Journal of Cognitive Psychotherapy: An International Quarterly, Volume 10, Number 1,1996

The Role of the Sexual

Behavior/Attractiveness
Schema in Morbid Jealousy
Mairead Dolan
Ashworth Hospital, Maghull, U.K.

Nagy R. Bishay
North Manchester General Hospital, Manchester, U.K.
The article reviews the literature on morbid jealousy with special emphasis
on the psychopathology. It describes a study investigating the role of sexual
behavior/attractiveness schema in the nonpsychotic morbid jealousy syndrome by comparing 40 morbidly jealous and 40 nonjealous subjects. The
results demonstrate significant differences between jealous and nonjealous
subjects on measures of the cognitive, behavioral and emotional aspects of
jealousy and support the usefulness of a cognitive model in the
conceptualization of jealousy. Significant associations are observed between
measures of sexual behavior/attractiveness schema and emotional and behavioral disturbance but also with a tendency to persistently misinterpret neutral
situations as a threat to key relationships.

Jealousy is a common and complex human emotion experienced by most

people at some time in their lives. In its mildest form jealousy may be seen as
an expression of devotion within a relationship but in its extreme form, it can
become a problematic and destructive emotion (Mullen, 1991). Over the years
several attempts have been made to classify jealousy according to a variety of
descriptive, clinical and causal hypotheses, with the result that the categories
ranging from normal to pathological overlap to a certain degree (Mullen,
1990). One reason for the difficulty in defining the parameters of pathological
or morbid jealousy is that many of the typical features of morbid jealousy are
observed in the process of normal jealousy (Tiggelaar, 1956). To overcome this
problem some authors restrict the term "morbid jealousy" to conditions
characterized by delusions of infidelity (Krafft-Ebing, 1905; Todd & Dewhurst,
1996 Springer Publishing Company

41

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Dolan and Bishay

1955; Enoch & Trethowan, 1979; Dominik, 1970). Indeed, this approach has
been adopted in the DSM IIIR classification (APA, 1980) where jealousy is
subsumed under the category of delusional disorder. However, others consider
jealousy morbid or pathological even in the absence of delusional beliefs when,
for example, jealous responses are excessive or intense (Mairet, 1908; Shepherd, 1961; Mullen, 1990; Shresthaetal., 1985). This broader concept permits
nonpsychotic individuals with neurotic or personality disorders to be labeled
as morbidly jealous but also creates difficulties in designing the boundaries
between what constitutes normal and what constitutes morbid jealousy, as the
designation rests largely on subjective, often culture-based, judgments (Mullen,
1990). Tarrier, Beckett, Harwood, and Bishay (1990) avoided some of these
difficulties by basing their definition of morbid jealousy on the rationality of
the response rather than the extent. They suggested the definition should
include an unfounded "belief or suspicion that the partner is unfaithful which
has consequential thoughts, feelings or behavior." According to this formulation the jealous thoughts are irrational, unsubstantiated and out of context, i.e.,
the subjects' suspicions are not precipitated or maintained by reliable evidence. Jealous reactions are generalized across situations, time and rivals and
cause both intra- and interpersonal dysfunction. By contrast, normal jealousy
is seen as transient, reality based and specific to the partner, event or rival.
From a clinical perspective Shepherd (1961) provided a most comprehensive account of the diversity of jealous presentations by illustrating the
phenomenology through 66 case reports. More recently, Tarrier and colleagues
(1990) also described the core features but within the context of a multidimensional complex relating to the unfounded suspicion of a sexual and emotional
rival and the fear of losing the partner. The latter authors viewed jealous
manifestations as responses in cognitive, emotional and behavioral domains
with the central feature of morbid jealousy being the intrusive thoughts/
suspicions about the partners' fidelity, particularly, the belief that the partner
should love them and therefore owes fidelity, and this love/fidelity is now in
question. Within this cognitive model the jealous beliefs can be delusions,
overvalued ideas or obsessional phenomena the key is that they are held on
inadequate grounds. Their frequency, intensity and situation specificity may
vary with the individual (Bishay et al., 1989). In psychotic forms of morbid
jealousy, the central delusions of infidelity are held with absolute conviction
but secondary delusions are not uncommon (Enoch & Trethowan, 1979). In
nonpsychotic forms the thoughts resemble obsessive ruminations (Cobb,
1976; Cobb & Marks, 1979) or automatic thoughts (Bishay et al., 1989) and are
accepted without challenge.
The jealous patient wishes to expose and punish the supposed infidelity yet,
paradoxically, wishes to restore and retain the relationship. The clinical picture
is further extended by the efforts of the patients to substantiate their suspicions
(Shepherd, 1961; Mooney, 1965; Seeman, 1979; Docherty & Ellis, 1976;

Sexual Behavior/Attractiveness Schema

43

Mullen, 1990). They become vigilant for telltale signs and check their partners'
belongings for clues to their supposed rival. They may follow the partner or
hire a private investigator to spy on them. They scrutinize correspondence,
listen in on telephone conversations or examine bed linen/underwear for signs
of lovemaking. They constantly question and cross-examine their partner
about their movements and activities. Some demand that their partners submit
to a polygraph test (Mooney, 1965). Sexual arousal may be heightened
(Mullen, 1990) and excessive sexual demands may be made of their partners
to ensure fidelity (Shepherd, 1961). Aggressive and violent behavior is more
common in males and domestic violence is frequently reported (Church, 1984;
Dobash & Dobash, 1984; Taylor, 1985; Doherty& Ellis, 1976; Gayford, 1975;
Daly et al., 1982).
Forensic psychiatric studies also suggest that jealousy is one of the most
common motives for murder (Gibbens, 1958; Mowat, 1966; West, 1968).
Unfortunately, many of the studies linking jealousy with violence do not
distinguish morbid jealousy from the extremes of justified jealousy (Mullen,
1990) and criminal statistics probably underestimate the prevalence of sexual
jealousy as a motive for violence (Guttmacher, 1955). Avoidance behavior as
a feature of the jealousy complex is also frequently reported by patients
(Tarrier et al., 1990). Jealousy-provoking situations, particularly magazines or
television programs depicting attractive members of the opposite sex are
avoided by both patients and partners in order to minimize the risk of repeated
arguments and domestic disharmony. The mood of a jealous person can vary
(Shepherd, 1961; Mooney, 1965; Seeman, 1979; Cobb, 1979; Teismann, 1979;
Bishay et al., 1989; Mullen, 1985).
Jealousy provokes feelings of depression, anxiety and despair. Irritability,
frustration and anger may also occur as a consequence of the belief that the
partner is making a fool of them. Feelings of inferiority, unattractiveness and
a poor self-image may be a consequence of jealousy or key variables in its
genesis (Shepherd, 1961; Teismann, 1979; Enoch &Threthowen, 1979; Seeman,
1979; Im et al., 1983; Bishay et al., 1989).
The clinical presentation of morbid jealousy occurring in the context of
primary psychiatric illness is further complicated by the features of these
disorders (Shepherd, 1961; Mullen, 1990). Krafft-Ebing (1905) claimed that
80% of alcoholics who had partners were affected by delusions of infidelity.
However, more recent surveys challenge the emphasis on alcohol abuse in the
development of morbid jealousy although it is reported to be an associated
factor in 10% to 20% of cases (Shepherd, 1961; Langfelt, 1961; Vauhkonen,
1968; Mullen & Maack, 1985). Affective disorders, particularly depression,
can present with morbid jealousy. The interaction is complex and common,
however, as depression maybe the primary disorder or a consequence of
chronic morbid jealousy. Personality disorders, particularly the paranoid
subtypes, are believed to be important predisposing factors in both psychotic

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Dolan and Bishay

and nonpsychotic forms of morbid jealousy (Jaspers, 1913; Kretschmer, 1974;

Shepherd, 1961; Enoch & Trethowan, 1979). Indeed, between 38% and 57%
of morbidly jealous subjects in the four major surveys were diagnosed as
suffering from one or more forms of personality disorder (Shepherd, 1961;
Langfeldt, 1961; Vauhkonen, 1968; Mullen & Maack, 1985).
The literature on the psychodynamic psychopathology of jealousy, particularly morbid jealousy, is complex. Mairet (1908) believed the origin of all
jealousy lay in "the possessive instinct" and the development of mistrust.
Lagache (1950) also thought jealousy developed from tensions and
dissatisfactions between partners as a result of the jealous man's projection of
his own sexual fantasies onto his partner. Langfeldt (1961) stressed the
importance of sensitivity, suspiciousness and self-reference in the predisposition to jealousy, and Kretschmer (1974) believed that jealous patients "had a
spot in the core of their being, a hypersensitive nervous vulnerability" which
left them susceptible to threat from any source. Freud (1922) suggested
jealousy arose from an early mother fixation but argued that the delusional
form represented "acidulated homosexuality." Lagache (1950) and Fenichel
(1945) also believed jealousy had a homosexual basis with the patients ridding
themselves of their own impulses toward infidelity by means of projection onto
the partner. Klein (1957) suggested that displacement of Oedipal wishes led to
ambivalence and an inability to develop genuine love so that relationships
became tainted with narcissistic need and jealousy, whereas Freeman (1990)
specifically explained jealousy in female patients in terms of a "pathological
castration complex." By contrast, some psychodynamic theorists suggest
jealousy in males can be attributed to the operation of projective transference
distortions in adult relationships which developed from a witnessing of
maternal sexual infidelity and the resurgence of adolescent Oedipal conflict
(Docherty & Ellis, 1976).
In recent years, emphasis has shifted from intrapsychic mechanisms and
personality factors toward a more socio-cognitive approach. Social, cultural
and relationship factors are seen by some authors as important in the development of morbid jealousy and often color the presentation. Ellis (1985) concluded jealousy owed a lot to cultures which favored monogamic philosophies
of sex, love and marriage but noted that despite a trend toward more liberal
attitudes about sex role behavior, jealousy remained a common problem.The
contribution of the partner and the nature of the sexual relationship was also
increasingly recognized as an important issue in the development of jealousy
(Weakland, Fisch, & Watzlawick, 1974; Tiggelaar, 1956). Ellis (1985) recognized the significance of cultural factors but proposed that morbid or irrational
jealousy stemmed from the individuals "need" rather than "preference" for a
partner's love, together with a pervasive feeling of inadequacy if that love was
lost. He believed jealousy arose out of ego-insecurity, hostility, low frustration
tolerance, obsessive/compulsive attachment, projection, dependency and a
misinterpretation of the partner's provocative behavior.

Sexual Behavior/Attractiveness Schema

45

In a behavioral model, Cobb and Marks (1979) equated jealous thoughts and
checking behavior with the ruminations and rituals of obsessive compulsive
neurosis. Tarrier, Beckett, Harwood, and Bishay (1990) developed this theme
and proposed a cognitive behavioral formulation of morbid jealousy. This
model was able to explain the affective component together with the tendency
for jealous behavior to continue in the absence of objective evidence to support
it. The central feature of the cognitive model of morbid jealousy is the
individual's tendency to make systematic distortions and errors in the perception and interpretation of events and information. The jealous thoughts are
equated with automatic thoughts as described by Beck (1976, 1983). They
emerge when a person's schemata and assumptions are activated by triggering
events. In jealousy, the automatic thoughts center on unfaithfulness, a fear of
unfaithfulness, or the loss of the relationship. The jealous cognitions appear
plausible and reasonable to the patient and are accepted without question. The
schemata or underlying beliefs are seen as stable and enduring and related to
erroneous assumptions about sexual behavior/attractiveness. In this cognitive
model personality traits, for example, insecurity or poor self-confidence, are
believed to play a part in the development or the clinical presentation of
jealousy. In support of this contention, Tarrier, Beckett, Harwood, and Ahmed
(1989) found high scores for neuroticism, introversion and psychotism on the
Esyenck Personality Questionnaire in morbidly jealous females. The reported
association between neuroticism and a negative evaluation of self (Bagley &
Evan Wong, 1975) may also explain how low self-esteem could foster jealousy. Previous experience, cultural and social factors probably act together to
form the schema about sexual behavior, relationships and attractiveness. These
schemata (particularly if erroneous) are activated by salient events so as to
further distort the processing of information and the interpretation of the
partners behavior (Bishay, Peterson, & Tarrier, 1989; Tarrier and colleagues,
1990). The misinterpretation of events continues even though the original
activating event has passed and the nature of the activating event/trigger maybe
highly idiosyncratic.
In view of the lack of systematic research to support these cognitive
theories, the present study was conducted to assess the application of the latter
cognitive model to morbid jealousy and assess the role of sexual behavior/
attractiveness schema in (1) the misinterpretation of neutral stimuli in jealousy
and (2) the behavioral and emotional aspects of the jealousy complex.

METHOD
Subjects and Procedure
The study group initially comprised 40 "morbidly jealous" patients referred by
their general practitioners, psychiatrists and psychologists to an outpatient

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Dolan and Bishay

clinic run at North Manchester General Hospital. Referrers and potential cases
became aware of the service through advertisements placed in health centers
and a national women's magazine. For the purposes of the study the definition
of morbid jealousy was that suggested by Tarrier and associates (1990), i.e.,
patients with an excessive unfounded preoccupation with the partner's fidelity
which led to significant personal and interpersonal dysfunction. Subjects with
a recent history of drug/alcohol dependence; organic brain disease; psychotic
illness or major affective disorder were excluded. Those with neurotic jealousy, as agreed by the assessor (MD) and the therapist (NB), were interviewed
and invited to participate in the study. Demographic data were collected on
age, sex, ethnic origin, marital status and occupational status. During a
semistructured interview details pertaining to previous medical/psychiatric
history, level of substance abuse, duration of problem jealousy, previous
treatment sought and the reason for the current presentation were obtained
from the morbidly jealous group.
A comparison group, consisting of 40 people from similar social backgrounds, were recruited from the general population. The latter had never been
advised to seek treatment for problem jealousy or other psychiatric disorder.
Where possible, they were matched for age and sex with the study group. Both
the patient and comparison group were asked to complete a battery of standardized and nonstandardized questionnaires so that scores on individual instruments could be compared. Differences in the cognitive, emotional and behavioral aspects of jealousy in the two populations were examined.

Measures
Standardized.The following measures were used to assess the severity of the
emotional aspects of morbid jealousy:
(1) Beck Depression Inventory (BDI), Beck et al. (1961). A well-known selfresponse questionnaire was used to assess the severity of depression. Each
item consists of four statements about depressive symptoms scored from 03. Respondents were asked to select the option that most closely corresponded to their mood over the last week. A total score was obtained by
summing ratings made across all 21 items.
(2) The Beck Anxiety Inventory (BAI) (Beck et al., 1988). A 21-item questionnaire listing the common symptoms of anxiety. Like the depression
inventory each item had 4 responses ranging from 0-3. Measures assess the
degree of anxiety over the previous week.
(3) Hospital Anxiety and Depression Scale (HADS) (Zigmund & Snaith, 1983).
A 14-item scale for detecting these two disorders in a medical outpatient
setting. Each item is scored 0-3 depending on severity.

Sexual Behavior/Attractiveness Schema

47

Nonstandardized Measures. (1) Behavioral Instrument: The Sexual Jealousy Questionnaire (SJQ) (Shrestha, 1985). A 23-item questionnaire focusing
on attitudes and behavior related to jealousy. Each item is scored 0-3 depending on the frequency of each response. Zero indicating never, 1 occasionally
and 2 often.
(2) Cognitive Assessments: Four scales were developed specially for the
study.
a) The Scale for Tenacity of a Jealous Belief (TEN) (Goldberg & Beck)
provides a measure of strength of the jealous beliefs. Subjects were supplied
with a vignette which could be modified to illustrate a typical stimulus to a
jealous reaction, e.g., staying out late. They were asked to imagine the scenario
and rate their belief/suspicion that their partner had been unfaithful, given that
set of circumstances. Subjects were given progressively more evidence to
support the partner's explanation and were again asked to reevaluate their
suspicions of infidelity.
b) Morbid Jealousy Questionnaire for Men/Women (MJQ). A 16 item
inventory containing erroneous statements/assumptions pertaining to sexual
behavior and attractiveness, perceived threat and anger. Subjects were required to report the frequency of these assumptions on a 5-point scale. The
degree of emotional distress engendered by these beliefs was scored on a 4point scale.
c) The Jealousy Interpretation Questionnaire (JIQ). Subjects were presented
with 11 brief scenarios (neutral stimuli) presented in a booklet form. Typical
examples included the partner watching/looking or encountering members of
the opposite sex on television, magazines or in person. Subjects were asked to
choose from three recorded explanations, one represented a normal response,
one a threat (e.g., the loss of the partner's affection to another), the third, the
extremes of a jealous reaction, i.e., the belief that the partner intended to leave.
Other Measures. Spouses Jealousy Questionnaire (SPQ). This examined
the partner's independent assessment of the severity of the jealousy. Each
partner rated the subject's reactions and behavior on a visual analogue scale
from 0-8 (0 represented indifference, 8 physical violence). Spouses were also
asked to record the frequency of the behaviors and the overall impact of
jealousy on the relationship on two further scales. Subscales were summed to
give a composite score.

RESULTS
In response to the initial recruitment drive 42 cases were referred to our
service. Thirty-six came from general practitioners, two were referred by other
psychiatrists and two by clinical psychologists. Of the 42 cases, two were
excluded during the initial assessment. One had a normal jealous reaction to a
partner's current infidelity, the other a severe depressive illness requiring

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Dolan and Bishay

chemotherapy. The remaining 40 patients agreed to complete the questionnaires supplied and their scores were compared with the responses from the
matched comparison (nonjealous) sample. The demographic characteristics of
both populations are shown in Table 1. The majority of the patient group were
female (28) and almost all (36) were in a long-term relationship at the time of
study. Ages ranged from 17 to 66 years, with a mean of 31 years. Over half the
sample were employed outside the home. The majority of cases (29) reported
long-standing problems with jealousy. During the assessment interview, all the
sample (40) reported some degree of emotional upset. Most cases (33) had only
sought help following an ultimatum or threat from their partner, and a quarter
of the sample admitted that their jealousy had resulted in a temporary breakup
of their current relationship at some point. The comparison group comprised
TABLE 1. Characteristics of Patient and Comparison Groups
Variable
Patient
Statistical
Patient
Group
Group
Signifcance
(Chi-Squared)
Race

White
Non-White

39
1

40
0

(X2 = .000)
p= 1.000
df=l1

Sex

Male
Female

12
28

14
26

(X2 = .057)
p = .811
d f = l1

Marital
status

Married
Steady relationship
Single/divorced

24
12
4

20
18
2

(X2 = 2.230)
p = .328
df=2

Occupation

Professional
Skilled
Semi-skilled
Student
Housewife
Unemployed

5
2
13
1
8
11

7
4
10
5
4
10

(X2 = 5.439)
p = .365
df=5

Age ranges

15-25
25-35
>35

15
16
9

10
25
5

(X2 = 4.118)
p = .128

Duration
of
jealousy

< 5 years
5-10 years
> 10 years

11
19
10

N/A
N/A
N/A

N/A

Reason
for
referral

Self-instigated
Partner threat

7
33

N/A
N/A

N/A

Note. N/A = not applicable.

df=2

49

Sexual Behavior/Attractiveness Schema

40 Caucasian individuals ranging in age from 18-55 years, with a mean of 28

years. Fourteen subjects were male and 26 female. The majority (24) were
employed outside the home in semiskilled and skilled jobs. Almost all of the
comparison group were in long-term, stable relationships (38). No significant
differences in the demographic data in the two groups were demonstrated on
chi-squared analyses.

Analyses of Instruments
Comparison of Test Scores Between Jealous and Nonjealous Subjects. Table
2 indicates that the median scores on all test items measuring the cognitive,
affective and behavioral components of jealousy revealed statistically higher
scores in the patient group (Mann Whitney 2-Tailed Test, p < 0.001). Both
standardized and nonstandardized measures effectively distinguished jealous
from nonjealous subjects.
TABLE 2. Median Scores and Significance Levels on Test Items: Patient
Group Versus Comparison Group
Comparison Group
Median &
Interquartile
Range
[n = 40]

Mann-Whitney
((7 Test)
2-Tailed p

Test

Patient Group
Median &
Interquartile
Range
[n = 40]

JIQ

8.00
(6.00-10.00)

.00
(.OO-.OO)

((7=1.000)
p = .000***

HAD

21.50
(15.00-28.00)

7.00
(4.00-9.00)

((7 = 71.500)
p = .000***

TEN

6.00
(3.25-10.00)

.00
(.OO-.OO)

((7=142.000)
p = .000***

SJQ

15.00
(8.50-24.00)

.00
(.00-1.00)

((7 = 55.000)
p = .000***

MJQ

66.50
(49.50-77.00)

7.00
(5.00-12.75)

((7=14.400)
p = .000***

BDI

18.00
(13.00-24.50)

5.50
(3.00-7.00)

((7=107.000)
p = .000***

BAI

20.50
(10.50-30.00)

5.00
(3.00-7.75)

((7=161.500)
p = .000***

SPQ

40.00
(30.00-49.00)

4.50
(2.00-8.00)

((7 = 2.000)
p = .000***

***/? <.001.

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Dolan and Bishay

TABLE 3. Tenacity of a Jealous Belie.f

Score Ranges
0-4
5-8
9-12
13-16.
17-20.
Median score
Minimum-Maximum

Patient Group
(n = 40)
16
10
9
5
0
6.0.0
.00-16.00

Comparison Group
(n = 40)
39
1
0
0
0
.00
.00-8.00

Further analysis of indivdual measures allowed a more detailed examination of differences in the responses of each group according to the cognitive,
behavioral and emotional domains. Taking each in turn it can be seen, for
example, that none of the patient group attained the maximum possible score
of 20 on the tenacity scale, which would indicate the jealous beliefs were of
delusional intensity (see table 2 and 3). However, the median score for patients
was 6 compared with 0 for the comparison group (Mann-Whitney, p < 0.001).
Fourteen patients had overall scores greater than 8 but none of the comparison
group scored above this value.
For the purposes of statistical analyses on measures evaluating jealous
cognitions and schema, individual responses on the frequency scale of the MJQ
were dichotomised on a "> 3" score so that comparisons could be made (Table
4). (Throughout the study, subjects had rated individual statements as follows:
0 = never, 1 = rarely, 2 = sometimes, 3 = most of the time, 4 = all of the time.)
The patient group scored highly on several erroneous statements about sexual
behavior, for example, "Any man/woman will go with any woman/man," (21
patients vs. 2 comparison groups, chi-squared test,/? <0.001). When attractiveness schema were examined, similar patterns emerged. Nineteen of the patient
group reported frequent thoughts that they were unattractive and, eight felt
"they were not a real man/woman." More than half the patients realized theirir
jealous thoughts were unfounded, and the majority (29) appreciated that
jealousy was ruining their lives. Despite this, just over one quarter (13) were
preoccupied with the thought that their partner would have an affair or would
love someone else, (danger/fear-related schema). A high proportion (21) were
preoccupied with not allowing their partner to fool them (an anger-related
schema). Few of the comparison group had similar preoccupations and statistically significant differences were observed between the two groups on 15 of
the 16 statements.
The Jealousy Interpretation Questionnaire (JIQ) which measured the subjects' response to neutral stimuli, i.e., cognitive biases, rated each scenario as
benign, threat, or extreme threat. This allowed an analysis of overall scores and

Sexual Behavior/Attractiveness Schema

51

TABLE 4. Morbid Jealousy Questionnaire Breakdown: Patient Group

Versus Comparison Group (Numbers of Subjects Scoring 3 or More per
Statement)
Statements
Subject Groups
Test of Significance
d f = 1.
Frequency Patient Compariso.
(Chi-Squared)
Sca
= 40)) - 40)

SI
S2
S3
S4
S5
S6
S7
S8
S9
S10
Sll
S12
S13
S14
S15
S16

12
13
16
11
7
19
8
21
16
9
1
25
29
22
20
21

0
0
0
3
0
2
0
2
2
1
0
0
0

0
2

(X2 = l 1.863)
(% 2 = 13.226)
(X 2 = 17.578)
(X2 = 4.242)
(%2= 5.636)
(X2 = 16.529)
(t= 6.806)
(X2 = 19.771)
CC2 = 12.115)
(X2 = 5.600)
(5C2= -000)
(%2= 33.513)
(X2 = 42.407)
(X2 = 24.409)
(%2-24.067)
(X 2 = 19.771)

P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=
P=

0006***
.0003***
.0000***
.0394*
.0176*

oooo***

.0091**
.0000***
.0005***
.0180*
1.0000

oooo***

.0000***
.0000***

oooo***

.0000***

*p <.05. **p <.01. ***p <.001.

provided a means of assessing how subjects rated the 11 situations (see Table
5). Out of a maximum possible score of 22 on the JIQ the highest score recorded
among the patient group was 16. By contrast, the highest score in the comparison group was 2. The median score for patients on this measure was 8 compared
with 0 for nonjealous subjects (Mann-Whitney, p < 0.001). Whereas most of
the 11 scenarios were considered benign or nonthreatening by the comparison
group, only 4 of the situations were rated as benign by the patient group.
Patients demonstrated a tendency to misinterpret neutral or ambiguous situations as a threat to the relationship with their partner.
As expected, overall scores on the sexual jealousy questionnaire (SJQ)
which effectively examines jealous behaviors, were significantly higher in the
morbidly jealous group (Mann-Whitney 2-tailed test, p < 0.001). When the
frequency of responses to individual statements was dichotomized on a " >1"
score (0 = never, 1 = occasionally, 2 = often) in order to assist in the analyses
of jealous behavior some interesting responses emerged. Three of the comparison group admitted searching their partners' belongings for clues to the
identity of their rival. By contrast, 34 of the patient group engaged in such
behavior (%2 test, p < 0.001). Approximately half of the patients admitted
wanting to harm their partners; had spied on them or had attempted to catch
them out. Seventeen patients had considered hiring a private investigator and

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Dolan and Bishay

TABLE 5. Jealousy Interpretation Questionnaire Breakdown: Patient

Group Versus Comparison Group (Comparison of Responses to 11
Scenarios)
Responses
Patient Group
Comparison Group
Benign

Mean
Median

3.78
4.00

10.78
11.00

Threat

Mean
Median

6.35
6.50

.23
.00

Extreme
threat

Mean
Median

.88
.00

.00
.00

Overall
score

Median
8.00
Minimum-Maximum (2.00-16.00)

.00
(00.-2.00)

11 had followed their partner. Just over three quarters (31) of the patients challenged
or confronted their partner with their suspicions and 35 had monitored telephone
conversations in an attempt to identify their rival. Statistical analyses (%2 test)
revealed significant differences between the jealous and nonjealous subjects on 22
of the 23 items.
Jealous and nonjealous subjects also differed significantly in their scores on the
anxiety and depression scales (BDI, BAI and HAD) selected to evaluate the degree
of emotional distress associated with jealousy (Mann-Whitney 2-tailed test, p <
0.001) (see Table 2). The median HAD score, for example, in the jealous group was
21.5 compared with 7 for the comparison group. Median scores on the BDI and B AI
were 18.0 and 20.5, respectively, for the patient group and 5.5 and 5, respectively,
in the comparison group.
The spouses questionnaire provided an additional independent measure of
possible differences between groups. On this instrument partners confirmed patient
reports of a high level of emotional and behavioral disturbance within the relationship. The median score on the SPQ in the patient group was 40 in contrast to a
median score of 4.5 for the comparison group (Mann-Whitney, p < 0.001). The
highest recorded scores in patient and comparison groups were 68 and 20, respectively. On the subscale assessing the impact of jealousy on the relationship the
median score for patients was 6 out of a maximum possible score of 8 as aopposed
to 0 for the comparison group (Table 7).
Correlations between test measures (Table 8) in the jealous group revealed
significant associations between the frequency of jealous cognitions/schema on the
MJQ and the tendency to assess ambiguous situations as a threat on the JIQ (p <
0.05). Sexual behavior/attractiveness schema as measured by the MJQ were also
significantly associated with anxiety scores on the BAI (p < 0.01) and the frequency
of confirmatory behaviors on the SJQ (p < 0.01). The association between scores

53

Sexual Behavior/Attractiveness Schema

TABLE 6. Sexual Jealousy Questionnaire Breakdown: Patient Group

Versus Comparison Group (Numbers of Subjects Scoring 1 or More per
Statement)
Statement

Qi

Q2
Q3
Q4
Q5
Q6
Q7
Q8
Q9
Q10
Qll
Q12
Q13
Q14
Q15
Q16
Q17
Q18
Q19
Q20
Q21
Q22
Q23

Subject Groups
Patient Comparison
(n = 40) (n = 40)
40
11
34
16
7
17
14
11
26
1
35
22
25
31
32
22
23
14
17
32
21
13
8

Test of Significance
df=1
(Chi-squared)

11
1
3
3
0
0
0
0
1
0
2
2
1
1
1
3
2
1
1
2
0
0
1

(%2= 42.407)
(X 2 = 7.941)
(X2 = 45.254)
(X2 = 9.939)
(X2 = 5.636)
(X 2 =19.122)
(X 2 = 14.632)
(X 2 = 10.540)
(X2 = 32.201)
(X 2 = -000)
(X2 = 51.489)
(X2 = 21.488)
(X 2 = 30.142)
(X2 = 43.802)
(X2 = 46.421)
(X 2 = 18.851)
(X 2 = 23.273)
(X 2 =11.815)
(X 2 =16.129)
(X2= 43.018)
(X2= 25.827)
(X 2 = 13.226)
(X 2 = 4.507)

P=
P=
PP=
P=
P=
PP=
P=
P=
P=
P=
P=
P=
P=
PP=
P=
P=
P=
P=
P=
P=

.0000***
.0048**
.0000***
.0016**
.0176*
.0000***
.0001***
.0012**
.0000***
1.0000

o.ooo***

.0000***
.0000***

oooo***.

.0000***
.0000***

oooo***.
0001***
oooo***.
oooo***.

0006***.

0003***.
.0338*.

*p <.05. **p <.01. ***/? < .001.

TABLE 7. Spouses Questionnaire Breakdown: Patient Group Versus
Comparison Group
Overall Score
Impact of Jealousy
(0-96)
Subscale
(0-8)
Patient
group
(n = 40)

Median
Minimum
Maximum

40.00
18.00
68.00

Median
Minimum
Maximum

6.00
2.00
8.00

Comparison
group
(n = 40)

Median
Minimum
Maximum

4.50
.00
20.00

Median
Minimum
Maximum

.00
.00
4.00

54

Dolan and Bishay

TABLE 8. Between-Test Correlations (Spearman's Rho)

Test

JIQ

HAD

TEN

SJQ

MJQ

(.014)
= .932

(.307)
(.230) (.069)
= .054 = .154 p = .670

BDI

SPQ

(-.15)
^ = .374

BAI

(.289)
(.683)
(.159)
(.393)
(.482)
(.452)
p = .071 p = .000***;? = .327 p = .012* = .002** =.003**

BDI

(.052)
(.579)
(.059)
(.085.)
(.087)
^=.748 p = .000*** = .717 /? = .601 = .593

MJQ

(.327)
(.423.) (.17)
463)
=.039 =.007** = .288 = .003**

SJQ

(.093)
= .570

TEN

(.331)
(.652)
= .037* = .689

BAI

(.001)
(.266)
=.996 = .097

(.263)
(.523)
= .102 = .001***

HAD (.261)
= .104
Note. No. of cases = 40.
*p<.05. **p<.01. ***p<.001.

on the BDI and erroneous schema (MJQ) did not reach statistical significance
(p = 0.59). The Tenacity of Jealous Beliefs was not significantly associated
with scores on the MJQ.

DISCUSSION & CONCLUSION

The literature on the psychology of morbid jealousy is extensive and has
largely focused on the role of aberrant psychosexual development (Freud,
1922; Fenichel, 1945; Lagache, 1950; Klein, 1957; Freeman, 1990) or personality factors (Tiggelaar, 1956; Vauhkonen, 1968; Kretschmer, 1974). More
recently, a cognitive behavioral formulation has been proposed to explain the
clinical and psychological features of nonpsychotic morbid jealousy, as well
as the self-perpetuating nature of the condition. Theoretically this model
provides a useful framework for differentiating normal from morbid jealousy
but also should open up alternative treatment avenues for a condition which is
notoriously difficult to treat (Bishay et al., 1989). This study which examined
jealousy along a cognitive behavioral framework looked at the nature of

Sexual Behavior/Attractiveness Schema

55

jealous cognitive distortions by analyzing the responses of morbidly jealous

and nonjealous subjects on cognitive measures specifically designed for the
study.
The patient group, whose characteristics were presented in Table 1, were
predominantly female despite previous reports of a higher prevalence of
morbid jealousy in men (Shepherd, 1961; Langfeldt, 1961). The authors
suspect the sex biases in this study can at least be partly explained by the
method of recruitment. Similarly, the overrepresentation of Caucasian subjects in the study is more likely to reflect the characteristics of the local
population than a true ethnic difference in prevalence. A general lack of
awareness of suitable treatment approaches for nonpsychotic forms of morbid
jealousy may explain our finding that a significant proportion of the patients
had long-standing problem jealousy, yet few had been referred for treatment
prior to this study. Interestingly, we also observed that an ultimatum given by
the partner was an important factor in seeking help. Within the context of
ambivalent social attitudes to jealousy it was surprising that many patients
were still in long-term relationships despite frequent reports of domestic
disharmony. It was beyond the scope of this study to examine the causes of the
apparent tolerance of the partners.
Examination of the applicability of a cognitive model to nonpsychotic
morbid jealousy, however, did provide support for some of Tarrier and
associates' (1990) proposals. Measures specifically designed to assess the
nature and frequency of erroneous sexual behavior/attractiveness schema
successfully differentiated normal from morbidly jealous subjects and identified common and recurring cognitive distortions and misconceptions in the
latter group. Similarly, the instruments used to assess the severity of emotiona
upset and the frequency of confirmatory behavior proved useful in the assessment of other aspects of the jealousy complex.
Our finding that morbidly jealous subjects who report a high frequency of
erroneous schema also have a tendency to misinterpret ambiguous or neutral
stimuli as a threat suggest underlying schema may be influencing their
perception of events. Fear may be a factor in this process. The pattern of scores
on the JIQ demonstrated an appraisal system in jealous subjects which is rare
in those who do not have problem jealousy. Similar cognitive biases have been
reported in other neurotic disorders but their significance in terms of treatment
strategies has yet to be evaluated (McNally & Foa, 1987; Butler & Mathews,
1983). The associations found between measures of jealous cognition's (schema)
jealous behavior and emotional upset suggest dysfunctional cognitive processes may play a role in the development of all aspects of the jealousy
complex. While this study lends some support to the role of the schema
proposed by Tarrier and colleagues (1990), our findings suggest dangerrelated schema may have been underestimated in his formulation.

56

Dolan and Bishay

The cognitive model proposed by Bishay, Tarrier, Dolan, Beckett, and

Harwood (1992) had assumed a role for fear in morbid jealousy. This assumption was borne out by our finding of high scores on measures of anxiety as well
as frequent reports (on the MJQ and JIQ) of a fear that the partner would
become emotionally or physically involved with another.
The therapeutic implications of these findings are currently being evaluated
in a controlled treatment trial of 40 nonpsychotic morbidly jealous subjects.

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Maghull, Liverpool, L31 1HW England.

APPENDIX
Morbid Jealousy Questionnaire
2.A
51
52
53
54
55
56
57
58
59
510
511
512
513
514
515
516

ABBREVIATED MJQ
He/She will leave me.
He/She will go off with someone else.
He/She will love someone else.
He/She does not love me.
He/She loves someone else.
I am not attractive.
I am not a real man/woman.
Any man/woman will go with any woman/man.
A man/woman can get any partner he/she wants when he/she
wants.
He/She was unfaithful before, so he/she will do it again in
future.
I was unfaithful to my previous partner so my partner will be
unfaithful to me.
I know it is nonsense but I can't help thinking it.
Jealousy will ruin my life.
In marriage anything can happen while one thinks everything
is okay.
He/She like other men/women will be unfaithful.
I'll not allow him/her to fool me.

Sexual Behavior/Attractiveness Schema

59

Scoring System
0 = Not at all.
1 = Rarely.
2 = Sometimes.
3 = Most of the time.
4 = Almost all the time.

Sexual Jealousy Questionnaire

2.B ABBREVIATED SJQ
Ql Do you ever have the thought that your partner is being unfaithful to
you?
Q2 Do you ever follow your partner to work to find out who he/she is
having an affair with?
Q3 Do you ever search your partner's belongings for clues as to the
identity of the person he/she is having an affair with?
Q4 Do you ever check your partner's body for signs of lovemaking with
someone else?
Q5 Do you ever have the idea that your partner has V.D?
Q6 Have you ever considered hiring someone to follow your partner to see
who he/she is having an affair with?
Q7 Do you ever search your partner's bed for signs of lovemaking with
someone else?
Q8 Do you ever have the feeling that your partner makes love to someone
else whilst you are asleep?
Q9 Do you ever become depressed because you know your partner is
being unfaithful to you?
Q10 Do you ever have the idea your partner is trying to poison you to affect
your sex drive?
Q11 Do you ever try to listen in to your partner's telephone calls to discover
who it is he/she is having an affair with?
Q12 Do you ever hide yourself so that you can watch what your partner is
doing without him/her knowing?
Q13 Do you ever arrive home unexpectedly in an attempt to catch out your
partner?
Q14 Do you ever tell your partner you believe he/she is having an affair
with someone else?
Q15 Do you ever get angry because you believe your partner is having an
affair with someone else?
Q16 Do you believe that your partner's sexual relations with you have
declined because of his/her relationship with someone else?

60

Dolan and Bishay

Q17 Are you convinced your partner is having an affair?

Q18 Do you ever check your partner's underclothes for signs of lovemaking
with someone else?
Q19 Does your partner behave in such a way that would suggest to you that
he/she has a lover?
Q20 Do you ever check his pockets/her handbag for the name, address or
telephone number of the person your partner could be having an
affair with?
Q21 Have you ever wanted to harm your partner because you believe he/
she is being unfaithful?
Q22 Have you ever taken time off from work to be able to keep a check on
your partner?
Q23 Have you ever accused someone of having an affair with your partner?
Scoring System
0 = Never.
1 = Occasionally.
2 = Often.
Jealousy Interpretation Questionnaire
2.C ABBREVIATED J1Q
51 Your partner is watching a TV program, a nude picture of
a member of the opposite sex appears. What do you think
your partner will think?
e.g., response
a) The partner is watching the program- 0
b) The partner will love/fancy that person - 1
c)
The partner will leave - 2
52

You and your partner are at a party, your partner is talking to

a member of the opposite sex. What do you think is going on?

53

Your partner is two hours later than expected. What do you think the
most likely cause to be?
You know about a previous relationship your partner had with some
one you know, the partner arrives three hours late. What do you
think is going on?
Your partner is reading a magazine with a nude picture of a member
of the opposite sex. What do you think the partner is doing?

54
55
56

Your partner went on an outing with colleagues of both sexes at work.

What do you think is going on?

Sexual Behavior/Attractiveness Schema

61

57

An attractive member of the opposite sex walks past you and your
partner in a shopping center. What do you think is going on?

58

You cannot get a reply when you answer the telephone, Why?

59

A car is parked across the road, opposite your home. Why?

510 You go to a partner's place of work and find your partner talking to a
member of the opposite sex. What do you think is going on?
511 Your partner is talking to someone on the telephone and he/she lowers
his/her voice when you come close. Why?

Scoring System
0 = Neutral/normal response.
1 = Fear partner will be attracted to supposed rival.
2 = Fear partner will leave them for supposed rival.

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