but do not experience delusions will not fit the diagnostic criteria. Using a database of 398 case histories of jealousy disorders reported in the literature from 1940-2002, we examined the percentage of these cases that met the diagnostic criteria for delusional disorder-jealous type. Only 4% of the cases met all diagnostic criteria. This is the first systematic comparison of the prevalence of these disorders. The results provide evidence that the diagnostic criteria are not inclusive, as most individuals suffering with a jealousy disorder were excluded from the diagnosis.     

Risk factors for intimate partner violence during pregnancy and postpartum

This longitudinal investigation examined potential risk factors for intimate partner violence (IPV) among women during pregnancy and 6 weeks postpartum. A sample of 180 pregnant women was collected in order to investigate (1) whether associations between partner alcohol misuse, partner jealousy, partner suspicion of infidelity, and stress were associated with IPV victimization; (2) the indirect effects of alcohol misuse on these relationships; and (3) factors related to changes in IPV victimization over time. At baseline, partner alcohol misuse was associated with each type of IPV victimization and the combination of partner alcohol misuse, partner jealousy, and partner suspicion of infidelity was most strongly associated with severe physical victimization. Partner alcohol misuse mediated the relationship between partner jealousy and psychological and severe physical victimization. At follow-up, partner jealousy and stress were related to women’s psychological victimization and partner alcohol misuse was related to women’s severe physical victimization. Findings suggest that partner alcohol misuse is a risk factor for women’s IPV victimization during pregnancy and jealousy and that stress may increase risk for some types of IPV. Findings also suggest that intervention should target parents early in pregnancy in order to reduce the risk for future IPV.     

从精神分析理论的角度探讨嫉妒产生原因

目的 本文欲从精神分析的角度去探讨嫉妒产生的根源。方法 根据弗洛伊德的精神分析理论原理,作者寻找嫉妒产生的可能原因。结果 作者发现,很多迹象表明嫉妒的产生与人们潜意识中的恋母情结(男性)或者恋父情结(女性)有关。结论 从精神分析理论的角度来讲,嫉妒产生的根源正是人们潜意识中存在的恋母(恋父)情结。     

The expression and understanding of jealousy in children with autism

We investigated the expression and understanding of jealousy in 16 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. We examined the expression of jealousy via children's behaviors, verbalizations, and affects demonstrated during two jealousy-provoking triadic scenarios (drawing and playing) enacted among the child in the experimental group (autism or typical), that child's main caregiver (mostly mothers), and a familiar peer or sibling. The two scenarios corresponded with the two types of jealousy described in past studies: social-comparison jealousy (drawing scenario) and social-relational jealousy (playing scenario). To tap children's understanding, we asked them to identify jealousy from a picture, to provide examples of times they felt jealous, and to offer suggestions for coping with jealousy. The main results revealed that children with autism expressed jealousy in situations similar to their typical age mates but manifested it in different behaviors. Moreover, children with autism revealed a less coherent understanding of the feeling. We discuss the meaning of the gap between demonstrating and understanding jealousy in light of the two central theoretical views conceptualizing the core emotional deficit in children with autism.     

Surgical treatment for morbid obesity

Obesity has become a serious public health problem in Mexico and at present time and the best treatment for morbid obesity is surgery. Recently, laparoscopic techniques have become available for treatment of this disease. Surgery is indicated in patients with body mass index (BMI) >35 kg/m2, and with comorbidity. Restrictive procedures such as adjustable gastric banding and vertical banded gastroplasty have less incidence of postoperative complications; however efficacy in terms of weight loss is not as good as in malabsorptive or mixed procedures. Patients who undergo these malabsorptive or mixed procedures (gastric bypass, biliopancreatic diversion) are at higher risk for postoperative complication. To date, gastric bypass is considered the care standard for treatment of morbid obesity; it confers an approximately 70% of body-weight-loss excess, with an acceptable rate of complications.     

The role of the pathologist in environmental medicine and public health.

The present paper summarizes the role of the morbid anatomist and clinical pathologist in environmental carcinogenesis. It points out that in the past he has contributed considerably to the identification of rare tumors and their etiology. He has an important role to play in the future in providing more accurate data on which epidemiology studies can be developed. The view is also expressed that it is highly important that modern pathologists have an understanding of toxicologic and pharmacologic techniques and their potential application to biologic material in order that they may be in a position to correlate and develop multidisciplinary approaches to the identification of environmental hazards. Some of these approaches are illustrated and their potential developments outlined.     

Mania and DSM-III schizophreniform disorder

The investigations applied DSM-III schizophreniform criteria to 111 patients satisfying Feighner criteria for mania. Thirteen manics (12%) who met the DSM-III criteria were compared to the remaining manics. Manics satisfying DSM-III schizophreniform criteria had more depressive symptoms, but the two groups did not differ significantly on a number of demographic, clinical, and laboratory variables previously found to discriminate schizophrenics from affectives.The morbid risk for affective disorder in first-degree relatives of manics satisfying DSM-III schizophreniform criteria, although not significantly different, was one-third that of the remaining manics. However, the morbid risk for alcoholism in the relatives of the schizophreniform sample was twice that of the other group. The relative groups did not differ in combined morbid risk for alcoholism and affective disorder. The validity for psychiatric research of the DSM-III schizophreniform category is discussed in light of these findings.     

Infections in British clinical laboratories 1980-81.

This survey through the Association of Clinical Pathologists was continued and extended for 1980-81, with the help of the Institute of Medical Laboratory Sciences. Hepatitis maintained a low attack rate of 26/100 000 person-years, including only three cases of hepatitis B probably attributable to laboratory work (attack rate 9). Nineteen cases of tuberculosis (attack rate 56) included 14 of probable occupational origin (attack rate 41) half of which involved post-mortem or mortuary work. Thirteen bacterial infections of the bowel (attack rate 38, predominantly shigellosis) involved almost exclusively microbiology MLSOs, with 10 attributed to laboratory work (attack rate 29). The seven other infections included 4 of occupational sepsis in morbid anatomy and post-mortem workers. There appears to be scope for improvement in bacteriological bench techniques particularly at the faeces bench and for reduction in the hazards of tuberculosis and sepsis for morbid anatomy and mortuary workers.     

Primary gastroesophageal-ileal hodgkin lymphoma

Primary Hodgkin lymphoma of the gastrointestinal tract is exceedingly rare to the point that some authors regard with skepticism the existence of this entity. Cases of gastrointestinal Hodgkin lymphoma have been reported previously; however, most of these cases represented secondary involvement of the digestive tract in the context of systemic disease. Other cases have been reclassified in retrospective studies as non-Hodgkin lymphomas after the application of immunohistochemical techniques. We report a case of primary Hodgkin lymphoma of the gastrointestinal tract in a patient who presented with obstructive symptoms at the site of a gastroileal bypass; the bypass had been performed years earlier because of morbid obesity. Some non-Hodgkin lymphomas may morphologically mimic Hodgkin lymphoma and vice versa; therefore, an accurate pathologic diagnosis is important, since the therapeutic approach and prognostic implications differ significantly for these diseases. In this context, immunohistochemistry should be used to confirm or to exclude the histologic diagnosis of Hodgkin lymphoma.     

Advances in gastrointestinal electrical stimulation

Electrical stimulation of the gastrointestinal (GI) tract, analogous to pacing the human heart, is an attractive idea. This is because these organs, like the heart, have their own natural pacemakers, and the electrical signals they generate can be altered by externally delivering certain types of electric currents via intraluminal or serosal electrodes to certain areas of the GI tract. A number of studies on animals have been accomplished successfully to treat a variety of disease models, including gastroparesis, dumping, and short bowel syndrome. Over the past 10 years or so, electrical stimulation of the GI tract has received increasing attention among researchers and clinicians because of new techniques, such as implantable devices, and promising results achieved in treatment of gastroparesis and morbid obesity. The objective of this article is to review the advances in electrical stimulation of the gastrointestinal tract. First the electrophysiology of the GI tract and history of GI electrical stimulation are introduced. Then various methods of electrical stimulation of the stomach and small bowel in healthy animals and models of GI diseases are reviewed. Finally clinical applications of electrical stimulation to GI disorders and their possible mechanisms are discussed.     

Handling sentinel lymph node biopsy specimens.A work in progress.

This article reviews the "state of practice" with regard to sentinel lymph node biopsy, a new and evolving technique currently used most commonly for staging of malignant melanoma and adenocarcinoma of the breast. Sentinel lymph node biopsy has the potential to both increase the accuracy of lymph node sampling as a prognostic tool and to decrease the need for unnecessary and morbid extensive lymph node dissection in such patients. The need for close cooperation and planning involving the surgeon and pathologist is stressed, and gross room tissue handling, radiation safety, microscopic examination, and the use of ancillary diagnostic techniques are discussed.     

Estimating morbidity risks in relatives: The effect of reduced fertility

Reduced fertility for a disease can greatly influence the estimation of morbid risk in various classes of relatives. The strongest effect is on parents of probands. Essen-Möller [(1955).Acta Genet. 5:334–342] derived an approximate correction for the morbid risk to parents and applied it to a sample of schizophrenics. That reduced fertility can also diminish the observed morbid risk to other classes of relative, such as siblings, grandchildren, niece/nephew, etc., seems to have been unappreciated in the literature. This report gives a simple method for correcting the morbid risk estimate to parents under reduced fertility which requires fewer assumptions than the method of Essen-Möller (1955). In addition, a method is derived for determining the potential effect of reduced fertility on morbidity risk estimates for other classes of relatives.     

Evolution of liver disease in morbid obesity after small-intestinal bypass and its restoration. A case report

We studied a woman who underwent a jejunoileal bypass for the treatment of morbid obesity and in whom severe jaundice and hepatic failure developed six months later; these developments prompted restoration of the normal continuity of the small bowel. Four serial wedge biopsy specimens of the liver were taken during a three-year follow-up. The first biopsy was performed before the bypass surgery, the second six months after the operation, the third three months after restoration of normal continuity of the bowel, and the fourth three years later. The biopsy specimens clearly showed the morphologic changes of the liver in obesity, the effect of small intestinal bypass and its reversal on hepatic structure, and the natural evolution of liver disease in morbid obesity.