Psychiatry Research 259 (2018) 562–570

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Pathological jealousy and pathological love: Apples to apples or apples to T

oranges?
⁎
Andrea Lorena da C. Stravogiannisa, , Hyoun S. Kimb, Eglacy C. Sophiaa, Cíntia Sanchesa,
Monica L. Zilbermanc, Hermano Tavaresa,d
a
Impulse Control Disorder Outpatient Clinic (AMITI), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
b
Addictive Behaviours Laboratory, Department of Psychology, University of Calgary, Canada
c
Department of Psychiatry, and Laboratory of Psychopharmacology (LIM-23), Faculty of Medicine, University of São Paulo, Brazil
d
Department of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil

A R T I C L E I N F O A B S T R A C T

Keywords: Pathological jealousy evokes emotions, thoughts, and behaviors that cause damage to social and interpersonal
Pathological jealousy relationships. On the other hand, pathological love is the uncontrollable behavior of caring for a partner that
Pathological love results in neglecting the needs of the self. The aim of the present research was to assess the similarities and
Love-bonding psychopathology differences between the two psychopathologies of love. To this end, thirty-two individuals with pathological
jealousy and 33 individuals with pathological love were compared on demographics, aspects of romantic re-
lationship (jealousy, satisfaction, love style), psychiatric co-morbidities, personality and psychological char-
acteristics (e.g., impulsivity). In a univariate analysis individuals with pathological jealousy were more likely to
be in a current relationship and reported greater satisfaction. The avoidant attachment and the ludus love style
were associated with pathological jealousy whereas the secure attachment and agape love style was associated
with pathological love. Almost three-quarters (72.3%) of the sample met criteria for a current psychiatric dis-
order, however no differences emerged between the pathological jealousy and pathological love groups. In a
binary logistic regression, relationship status and impairments in parenting significantly differentiated the
groups. While both pathological jealousy and pathological love share similarities, they also present with unique
differences, which may have important treatment implications.

1. Introduction
Romantic relationships are a significant part of our lives. A healthy
relationship can increase our life satisfaction and psychological well-
being, while buffering us against the deleterious effects of stress
(Kawamichi et al., 2016; Kiecolt-Glaser and Wilson, 2017; Love and
Holder, 2016). Indeed, romantic relationships provide a variety of po-
sitive rewarding effects such as companionship, passion and intimacy
(Gable and Impett, 2012). Unfortunately, however, romantic relation-
ships can also be a source of great sorrow and suffering. This is because
factors such as rejection, abandonment and conflicts in a relationship
can lead to psychological distress and emotional pain. In fact, problems
in romantic relationships may lead to the emergence of or exacerbate
existing psychopathological symptoms such as depression, anxiety, and
substance abuse (Gable and Impett, 2012; Collins et al., 2002).
Despite the potential to lead to significant impairments and distress,
the psychopathology of love and romantic relationships has historically
been neglected by psychiatry and clinical psychology (Berscheid,
2010). A potential reason for this is that reports on the psychopathology
of love/romantic relationships usually lacked clinical precision. Re-
cently, however, two clusters of pathological love and romantic re-
lationships have been identified: pathological jealousy, involving the
feeling of ownership over the partner and the fear of betrayal, char-
acterized by possessiveness and aggressiveness and behaviors which try
to confirm the partners´ infidelity, and pathological love, involving
passion and selfless dedication, characterized by providing repetitive
and uncontrolled attention and care to the romantic partner (Berscheid,
2010; Marazziti et al., 2003; Sophia et al., 2009). Despite the increasing
empirical attention of the two love psychopathologies, it is not known
whether pathological jealousy and pathological love represent two
distinct psychiatric disorders. In the present research, we address this
empirical gap examining the similarities and differences between pa-
thological jealousy and pathological love on demographics, romantic
and interpersonal factors such as styles of love, psychological char-
acteristic (e.g., personality, impulsivity) and psychiatric co-morbidities.

⁎
Correspondence to: Av. Brig. Faria Lima, 2081 – cj 31 Jardim Paulistano, CEP: 014520-001 São Paulo, SP, Brazil.
E-mail address: alorena.costa@gmail.com (A.L.d.C. Stravogiannis).

https://doi.org/10.1016/j.psychres.2017.11.029
Received 24 April 2017; Received in revised form 19 September 2017; Accepted 8 November 2017
Available online 13 November 2017
0165-1781/ © 2017 Elsevier B.V. All rights reserved.
A.L.d.C. Stravogiannis et al.
1.1. Pathological jealousy
Romantic jealousy – which occurs in the context of a romantic re-
lationship – is defined as a complex process of thoughts, emotions and
actions surrounding the relationship when it is under real or imaginary
threat (White and Mullen, 1989). Thus, jealousy necessitates a social
triangle, imagined or real to manifest (the individual, the partner and
the rival) (Harmon-Jones et al., 2009). It is characterized by feelings
such as anger, humiliation, sadness, insecurity, rejection, and is has
been associated with low self-esteem, dissatisfaction and chronic doubts
(Muzinic et al., 2003). Although jealousy is a normal emotion and can
be an important component of healthy relationships, with abnormally
highly levels of intensity, persistence and lack of insight, jealousy can
become pathological (Marazziti et al., 2003).
Jealousy is a multidimensional construct and consists of several
qualitatively different types. For example, reactive jealousy, occurs
when the partner is aware of an actual threat or danger to their ro-
mantic relationship. Further, this type of jealousycan be a relatively
healthy type of jealousy, and as such, is positively related to relation-
ship quality, (e.g., Barelds et al., 2017; Barelds e Barelds-Dijkstra,
2007). In contrast, anxious or preventive jealousy can manifest in the
absence of a real threat (i.e., imagined threat) and is thus more likely to
become pathological.
Furthermore, pathological jealousy may be obsessive (non-psy-
chotic) or delusional (psychotic) (Tarrier et al., 1990; Westlake and
Weeks, 1999). Delusional jealousy, also known as Othello Syndrome is
usually associated with male gender, chronic and severe abuse of al-
cohol, dementia and injury to the non-dominant right frontal lobe
(Graff-Radford et al., 2012). The focus of the current report, however, is
on the less studied non-delusional form of jealousy, which nonetheless
can be experienced by some individuals as excessive and a painful ex-
perience. This type of pathological jealousy is not associated with
gender, is more common in young adults and is associated with ob-
sessive-compulsive disorder but may also occur in otherwise healthy
individuals (Marazziti et al., 2003; Lima et al., 2017).
Non-delusional pathological jealousy is characterized by intrusive
and excessive thoughts that are usually accompanied by compulsive
behaviors such as checking partner´s belongs and spending a lot of time
thinking about the partner's fidelity. Not surprisingly, these behaviors
are associated with dissatisfaction in romantic relationships, affect the
individual and his or her partner's quality of life, and have been asso-
ciated with poor social adjustment (Öner, 2001; Kingham and Gordon,
2004; Costa et al., 2015). In this sense, the jealousy assessed in the
present research is more in line with the anxious, preventive jealousy
rather than reactive jealousy.
At the neurobiological level, jealousy is based upon the right (non-
dominant) prefrontal cortex (Kelley et al., 2015; Sun et al., 2016), and
manifests once the romantic attachment has been formed. This is be-
cause jealousy, at least to the jealous individual, is an act of protecting
the romantic relationship. Indeed, the word “jealous” is a derivative of
the Latin word zelus, which means zeal. For reasons yet unknown,
jealousy may become out of control. However, it has been speculated
that a combination of high trait anxiety (Costa et al., 2015) and/or early
attachment failures (Hou et al., 2016; Rodriguez et al., 2015) could be
potential reasons for feelings of intense and pathological levels of jea-
lousy that may occur during romantic relationships.
1.2. Pathological love
The other cluster of pathological love/relationships has been la-
beled pathological love. Some people feel that their way of loving their
partner causes suffering due to excessive care and devotion shown to
the partner. The partner is often considered a priority, while other ac-
tivities and interests, once valued, are ignored (Sophia et al., 2007). A
distinctive feature of pathological love is the desperate attempts to
sustain the relationship despite a strong inner feeling of impropriety
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Psychiatry Research 259 (2018) 562–570
and dissatisfaction with the relationship, which underscores the para-
doxical and pathological nature of the syndrome (Sophia et al., 2009).
Indeed, the combination of dependent traits of personality, anxiety
proneness, and over susceptibility to punishment increases the like-
lihood of maintaining a relationship even if it is burdensome due to the
fear of abandonment (Simon, 1982; Norwood, 1986).
In regards to the neurobiology of love, it has been suggested that
becoming romantically attached is a process mediated by neuropeptides
(vasopressin and oxytocin). Vasopressin and oxytocin are often called
the “love” hormone as they are released during intimate relationships
and is important for fostering feelings of intimacy (Zou et al., 2016).
However, it has been suggested that the dysregulation of oxytocin and
vasopressin may become like an addiction, as they both affect the
brain's reward system (Fisher et al., 2016; Zou et al., 2016).
1.3. Pathological jealousy and pathological love: two distinct
psychopathologies?
In sum, recent empirical studies have begun to shed light into the
etiology and clinical correlates associated with the two-love/bonding
psychopathologies. It is now known that pathological jealousy and
pathological love can cause significant distress and impairments in in-
dividuals, leading people to seek psychological treatment for symptoms
associated with the two love-bonding psychopathologies (Sophia et al.,
2009; Costa et al., 2015). Unfortunately, however, what is unknown is
whether pathological jealousy and pathological love represents two
distinct psychiatric disorders.
Interestingly, it has recently been proposed that pathological love
may be better classified as an addiction (Fisher et al., 2016). Providing
support for this supposition, individuals with pathological love report
increased novelty seeking, harm-avoidance, reward-dependence and
self-transcendence, low self-directedness and higher impulsivity - fac-
tors that are also associated with addictive behaviors (Sophia et al.,
2007; Fisher et al., 2016). Conversely, pathological jealousy is asso-
ciated with features that are closely associated with obsessive-com-
pulsive disorders, although characteristics related to substance use
disorders may also be present (Foran and O´Leary, 2008; Ecker, 2012)
Thus, there is some preliminary support that pathological jealousy and
pathological love may represent distinct psychiatric disorders. For ex-
ample, pathological jealousy may be characterized by obsessive and
anxious thoughts whereas pathological love may be associated with
greater levels of impulsivity. However, no study to date as empirically
tested the similarities and differences between pathological jealousy
and pathological love. The present paper addresses this empirical gap.
1.4. Overview of the present research
Thirty-two participants with pathological jealousy and 33 partici-
pants with pathological love were compared on demographics, at-
tachment styles (Bowlby, 1969, 1979), styles of love (eros, ludus,
storge, pragma, agape, and mania; see Lee, 1977), and relationship
characteristics. We assessed psychiatric co-morbidities as different rates
of psychiatric disorders between pathological jealousy and pathological
love may have important treatment implications. The personality and
psychological characteristic (e.g., impulsivity, psychosocial impair-
ments) were largely for exploratory purposes given the lack of empirical
investigations in this area.
Given the paucity of research on this topic, we were hesitant to
make any strong a priori hypotheses in regards to the differences be-
tween the two love bonding psychopathologies. Having said that, based
on the small empirical literature, we hypothesized that the main dif-
ferences between pathological jealousy and pathological love would be
related to intensity of jealousy – participants with pathological jealousy
will report higher levels of jealousy than participants with pathological
love, and attachment – pathological jealousy participants will be
characterized by avoidant attachment style, while pathological love
A.L.d.C. Stravogiannis et al.
will be characterized by anxious-ambivalent style. In regards to styles of
love, individuals with pathological jealousy will be more likely to de-
monstrate the Ludus and Mania love style whereas individuals with
pathological love will be more likely to have Agape and Mania love
styles.
Further, as pathological love has been proposed to resemble an
addiction, we hypothesized that participants with pathological love will
report significantly higher levels of addictive disorders and greater le-
vels of impulsivity. Conversely, given the potential role of anxious and
obsessive thoughts, we hypothesized that pathological jealousy would
be more likely to be associated with higher levels of anxiety.
2. Methods
2.1. Procedure and participants
The research was conducted at Impulse Control Disorder Outpatient
Clinic (PRO-AMITI) in Brazil. The PRO-AMITI is located in a public
university hospital that provides treatment free of charge. Ethics ap-
proval was obtained from the authors’ REB prior to data collection and
written consents were obtained from participants.
Participants with pathological jealousy were recruited through
media announcements that invited people who felt they overreacted to
jealousy-provoking situations, which could potentially harm themselves
or their romantic relationships. Interested participants first underwent a
semi-structured interview conducted by a registered psychologist to
assess for the presence of pathological jealousy. Thereafter, participants
completed a self-report scale assessing intensity of jealousy –
Questionnaire for Affective Relationships (QAR; Marazziti et al., 2003).
Participants with scores above 43, (Marazziti et al., 2003) and reporting
all the following symptoms were eligible for the present research: (1)
irrational thoughts and suspicions regarding the fidelity of the partner;
(2) excessive behavior directed at discovering information about sus-
pected infidelity; (3) intense feelings of anger, fear, sadness, and guilt;
verbal or physical violence against the partner or third party; and (4)
thoughts/behaviors that cause distress and damage to social, emotional,
or sexual relationships (Tarrier et al., 1990; Kingham and Gordon,
2004).
Participants with pathological love consisted of individuals seeking
treatment for pathological love at PRO-AMITI. PRO-AMITI specializes
in the treatment of impulse control disorders and behavioral addictions,
including pathological love. Patients seeking treatment at PRO-AMITI
are informed about ongoing research studies and asked about their
willingness to participate. Patients are clearly told that treatment is not
contingent upon research participation. Similarly to the recruitment of
individuals with pathological jealousy, registered psychiatrists and
psychologists conducted semi-structured clinical interviews to de-
termine eligibility.
To be eligible, patients needed to meet all the six following cri-
teria:1) signs and symptoms of withdrawal (insomnia, tachycardia,
muscle tension, alternate periods of lethargy or intense activity) when
their partner is physically or emotionally unavailable, or in threat of
abandonment; 2) the behavior of caring for the partner is more intense
than the individual would like it to be; 3) loss of control with frequent
frustrated attempts to reduce or interrupt the unhealthy attachment; 4)
spending too much time trying to control the partner's activities; 5)
abandonment of previously valued social activities like personal and
professional accomplishments, socialization with colleagues and re-
latives; and 6) maintenance of the pathological bond, despite personal,
family and professional damage (Sophia et al., 2007, 2009). The above
criteria were based on the criteria for addiction, given that pathological
love has been conceptualized as addictive disorder. Indeed, past re-
search suggest people with pathological love demonstrate among other
things, loss of control, pre-occupation and withdrawal symptoms
(Simon, 1982; Sophia et al., 2007), which are reflected in the above
criteria.
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Psychiatry Research 259 (2018) 562–570
Exclusion criteria for both groups were as follows: presence of de-
lusional jealousy or any other psychotic symptoms; any illness requiring
inpatient treatment; and any cognitive impairment that could com-
promise treatment and completion of questionnaires.
2.2. Participants
The total sample consisted of 65 participants. Thirty-two partici-
pants were classified as having pathological jealousy and 33 partici-
pants with pathological love. It should be noted that 69 individuals
responded to the pathological jealousy media announcement. However,
three were excluded due to cognitive impairments, two for psychotic
symptoms, 10 individuals refused to participate due to scheduling is-
sues, 21 did not want to participate and one interested participant did
not reach the minimum required score at QAR. For the pathological
love group, two participants were excluded as they did not meet the
inclusion criteria.
2.3. Measures
2.3.1. Demographics
A standard socio-demographic questionnaire used at the PRO-AMITI
was used to collect demographic information such as age, ethnicity,
marital status, and employment status.
2.3.2. Jealousy
The Questionnaire for Affective Relationship (QAR; Marazziti et al.,
2003) (Cronbach's α = 0.94) was used as the initial screener to measure
pathological jealousy. The QAR consists of 30 questions that assess
thoughts/behaviors related to jealousy. The items are anchored on a
likert scale from 1 (less severe) to 4 (most severe) with higher scores
indicating greater jealousy. The Interpersonal Jealousy Scale (IJS;
Mathes and Severa, 1981; Costa et al., 2012) was used to assess pre-
dictors, intensity and beliefs about jealousy, self-esteem, insecurity and
romantic love. It consists of 28 statements (Cronbach's α = 0.98), with
items anchored from 1 (absolutely false; disagree completely) to 9
(absolutely true; agree completely). Scores range from 28 to 252, with
higher scores indicating greater severity of jealousy. In addition, we
used the Self-Report Jealousy Scale Portuguese Edition (SRJS-P; Bringle
et al., 1979; Costa et al., 2012) to assess individual differences related
to jealousy-provoking situations. The SRJS assesses jealous behavior
through 24 statements (Cronbach's α = 0.98) that accesses three dif-
ferent levels of situations: non-romantic, minor romantic and very ro-
mantic in the areas of relationship, work, family, and social life. The
statements are anchored from 1 (pleased) to 5 (extremely upset), with
scores ranging from 24 to 120. Higher scores indicate higher presence
of jealousy.
2.3.3. Relationship characteristics
The Portuguese adapted version of the Relationship Assessment
Scale (RAS) (Hendrick et al., 1998; Hendrick, 1998) was used to assess
the quality of the relationship (e.g., “In general how satisfied are you with
your relationship”). The scale consists of 7 statements, ranging from 1
(low satisfaction) to 5 (high satisfaction). Scores ≥ 21 indicates high
relationship quality. Specifically, we derived a measure of relationship
satisfaction using four statements (Cronbach's α = 0.85) from the ori-
ginal measure (Sophia et al., 2009).
2.3.4. Attachment styles
The Adult Attachment Questionnaire (Hazan and Shaver, 1987) was
used to assess participants’ attachment styles. The scale provides three
statements that the participant must choose corresponding to the three
attachment styles, 1) secure attachment (“I find it relatively easy to get
close to others and am comfortable depending on them and having them
depend on me. I don't worry about being abandoned or about someone
getting too close to me”), 2) avoidant attachment (“I am somewhat
A.L.d.C. Stravogiannis et al. Psychiatry Research 259 (2018) 562–570

uncomfortable being close to others; I find it difficult to trust them com- physical neglect (Cronbach's α = 0.46). The items are anchored from 1
pletely, difficult to allow myself to depend on them. I am nervous when (never) to 5 (very often), with scores ranging from 5 to 25 for each
anyone gets too close, and often, others want me to be more intimate than I subscale. Higher scores indicate greater severity of childhood trauma.
feel comfortable being”), and 3) anxious-ambivalent (“I find that others
are reluctant to get as close as I would like. I often worry that my partner 2.3.10. Social adjustment
doesn't really love me or won't want to stay with me. I want to get very close Social adjustment was measured by the Social Adjustment Scale
to my partner, and this sometimes scares people away”). Self-report (SAS) – Portuguese version (Gorenstein et al., 2000). The
SAS contains 42-items (Cronbach's α = 0.85), measuring impairments
2.3.5. Love styles in seven psychosocial areas: work, social and leisure activities, re-
The Love Attitudes Scale (LAS) (Hendrick et al., 1998), categorized lationship with extended family, marital role as a spouse, parental role,
participants love styles through 24 statements divided into six styles of membership in the family unit, and economic adequacy. Items are an-
love: Eros (healthy, erotic and joyful love) (Cronbach's α = 0.74), ludus chored scored on a five-point scale, 1 (normal) to 5 (severe), with
(love played like a game, pluralistic) (Cronbach's α = 0.45), storge higher scores indicate greater impairment.
(friendship love) (Cronbach's α = 0.90), pragma (shopping list love,
based on looking for a partner with ideal characteristics) (Cronbach's α
2.4. Analytic plan
= 0.65); mania (obsessive, jealous and dependent) (Cronbach's α =
0.87), or agape (altruistic, love as duty) (Cronbach's α = 0.88). Items
First, univariate analyses were conducted to identify differences
are anchored from strongly disagree (1) to strongly agree (5) with
between pathological jealousy and pathological love. Specifically, chi-
scores summed for each of the six love styles. Lower scores indicate a
square (χ2) tests were used for categorical variables and t-tests were for
greater propensity towards a specific style of love and a cut off score
continuous measures. Fisher's Exact Test was used when expected cell
of < 7 may be used to categorize peoples’ styles of love.
counts were less than 5 and the Mann-Whitney (U) test was used when
assumptions of normality were violated as indicated by the
2.3.6. Psychiatric co-morbidities
Kolmogorov-Smirnov test. Next, all variables significant at p < 0.10 in
A registered psychiatrist assessed for current psychiatric co-mor-
the univariate analysis (Tabachnick and Fidell, 2001) were entered in a
bidity using The Mini International Neuropsychiatric Interview –
forward stepwise logistic regression (Wald) to assess for variables that
Portuguese version (M.I.N.I; Amorim, 2000). The M.I.N.I is a brief semi-
differentiated between pathological jealousy and pathological love.
structured interview that assesses for a variety of AXIS-I clinical dis-
orders and has been shown to demonstrate strong reliability as com-
pared to the Structured Clinical Interview for the DSM (Spitzer et al., 3. Results
1992).
3.1. Univariate analysis
2.3.7. Impulsivity
Impulsivity was assessed using the Barratt Impulsiveness Scale, 3.1.1. Demographics
Portuguese version 11 (BIS-11) (Patton et al., 1995; von Diemen, Table 1 contains demographic characteristics of the sample. No
Szobot, Kessler and Pechansky, 2007). The BIS-11contains 30 state- demographic differences were between individuals with pathological
ments (Cronbach's α = 0.62) and evaluates three dimensions of im- jealousy and individuals with pathological love, ps > 0.24.
pulsivity: lack of attention, characterized by hasty actions and thoughts,
which tend to be prominent in anxious situations; motor impulsivity, 3.1.2. Relationship characteristic and jealousy
defined as hyperactivity (the need to move), which is influenced by Individuals with pathological jealousy were significantly more
stress; and lack of planning, evidenced by precipitous attitudes and likely to be in a relationship (90.7%) compared to individuals with
conclusions arrived at without reflection, as well as behavior focused on pathological love (48.4%), χ2 (1) = 13.54, p < 0.001 (Table 2). Fur-
immediate returns. The scores range from 30 (1 - rarely/never) to 120 thermore, participants with pathological jealousy reported greater re-
(4 - Always) (Patton et al., 1995; Zilberman et al., 2003), with higher lationship satisfaction compared to individuals with pathological love
scores indicating greater impulsivity. (2.31 vs. 1.73), U = 355, p = 0.015. Interestingly, however, no dif-
ferences were found in terms of jealousy between the groups on all
2.3.8. Personality three measures of jealousy, ps > 0.256. Across both groups, the anxious
The Temperament and Character Inventory (TCI) (Cloninger et al., attachment style was the most frequent, with 53.1% of participants
1993; Fuentes et al., 2000) consists of 240 true or false questions, and
was used to examine four dimensions of personality: novelty seeking, Table 1
harm avoidance, reward dependence and persistence, as well as three Socio-demographic characteristics of the sample and comparison between pathological
jealousy and pathological love.
dimensions of character: self-directedness, self-esteem and self-trans-
cendence. In addition to the above dimensions of personality, we Variables Pathological Pathological Coefficient P
grouped participants into three personality clusters; A, B and C. Pre- Jealousy (n = 32) Love (n = 33)
vious research has found that scores of < 20 on the self-directedness
Age 39.7 (SD = 11.8) 39.3 (SD = 10.8) U = 524.0 0.958
subscale strongly suggests a presence of a personality disorder (Svrakic
Gender χ2 = 0.30 0.868
et al., 1993), with low reward dependence corresponding to Cluster A, Male 8 (25.0%) 7 (21.2%)
high novelty seeking with Cluster B and high harm avoidance with Female 24 (75.0%) 26 (78.8%)
Cluster C personality disorders. Sexual χ2 = 1.00 0.613
Orientation
Heterosexual 31 (96.9%) 30 (90.9%)
2.3.9. Childhood trauma Homosexual 1 (3.1%) 3 (9.1%)
The Childhood Trauma Questionnaire – Portuguese version Ethnicity χ2 = 5.47 0.242
(Bernstein et al., 1994; Bernstein et al., 1994; Grassi-Oliveira et al., Caucasian 27 (84.4%) 22 (66.7%)
2014) was used to assess childhood abuse and neglect. The scale con- Non-caucasian 5 (15.6%) 11 (33.3%)
Employment χ2 = 0.12 0.726
sists of 28 statements measuring five types of maltreatment – emotional
Employed 20 (62.5%) 23 (69.7%)
(Cronbach's α = 0=0.80), physical (Cronbach's α = 0.80), and sexual Unemployed 12 (37.5%) 10 (30.3%)
abuse (Cronbach's α = 0.90), and emotional (Cronbach's α = 0.91) and

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A.L.d.C. Stravogiannis et al. Psychiatry Research 259 (2018) 562–570

Table 2
Comparison between pathological jealousy and pathological love on romantic relationship characteristics.

Variables Pathological Jealousy (n = 32) Pathological Love (n = 33) Coefficient P

Relationship Status X2 = 13.54 > 0.001***

Single 3 (9.4%) 17 (51.5%)
Relationship 29 (90.7%) 16 (48.4%)
Jealousy
QAR 87.44 (SD = 9.74) 85.09 (SD = 11.45) t = 0.89 0.377
SRJS 93.28 (SD = 13.61) 89.36 (SD = 13.46) U = 441.5 0.256
IJS −64.72 (SD = 25.35) −57.30 (SD = 30.34) U = 445.5 0.279
Relationship satisfaction 2.31 (SD = 1.15) 1.73 (SD = 1.15) U = 355.0 0.015*
Attachment style X2 = 10.017 0.007**
Secure 3 (9.4%) 11 (33.3%)
Avoidant 12 (37.5%) 3 (9.1%)
Anxious-ambivalent 17 (53.1%) 19 (57.6%)
Love Style
Eros 10.56 (SD = 2.91) 10.58 (SD = 3.84) t = −0.02 0.988
Ludus 11.38 (SD = 3.70) 13.06 (SD = 3.16) U = 393.5 0.075
Storge 14.81 (SD = 3.50) 14.00 (SD = 4.28) U= 472.0 0.461
Mania 6.81 (SD = 2.57) 7.09 (SD = 3.36) U = 513.5 0.847
Pragma 15.00 (SD = 3.93) 16.24 (SD = 3.28) U = 430.5 0.197
Agape 10.09 (SD = 3.25) 8.64 (SD = 3.32) U = 392.5 0.074

Note.
Note. QAR = Questionnaire for Affective Relationship, SRJS = Self Report Jealousy Scale, IJS = Interpersonal Jealousy Scale.
* p < 0.05.
** p < 0.01.
*** p < 0.001.

with pathological jealousy and 57.6% of individuals with pathological
jealousy being characterized as anxious. The avoidant attachment style
was significantly more frequent in participants with pathological jea-
lousy (37.5% vs. 9.1%), χ2 = 10.017, p = 0.007, whereas participants
with pathological love were more likely report a secure attachment
style (33.3% vs. 9.4%), χ2 = 10.02, p =0.007. Mania was the most
frequent endorsed style of love for both individuals with pathological
jealousy and pathological love. However, no differences were found
between the groups on love styles, ps > 0.075.
3.1.3. Psychiatric co-morbidity
Psychiatric co-morbidity was high, with 72.31% (n = 47) of the
sample meeting diagnostic criteria for at least one current co-morbid
psychiatric disorder (Table 3). The most frequent psychiatric co-mor-
bidity associated with pathological jealousy and pathological love was
major depressive episode, with 46.9% of individuals with pathological
jealousy and 63.6% of individuals with pathological love meeting cri-
teria. However, this difference was not statistically significant p =
0.147. Indeed, no differences emerged in overall rates or specific psy-
chiatric co-morbidities between the two-love/bonding
psychopathologies, including alcohol and substance use dependence,
ps > 0.054. Of importance, it should be noted that suicidality was
elevated with 30.77% of the sample (n=20), reporting lifetime sui-
cidality.
3.1.4. Personality characteristics
No differences in personality characteristics were found as mea-
sured by the TCI, ps > 0.119 (Table 4). However, when participants
were grouped into personality clusters, individuals with pathological
jealousy were more likely to be grouped into Cluster B (31.3%, vs.
10.3%), χ2 = 3.96, p = 0.046. No differences were observed between
the two groups in Cluster A or C, ps > 0.131.
3.1.5. Psychological characteristics
Participants with pathological love reported significantly greater
impairments in their parental role as measured by Social Adjustment
Scale (1.70 vs. 2.43), U = 207.5, p = 0.002. No differences were found
between the two love/boding psychopathologies in regards to im-
pulsivity, childhood trauma and social impairments, ps > 0.70
(Table 5).

Table 3
Comparison of psychiatric co-morbidities between pathological jealousy and pathological love.

Psychiatric Disorders Pathological Jealousy(n = 32) Pathological love (n = 31) Coefficient P

Major depressive episode (MDE) 15 (46.9%) 21 (63.6%) Χ2 = 1.85 0.147

MDE with melancholic features 9 (28.1%) 17 (51.5%) Χ2 = 3.70 0.054
Hypomanic episode 2 (6.3%) 2 (6.1%) 0.682a
Panic disorder 2 (6.3%) 1 (3%) 0.488a
Agoraphobia 1 (3.1%) 1 (3%) 0.746a
Social phobia 1 (3.1%) 5 (15.2%) 0.105a
Obsessive-Compulsive disorder 2 (6.3%) 1 (3%) 0.488a
Post-traumatic stress disorder 0 (0%) 1 (3%) 0.508a
Alcohol dependence/abuse 2 (6.3%) 4 (12.1%) 0.351a
Substance dependence/abuse 1 (3.1%) 1 (3%) 0.746a
Psychotic disorders 1 (3.1%) 2 (6.1%) 0.512a
Anorexia Nervosa 0 (0%) 0 (0%) – –
Bulimia Nervosa 0 (0%) 1 (3%) 0.508
Antisocial personality disorders 6 (18.8%) 5 (12.2%) Χ2=0.15 0.699

Note.
a
Fisher's Exact Test was used as the expected cell counts were less than 5.

566
A.L.d.C. Stravogiannis et al. Psychiatry Research 259 (2018) 562–570

Table 4
Comparison of personality characteristics (Temperament and Childhood Inventory) between pathological jealousy and pathological love.

Variables Pathological Jealousy (n = 32) Pathological Love (n = 33) Coefficient P

Novelty seeking 21.06 (SD = 5.76) 22.0 (SD = 5.04) t = −0.70 0.487
Harm avoidance 21.75 (SD = 5.73) 21.18 (SD = 6.67) U = 497.5 0.668
Reward Dependence 16.03 (SD = 3.97) 16.39 (SD = 3.94) t = −0.37 0.713
Persistence 4.31 (SD= 1.87) 4.06 (SD = 1.97) U = 478.0 0.507
Self-directedness 19.41 (SD = 7.57) 22.30 (SD = 7.54) t = −1.55 0.127
Cooperativeness 29.38 (SD = 6.84) 29.0 (SD = 7.12) U = 515.0 0.684
Self-transcendence 18.44 (SD = 6.80) 17.82 (SD = 7.13) U = 499.5 0.708
Clusters
Cluster A 0 (0%) 2 (7%) χ2 = 2.28 0.131
Cluster B 10 (31.3%) 3 (10.3%) χ2 = 3.96 0.046*
Cluster C 8 (25%) 10 (34.5%) χ2 = 0.66 0.417

Note.
* p < 0.05.

3.2. Binary logistic regression Table 6

Forward binary logistic regression with gender coded (0 = pathological jealousy, 1 =
pathological love), with variables associated p < 0.10 entered as predictors.
To provide a more conservative assessment of differences between
pathological jealousy and pathological love, all variables that were Variables Wald χ2 P Exp (B) 95% for Exp (B)
associated with p < 0.10 in the univariate analysis (Tabachnick and
Fidell, 2001) were included into a binary logistic regression (Table 6). Lower Upper
Specifically, the following variables were included in the final model:
Relationship Status 7.52 0.006 50.76 3.07 840.31
major depressive episode with melancholic characteristics, cluster B, Impairments with Parenting 7.03 0.008 13.59 1.98 93.46
marital status, non-planning factor of BIS-11, impairments in parental Constant 7.67 0.006 0.001
and family relationships, emotional negligence, attachment styles, re-
lationship satisfaction and ludus and agape love styles.
The overall model fit was significant χ2(6) = 23.21, p < 0.001, with and pathological love. To this end, we assessed whether the two groups
a classification accuracy of 93.8%. The results of the binary logistic differed on socio-demographics characteristics, relationship factors
regression found that individuals with pathological love were 13x more such as jealousy, relationship satisfaction, attachment/love styles,
likely to report impairments in parenting, Wald'sχ2 (1) = 13.59, p = psychiatric-comorbidities, personality and psychological characteristics
0.008, B = 2.61, SE = 0.98, Odds Ratio (OR)= 13.59, 95% Confidence (e.g., impulsivity, psycho-social impairments). Whilst there is pre-
Interval (CI) = [1.98, 93.46] and over 50x more likely to be single liminary evidence to suggest that pathological jealousy and patholo-
Wald's χ2 (1) = 8.52, p = 0.006, B = 3.93, SE = 1.43, OR = 50.76, gical love may represent distinct psychopathologies, no study to date
95% CI = [3.07, 840.31]. has directly tested this assertion.
The univariate analysis found that individuals with pathological
jealousy were more likely to be in a relationship than individuals with
4. Discussion
pathological love, suggesting despite the interpersonal difficulties as-
sociated with the two love/boding psychopathologies, participants with
The aim of the present study was to assess differences and simila-
pathological jealousy are better able to maintain romantic
rities in the two-love/bonding psychopathologies: pathological jealousy

Table 5
Comparison between pathological jealousy and pathological love on psychological variables.

Variables Pathological jealousy (n = 32) Pathological love (n = 33) Coefficient P

Impulsivity
Attentional 20.81 (SD = 2.92) 21.88 (SD = 3.71) U = 447.0 0.284
Motor 25.84 (SD = 4.94) 25.45 (SD = 5.70) t = 0.294 0.770
Nonplanning 28.06 (SD = 4.36) 30.21 (SD = 5.10) t = −1.82 0.073
Total 74.72 (SD = 10.06) 77.55 (SD = 12.16) t = −1.02 0.312
Childhood trauma
Physical abuse 7.44 (SD = 3.02) 8.30 (SD = 4.06) U = 485.5 0.567
Emotional abuse 10.53 (SD = 5.39) 12.03 (SD = 5.14) U = 425.5 0.175
Sexual abuse 7.88 (SD = 5.21) 7.21 (SD = 4.08) U = 509.5 0.784
Emotional neglect 12.41 (SD = 4.02) 14.39 (SD = 5.62) U = 402.5 0.098
Physical neglect 8.28 (SD = 3.28) 9.45 (SD = 3.88) U = 434.5 0.215
Total 46.53 (SD = 16.19) 51.39 (SD = 16.74) U = 438.5 0.240
Social adjustment
Work 2.34 (SD = 1.36) 2.52 (SD = 1.40) U = 382.0 0.486
Social and leisure activities 2.61 (SD = 0.75) 2.88 (SD = 0.72) U = 420.5 0.170
Relationship with extend family 2.09 (SD = 0.61) 2.27 (SD = 1.02) t = −0.81 0.424
Marital role as spouse 2.69 (SD = 0.85) 2.50 (SD = 0.85) U = 131.5 0.470
Parental role 1.70 (SD = 0.53) 2.43 (SD = 0.67) U = 57.0 0.002**
Membership in the family unit 3.00 (SD = 0.86) 2.55 (SD = 1.10) U = 207.5 0.070
Economy adequacy 2.22 (SD = 1.56) 2.39 (SD = 1.28) U = 441.5 0.430
Total 2.45 (SD = 0.56) 2.56 (SD = 0.65) U = 575.0 0.537

Note. *p < 0.05.

** p < 0.01.

567
A.L.d.C. Stravogiannis et al.
relationships. That said, given pathological jealousy necessitates to be
in a current relationship to feel romantic jealousy, this finding makes
intuitive sense. Interestingly, however, less than half of individuals with
pathological love reported being in a relationship. A potential reason
for this could be due to the needy features of participants with patho-
logical love, which may be unattractive to partners, leading them to end
the romantic relationship more commonly and/or quickly. On the other
hand, individuals with pathological jealousy may be more likely to
elicit feelings of guilt in their partners, which in turn may lead the
partner to maintain the relationship despite the ongoing difficulties.
With regards to relationship satisfaction, individuals with pathological
jealousy reported higher levels of relationship satisfaction than in-
dividuals with pathological love. Our findings are in accordance with
Sophia et al. (2009) who found that individuals with pathological love
had lower levels of relationship satisfaction. Indeed, a key feature of
pathological love is the paradoxical nature of sustaining the relation-
ship despite the ongoing dissatisfaction in their relationship.
Interestingly, participants with pathological jealousy did not report
higher levels of jealousy than participants with pathological love,
suggesting that differences in jealousy between pathological jealousy
and pathological love might be more qualitative than quantitative.
Indeed, some believe jealousy is in act of love (White and Mullen,
1989), which is used to demonstrate to the partner one's level of af-
fection, which is akin to the concept of reactive jealousy. In other
words, while both groups display high levels of jealousy, how the jea-
lousy manifests in behaviors and cognitions might differ. For example,
in the face of real or perceived threat, individuals with pathological
jealousy may resort to aggressive control, whereas as individuals with
pathological love may resort to submissive control, with the results
suggesting that pathological jealousy's display of jealousy is more effi-
cient in sustaining relationships. However, this is merely speculative
and future research would do well to directly test this hypothesis.
Several romantic characteristics differentiated between individuals
with pathological jealousy and individuals with pathological love. First,
the anxious-attachment style was the most frequent amongst both in-
dividuals with pathological jealousy and pathological love. However,
the avoidant style was predominantly associated with the individuals
with pathological jealousy, whereas a secure attachment style char-
acterized individuals with pathological love. The finding that patholo-
gical jealousy was associated with an avoidant attachment style is in-
teresting. This is because the avoidant style is characterized by the fear
of abandonment, which in turn leads to the individual to withdraw
emotionally and physically from their romantic partners. However, in
the case of individuals with pathological jealousy, rather than with-
drawing they tend to try and exert control over their partners. Thus, it is
possible that the fear of abandonment, which likely developed due to
attachment issues with the primary care giver may manifest differently,
with one strategy (e.g., exerting control) being associated with patho-
logical jealousy.
The most dominant love style that characterized both pathological
jealousy and pathological love was mania. This finding makes intuitive
sense as the mania love style is characterized by both obsessions and
jealously as well as dependent love. In other words, features of the
mania love style is characteristic of both pathological jealousy (ob-
sessive, jealous) and pathological love (dependent). Thus, while both
individuals with pathological jealousy and pathological love are likely
to have the manic style of love, the dominant features will manifest
differently whether one is more concerned about infidelity or the fear of
abandonment. Further, the mania style of love has been associated with
lower self-esteem and higher levels of impulsivity (Mallandain and
Davies, 1994), characteristics which are also found in pathological
jealousy and pathological love (Costa et al., 2015; Sophia et al., 2007).
Taken together, it is likely that the mania love style is the one most
closely associated with the psychopathology of love and the most clo-
sely related anxious attachment style. Unfortunately, attachment styles
are largely influenced by people's relationship with their primary
568
Psychiatry Research 259 (2018) 562–570
caregiver, with some evidence of attachment continuity (Fraley and
Shaver, 2000). That is, people who experience unhealthy and mala-
daptive relationship with their primary caregiver may be at greater risk
of experiencing love in a maladaptive manner.
Psychiatric co-morbidity was high in both individuals with patho-
logical jealousy and pathological love, with 72.31% of the sample
meeting criteria for a current co-morbid psychiatric disorder, with
major depressive disorder being the most common. While psycho-
pathology was predominant in both groups, there were no differences
in the rate or type of co-morbid psychiatric disorder between patholo-
gical jealousy and pathological love. It is worth noting that suicidality
was elevated in both samples, with roughly a third of participants en-
dorsing lifetime suicidality. This result is in accordance with previous
literature (Ecker, 2012; Kawamichi et al., 2016), which suggests that
while healthy romantic relationships increase subjective well-being and
thus may buffer psychological distress and risk of suicidality, difficulty
in romantic relationships has been found to be risk factor for suicidal
ideations and attempts (Kingham and Gordon, 2004). Clinicians would
do well to monitor risk, especially within the context of interpersonal
difficulties when working with individuals with pathological jealousy
and pathological love.
No differences emerged between the two groups in alcohol and
substance use co-morbidities, despite pathological love having been
conceptualized as an addiction. A potential reason for this could be due
to the relatively small sample size and the binary nature of alcohol and
substance use dependence. Thus, it would behoove researchers to assess
the relationship between pathological jealousy and pathological love
using continuous measures of alcohol and substance use to provide a
more nuanced assessment of whether the two groups differ on rates of
substance use. Secondly, the present research did not assess for beha-
vioral addictions. However, given no psychoactive substances are in-
gested in pathological love, it is conceptually more similar to beha-
vioral addictions, and thus pathological love may be more likely to be
associated with behavioral addictions than substance use disorders.
Regarding personality features, individuals with pathological jea-
lousy showed higher tendency to be classified as a Cluster B (antisocial,
borderline, histrionic and narcissistic personality disorders). A potential
characteristic in individuals with cluster B features is suspicion about
the loyalty of others and angry or hostile reaction in ordinary situations.
Indeed, the characteristics of individuals with pathological jealousy are
similar to the “abusive personality” described by Dutton (1994), sug-
gesting that jealousy may be related to maladaptive personality traits.
Lastly, participants with pathological love reported greater impair-
ments in parenting. This finding is not surprising as a key feature of
pathological love is the excessive devotion to their partner.
Unfortunately, however, this devotion may interfere with other activ-
ities and values, thus impairing the pathological love's ability to meet
the needs of their own children. The results of the binary logistic re-
gression found relationship status and impairments in parenting were
the only two variables that differentiated the two groups. Specifically,
participants with pathological love were more likely to be single and
reported greater impairments in their ability to parent because of their
symptoms of pathological love. Thus, the results suggest that the two
love bonding psychopathologies are more similar than different. Having
said that, these differences may be important when it comes to treat-
ment planning. For example, with individuals with pathological jea-
lousy it may be helpful to develop the capacity to trust and share in love
with their partners, while individuals with pathological love may
benefit from learning to love themselves.
The relatively small sample size should be noted as a limitation.
Although the results of our present research provide preliminary sup-
port for the differences and similarities between the two love disorders,
replication of our results with larger sample sizes are needed to further
validate the findings. In addition, we did not assess the qualitatively
different types of jealousy. Future studies comparing similarities and
differences of jealousy (e.g., reactive, preventive) to pathological love
A.L.d.C. Stravogiannis et al.
would be highly informative. Lastly, we did not assess the correlation
between pathological jealousy and pathological love as we did not have
a measure assessing the severity of pathological love. Future research
would do well to examining the overlap between these two constructs
to add to the growing literature on the psychopathology of love.
5. Conclusion
Throughout history, people have been fascinated and mystified by
love. Poets have tried to articulate it and researchers have tried to in-
vestigate it. Whilst love can be one of the life's most satisfying events, it
also has the power to cause immense pain and heartbreak. When love
goes awry it may become pathological. Herein, we attempted to add to
the growing understanding of the pathology of love by contrasting
pathological jealousy and pathological love. The results found simila-
rities and differences between the two love-boding psychopathologies.
Further research is needed in this important domain in order to develop
treatment strategies that helps people to love healthy and fully.
Acknowledgement
We would like to thank Julia C. Poole, Emma V. Ritchie and Iman
Musani of the University of Calgary for their helpful comments on the
earlier drafts of the manuscript.
Role of funding source
Supported by CAPES - Coordination for the Improvement of Higher
Level -or Education- Personnel
Conflict of interest
The authors declare no conflicts of interest.
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