Received: 15 October 2022      Accepted: 28 November 2022

DOI: 10.1111/bjc.12409

RESEARCH ARTICLE

Obsessional jealousy in a community sample:

Association with relationship factors, impairment
and perceived treatment needs

Johan Ahlen1 | Johan Bjureberg2 | Fabian Lenhard2 |

Tove Wahlund2 | Johanna Linde2 | David Mataix-Cols2

1
Department of Global Public Health, Karolinska
Institutet, Stockholm, Sweden Abstract
2
Department of Clinical Neuroscience, Karolinska Objectives: Romantic jealousy could be understood as a
Institutet, Stockholm, Sweden continuum, from reality-based, transient and functional jeal-
ousy to a more chronic form of jealousy with varying insight,
Correspondence
intensity and duration. The latter has some overlaps with
Johan Ahlen, SLSO, Att: CES/PHS, Johan Åhlén,
Box 454 36, 104 31 Stockholm, Sweden. obsessive–compulsive disorder (here termed obsessional
Email: johan.ahlen@ki.se jealousy). Little is known about the nature of obsessional
jealousy and its association with functional impairment,
perceived negative consequences (drinking, violence), current
and past relationship factors (e.g., length of relationship,
being in love, infidelity, previous jealousy) or perceived need
for professional support.
Methods: Participants were 1076 adults (55% women) who
filled in an anonymous survey.
Results: Obsessional jealousy, measured with the Obses-
sional Jealousy Severity Scale, was strongly associated with
functional impairment and verbal violence, and more weakly
with physical violence and alcohol consumption. Individuals
with a history of previous jealousy had more severe symp-
toms and were more likely to perceive the need for psycho-
logical support. Approximately 25% of the sample expressed
interest in treatment.
Conclusions: The results suggest that there is a group of
individuals with impairing levels of obsessional jealousy who
have a perceived need for help with their difficulties. More
research is needed on the prevalence and clinical characteris-
tics of these individuals. The development of jealousy-specific
psychological models and treatments is warranted.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any
medium, provided the original work is properly cited.
© 2022 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

298 wileyonlinelibrary.com/journal/bjc Br J Clin Psychol. 2023;62:298–311.

OBSESSIONAL JEALOUSY 299

KEYWORDS
functional impairment, obsessional jealousy, perceived needs

Practitioner points
• There is a group of individuals with impairing levels of obsessional jealousy who have a
perceived need for help with their difficulties.
• Few had previously been in contact with mental health professionals due to jealousy.
• The development of psychological models and treatments for obsessional jealousy is warranted.

BACKGROUND

Jealousy and negative consequences

Jealousy is a well-recognized psychological state which includes negative feelings, suspicious or worrying
thoughts about infidelity or loss of one's partner, and an urge to monitor or control one's partner or other
romantically treasured persons (Chung & Harris, 2018; Martínez-León et al., 2017). Previous research has
predominantly focused on evolutionary and psychological aspects of jealousy, where researchers have, for
example, explored potential gender differences in terms of jealousy over intimacy- and sexual infidelity
(Sagarin et al., 2012). Cross-sectional studies have explored the association between jealousy and a range
of negative consequences. High levels of suspicious thoughts and worries about infidelity were found
to be strongly associated with low relationship quality and satisfaction (Barelds & Barelds-Dijkstra, 2007;
Dandurand & Lafontaine, 2014). High levels of jealous behaviours (monitoring, controlling and surveil-
lance) were found to be associated with cyber abuse (e.g., threatening, harassing, impersonating or humil-
iating using mobile phones, social media or e-mails) and cyber stalking (Deans & Bhogal, 2019; Strawhun
et al., 2013). Furthermore, Foran and O'Leary (2008) found that jealousy explained much of the variance
in partner aggression. Finally, sexual jealousy has been found to be a common motive for homicides
(Block & Block, 2012); according to a report from the Swedish Crime Prevention Council, jealousy was
the second leading cause of men's lethal violence against women in close relationships (Rying, 2007).

Relationship factors

A few studies have suggested that jealousy is positively associated with anxious and avoidant attachment
(Guerrero, 1998; Rydell & Bringle, 2007). The direct association between jealousy and infidelity has not
been studied. However, a positive association has been found between being the victim of infidelity
and feelings of distress when being asked hypothetical infidelity questions (Burchell & Ward, 2011). A
positive association between romantic love and jealousy was found in a small college sample (Mathes &
Severa, 1981) and being in a relationship was negatively associated with distress to questions about hypo-
thetical infidelity, in women only (Burchell & Ward, 2011).

A clinical perspective

From a clinical perspective, research on what constitutes problematic jealousy (often referred to as
morbid/pathological jealousy) has been fragmentary (De Silva, 1997; Tarrier et al., 1990). Morbid jeal-
ousy has mainly been described in the context of delusional jealousy sometimes occurring in psychoses
300 AHLEN et al.

(Batinic et al., 2013), though it seems likely that only a small proportion of individuals with morbid jeal-
ousy are psychotic (Easton et al., 2008). An obsessional type may be more common (Cobb & Marks, 1979;
Tarrier et al., 1990). In fact, obsessional jealousy is mentioned in the DSM-5 under ‘other specified
obsessive-compulsive and related disorders’ (American Psychiatric Association, 2013).
Although clinicians encounter patients with obsessional jealousy (Kellett & Totterdell, 2013), and
jealousy is a common reason for seeking couples therapy (De Silva, 1997), its prevalence is currently
unknown (Kellett & Totterdell, 2013; Kingham & Gordon, 2004). There is no established evidence-based
treatment for obsessional jealousy. To our knowledge, only a handful case studies and uncontrolled trials
exploring cognitive behavioural therapy and cognitive analytic therapy have been conducted (Cobb &
Marks, 1979; Curling et al., 2018; Kellett & Totterdell, 2013). A search on Google Scholar using the phrase
‘treatment for jealousy’ conducted on the 23rd of June 2022 resulted in only ten hits. It is unclear whether
individuals who have obsessional jealousy want help and if so, which kind of help.
In the current cross-sectional study, we used an open survey to gather preliminary data on the nature
of obsessional jealousy in the community and its association with functional impairment, perceived nega-
tive consequences (problematic drinking habits and violence), past and current relationship factors (e.g.,
length of relationship, being in love and infidelity) and perceived need for help. We hypothesized that
obsessional jealousy would be significantly positively associated with functional impairment, problem-
atic drinking and violence. Furthermore, we hypothesized that obsessional jealousy would be negatively
associated with length of relationship, and positively associated with being in love, current and previous
experiences of infidelity and jealousy in previous relationships. We also predicted that obsessional jeal-
ousy would be associated with higher perceived need for help.

METHODS

Participants

A total of 2321 participants opened the online survey by clicking on a link on the Karolinska Institute's
homepage. A total of 1087 of these (49%) completed the survey. No information was collected from
those who did not complete the survey. The survey was set to only allow one response from the same
computer. To exclude random careless responses, we used the semantic synonym technique identifying
respondents with inconsistent responses to similar items. We excluded 11 participants that gave inconsist-
ent responses on their relationship status (e.g., choosing the response ‘in a steady relationship’ and ‘not
in a current relationship’ on two different items). Consequently, the final study sample comprised 1076
participants, ranging between 18 and 80 years in age (M = 43.4, SD = 12.6). The gender distribution was
roughly equal (55% women), and most were born in Sweden (93%). See Table 1 for further characteristics
of the study sample.

Procedure

We recruited participants using a (in Swedish language) Facebook advertisement including the follow-
ing information ‘Jealousy is something that most of us have experienced at some point in life. You are
welcome to participate in our survey, regardless of whether you are jealous or not. Your answers will be
completely anonymous’. Participants, who clicked on the advertisement, were linked to a homepage at
Karolinska Institutet where they could read about the study and access the web survey on surveymonkey.
com. To start the survey, participants were required to read information about the study, confirm being
18 years or above and consent to participating in the study. The web survey was open for about one
month between September 10th and October 4th in 2020. Initially, a vast majority of the participants
who answered the survey were highly educated women. To reach a more representative sample, we even-
tually adjusted the advertisement to only reach people in the eight regions (out of 21) in Sweden with the
OBSESSIONAL JEALOUSY 301

TA B L E 1 Study sample characteristics

Variable Categories N (%)

Gender Women 595 (55%)
Men 454 (42%)
Other/uncertain/do not want to answer 27 (3%)
Age 18–29 years 188 (17%)
30–39 years 226 (21%)
40–49 years 292 (27%)
50–59 years 251 (23%)
60+ years 103 (10%)
Birth Country Sweden 1003 (93%)
Abroad 73 (7%)
Educational attainment ≤9 years 36 (3%)
10–12 years 307 (29%)
>12 years 733 (68%)
Employment Employed/self-employed 768 (71%)
Student 117 (11%)
Retired 74 (7%)
Sick leave/parental leave 54 (5%)
Jobseeker 45 (4%)
Other 18 (2%)
Relationship status Steady 739 (69%)
Dating 87 (8%)
Complicated/undefined 16 (1%)
Poly-relationship 38 (4%)
Single 196 (18%)
Sexual orientation Heterosexual 849 (79%)
Bisexual 121 (11%)
Pansexual 36 (3%)
Gay/lesbian 33 (3%)
Other /do not want to answer 37 (3%)
Previous contact for mental health issues Yes 737 (68%)
No 339 (32%)

(on average) lowest level of education. During the last two weeks of data collection, the ad was addi tion-
ally adjusted to only reach men, to increase the proportion of men in the study sample. The Swedish
Ethical Review Authority had no ethical concerns about this study (Dnr 2020-00985).

Measures

The Obsessional jealousy Severity Scale

The recently developed Obsessional jealousy Severity Scale (OJSS; Ahlen et al., 2022) was modelled on the
Yale-Brown Obsessive Compulsive Scale (Goodman et al., 1989) and, unlike other instruments, is specifi-
cally designed to capture the clinical aspects of jealousy (i.e., whether jealousy causes distress and disrupts
functioning). The OJSS is divided into two sections, (1) jealous thoughts and (2) jealous behaviours; both
302 AHLEN et al.

sections include a checklist and a severity scale. Respondents are informed that they may have jealous
thoughts/behaviours about someone that they have, have had or wish to have a romantic relationship
with (marked as ‘X’ in the checklist examples). In the jealous 17-item thoughts checklist, respondents
report if they recognize (yes/no) a series of jealous thoughts, for example ‘I suspect or worry that X is
attracted to someone else’. In the severity scale for jealous thoughts, respondents are asked to indicate
on a Likert scale from 0 to 4 how frequent, impairing, and distressing these jealous thoughts have been
during the past week, whether he/she has tried to resist these thoughts, and what control he/she has over
them. The respondents follow the same procedure regarding jealous behaviours, that is first respond to a
checklist of 32 jealous behaviours (for example ‘I check X's phone’, or ‘I forbid X to go the pub without
me’), and then according to the severity scale indicate frequency, impairment, distress, effort to resist and
control of these jealous behaviours during the past week. The total scores of the two severity scales are
summed to a total jealousy severity score. Scores range from 0 to 40, with higher scores denoting greater
severity. A preliminary psychometric evaluation of a self-rated version of the OJSS showed adequate
convergent and divergent validity, measurement invariance, and an excellent internal consistency (Ahlen
et al., 2022). In the current study sample, Cronbach's alpha of the 10 severity items was = .92.

The Work and Social Adjustment Scale (WSAS)

The WSAS is a self-rated questionnaire measuring functional impairment that is frequently used in psychi-
atry (Mundt et al., 2002). The version used in the current study measured impairments specifically caused
by jealousy. The brief questionnaire contains five questions rated between 0 (not at all impaired) and
8 (very severely impaired) and covers five life areas; work, home management, social leisure activities,
private leisure activities and close relationships. The WSAS has shown convergence with disorder sever-
ity (obsessive–compulsive disorder [OCD] and depression) and good reliability (test–retest correlation;
Mataix-Cols et al., 2005; Mundt et al., 2002).

The Alcohol Use Disorders Identification Test (AUDIT)

AUDIT is a validated 10-item instrument used for screening of harmful alcohol use and alcohol depend-
ence (Saunders et al., 1993). The items cover alcohol consumption, drinking behaviours and alcohol-related
problems in the past year. Each item is scored from 0 to 4. In the current sample, Cronbach's alpha
was = .84.

Violent behaviour

To assess any violent behaviour caused by jealousy, we included three questions covering verbal, physical
and sexual violence. Respondents were asked if jealousy (of the respondent) leads to quarrel or heated
discussions, physical violence or sexual violence, rated on a Likert scale ranging from 0 to 3 (0 = Never,
3 = Almost always).

Relationship factors

We included questions exploring the participants' current and previous relationships. Four questions
explored the current relationship: relationship status (single, dating, steady relationship, poly-relationships
or complicated/undefined relationships), length of current relationship (>3 months, 3–12 months,
1–5 years, 5–10 years, > 10 years or no current relationship), how in love they were (not at all, a bit,
pretty much, much or no current relationship) and experience of infidelity in the current relationship
OBSESSIONAL JEALOUSY 303

(participant unfaithful, partner unfaithful, both participant and partner unfaithful, no infidelity or no
current relationship). Two further questions explored previous relationships: infidelity in previous rela-
tionships (participant unfaithful, partner unfaithful, both participant and partner unfaithful, no infidelity
in previous relationships or no previous relationships) and whether they had been jealous in previous
relationships (never, seldom, sometimes, often, always or no previous relationships).

Data analysis

All analyses were performed in the R software (R Core Team, 2017). To examine differences in jealousy
severity between groups we performed one-way ANOVAs. In models with statistically significant differ-
ences, we applied post-hoc analyses (Tukey-HSD) to further explore these differences. The magnitude
of differences was described in terms of effect sizes (i.e., Cohen's d) calculated by dividing the difference
in jealousy severity by the standard deviation of the total sample. According to guidelines, Cohen's d ≥ .2
is typically interpreted as small effect, Cohen's d ≥ .5 moderate effect and Cohen's d ≥ .8 a large effect
(Cohen, 1977).
Associations between jealousy severity (as measured by OJSS), impairment and negative consequences
were analysed using Spearman rank-order correlation. The strength of associations was also interpreted
using Cohen's guidelines where a correlation coefficient (r) ≥ .1 is typically interpreted as a small associa-
tion, an r ≥ .3 a moderate association and a r ≥ .5 a strong association (Cohen, 1977).

RESULTS

Jealousy and personal characteristics

In Table 2, we present mean values of jealousy severity, as measured by the OJSS, stratified by personal
characteristics. In a series of ANOVAs, we found that age, educational attainment, relationship status,
sexual orientation and previous mental health care all were associated with jealousy severity scores. Specif-
ically, young adults, individuals with low educational attainment, single, identified as gay or lesbian and
those with a history of previous contact with mental health services had higher jealousy severity scores.
Conversely, country of birth, sex and employment status were not significantly associated with jealousy
severity.

Jealousy, impairment and negative consequences

A series of Spearman rank-order correlation analyses showed statistically significant positive correlations
between jealousy severity and impairment in all life areas explored (see Table 3). All correlations were
interpreted as strong.
Jealousy severity was also strongly associated with verbal violence, but only weakly to physical violence
and alcohol consumption. We found no association between jealousy severity and sexual violence (Table 3).

Jealousy and relationship factors

Table 4 presents the distribution of participants according to relationship length, being in love, infidelity
in their current relationship, infidelity in previous relationships and jealousy in previous relationships.
304 AHLEN et al.

TA B L E 2 Mean and standard deviations of the obsessional jealousy severity scale, divided by personal characteristics

OJSS
Variable M (SD) p-Valuea
Gender
Women 6.3 (6.0) .27
Men 5.7 (5.6)
Other/uncertain/do not want to answer 5.4 (6.2)
Age
18–29 years 8.2 (6.7) <.001***
30–39 years 5.6 (5.7)
40–49 years 6.0 (5.4)
50–59 years 5.6 (5.7)
60+ years 4.0 (4.8)
Birth Country
Sweden 5.9 (5.7) .05
Abroad 7.3 (7.0)
Educational attainment
≤9 years 7.8 (6.5) <.001***
10–12 years 6.7 (6.1)
>12 years 5.6 (5.6)
Employment status
Employed/self-employed 5.9 (5.7) .67
Student 6.6 (6.1)
Retired 5.8 (6.2)
Sick leave/parental leave 5.9 (6.1)
Jobseeker 6.9 (5.6)
Other 6.8 (6.2)
Relationship status
Steady 5.6 (5.7) <.001***
Dating 7.0 (6.3)
Complicated/undefined 8.8 (5.6)
Poly-relationship 4.4 (4.8)
Single 7.1 (5.9)
Sexual orientation
Heterosexual 6.2 (6.0) .002**
Bisexual 5.1 (4.9)
Pansexual 3.8 (4.1)
Gay/Lesbian 8.6 (5.9)
Other/do not want to answer 5.1 (5.6)
Any previous contact for mental health issues
Yes 6.3 (6.0) .01*
No 5.3 (5.5)
Abbreviation: OJSS, Obsessional Jealousy Severity Scale.
*p < .05, **p < .01, ***p < .001.
a
p-Value from ANOVA.
OBSESSIONAL JEALOUSY 305

TA B L E 3 Spearman rank correlation between OJSS, impairments in different life areas, violent behaviour and alcohol
consumption

Associated variable OJSS

WSAS – Work .60***
WSAS – Home management .53***
WSAS – Social leisure .63***
WSAS – Private leisure .64***
WSAS – Close relationships .63***
Verbal violence .51***
Physical violence .17***
Sexual violence .03
AUDIT .13***
Note: ***p < .001.
Abbreviations: AUDIT, The Alcohol Use Disorders Identification Test; OJSS, Obsessional Jealousy Severity Scale; WSAS, Work and social
adjustment scale.

TA B L E 4 Distribution of participants according to relationships factors

Variable Categories N (%)

Relationship length <3 months 55 (5%)
3–12 months 111 (10%)
1–5 years 257 (24%)
5–10 years 154 (14%)
>10 years 317 (29%)
Not relevant 182 (17%)
Being in love with partner Not at all 38 (4%)
A bit 131 (12%)
Pretty much 235 (22%)
Much 496 (46%)
No current relationship 176 (16%)
Unfaithful in current relationship Me 108 (10%)
Partner 95 (9%)
Me and partner 36 (3%)
Neither me, nor partner 636 (59%)
No current partner 201 (18%)
Unfaithful in previous relationships Me, but not partners 145 (13%)
Previous partner(s) but not me 278 (26%)
Both me and previous partner(s) 363 (34%)
Not me, not previous partner(s) 290 (27%)
Jealous in previous relationships Never 160 (15%)
Seldom 418 (39%)
Sometimes 314 (29%)
Often 119 (11%)
Always 44 (4%)
No previous relationships 21 (2%)
306 AHLEN et al.

Relationship length

An ANOVA showed significant differences in jealousy severity between groups with different relationship
length, F(5, 1070) = 7.51, p < .001. A post hoc analysis showed that individuals in relationships longer than
10 years had lower levels of jealousy compared to those without a current relationship (d = .35, p = .002),
a relationship that had lasted between 3–12 months (d = .48, p < .001) and 1–5 years (d = .40, p < .001).

Being in love

An ANOVA showed no significant differences in jealousy severity between groups with different levels
of being in love, F(4, 1071) = .41, p = .80.

Infidelity in current relationship

An ANOVA showed significant differences in jealousy severity between groups with experiences of infi-
delity in their current relationship, F(4, 1071) = 10.94, p < .001. A post hoc analysis showed that individu-
als who answered that neither them nor their partner had been unfaithful in the current relationship had
moderately lower levels of jealousy compared to those whose current partner (d = .51, p < .001), them-
selves (d = .41, p = .002) or both had been unfaithful (d = .50, p = .03), and also somewhat lower levels
of jealousy compared to those with no current relationship (d = .30, p = .002).

Previous experiences of infidelity

An ANOVA showed significant differences in jealousy severity between groups with experiences of infi-
delity in previous relationships, F(3, 1072) = 4.17, p = .006. A post-hoc analysis showed that individuals
with experiences of an unfaithful partner in previous relationships had slightly higher levels of jealousy
compared to those with no experiences of infidelity in previous relationships (d = .27, p = .02) and to
those who themselves had been unfaithful (d = .25, p = .04).

Previous jealousy

An ANOVA showed significant differences in jealousy severity between groups with different levels of
jealousy in previous relationships, F(5, 1070) = 62.92, p < .001. A post-hoc analysis showed moderate
to very large differences in jealousy severity between all levels of previous jealousy (except for those
who never or seldom had been jealous in previous relationships). For example, those who reported that
they always had been jealous in previous relationships had higher jealousy compared to those who often
(d = .89, p < .001), sometimes (d = 1.52, p < .001), seldom (d = 1.90, p < .001) or never (d = 2.04, p < .001)
had been jealous. OJSS values for different groups of previous jealousy are visualized in Figure 1.

Jealousy and need for help

Of the total sample, 88 (8%) reported that they wanted, and 183 (17%) that they maybe wanted help with
their jealousy. The remaining participants reported that they did not want help (n = 226, 21%) or that their
jealousy was not problematic (n = 579, 54%). OJSS values for different groups of perceived need for help
are visualized in Figure 2.
OBSESSIONAL JEALOUSY 307

Jealousy severity divided by previous jealousy

30
25
20
OJSS
15
10
5
0

Never Seldom Sometimes Often Always

Have you been jealous in previous relationships?

FIGURE 1 Jealousy severity divided by jealousy in previous relationship

Of the 271 participants who wanted or maybe wanted help, 37 (14%) had experienced partner infidel-
ity in their current relationship. Similarly, of the 805 participants who did not want help (or reported that
jealousy was not a problem), 94 (12%) had experienced partner infidelity in their current relationship. A
chi-square test showed no statistically significant difference between these proportions, X 2(1, 1076) = .58,
p = .45.
Of the 271 participants who wanted or maybe wanted help, only 44 (16%) had previously sought help
for jealousy, while 204 (75%) had previously sought professional help for other mental health issues. On
an open-ended question, 163 of those who wanted or maybe wanted help noted reasons for previous
contact with mental health care providers. We categorized reasons for previous contact with mental health
care providers into four groups; relationship problems; anxiety, depression and stress-related disorders;
obsessive–compulsive and related disorders; and other psychiatric disorders (such as personality disorder,
bipolar disorder, autism spectrum disorder, ADHD, substance use disorders or psychosis). The majority
(n = 120) reported reasons related to anxiety, depression and stress-related disorders, while 27 reported
other psychiatric conditions. Eleven reported relationship problems, and five reported OCD and related
disorders.
Of the 88 participants who wanted help with their jealousy, 83 would consider psychological treat-
ment if it was available, and the remaining five would maybe consider it.

DISCUSSION

In this open survey, we explored obsessional jealousy in the community and its association with func-
tional impairment, perceived negative consequences (violent behaviour and alcohol), relationship factors
and perceived need for help. We found a strong association between obsessional jealousy and functional
308 AHLEN et al.

Jealousy severity divided by perceived need of help

30
25
20
OJSS
15
10
5
0

Jealousy is not problematic No Maybe Yes

Do you want help with your jealousy?

FIGURE 2 Jealousy severity divided by perceived needs of help

impairment in different life areas, verbal violence, and relationship factors and about a quarter of partic-
ipants who wanted or maybe wanted help with their jealousy.
The strong association between jealousy and verbal violence and the small association between jeal-
ousy and physical violence are in line with previous research (Kar & O'Leary, 2013).
With regard to relationship factors, the strongest association found was between (current) jealousy
and being jealous in previous relationships. This suggests that clinical levels of jealousy may constitute a
durable trait. However, infidelity in the current relationship was moderately associated to jealousy, which
suggest that jealousy may also be affected by the current relationship situation. Notably, other relationship
factors, that is infidelity in previous relationships, length of the relationship, and how strongly in love one
was, were only marginally associated with jealousy severity.
Approximately 25% of the sample stated that they would definitely or might need help for their
jealousy. A somewhat unexpected finding was that only a small proportion of these had experiences
of partner infidelity in their current relationship. Thus, the perceived need of help for jealousy was not
driven by infidelity in the current relationship. Few of the participants with a perceived need of help had
previously been in contact with professionals due to jealousy, but many had sought help for other mental
health issues, mainly anxiety and depression. Very few reported previous contacts with mental health facil-
ities due to psychotic- or alcohol-related issues, which is in line with previous work (Tarrier et al., 1990).
Given the current study design, we cannot comment on the prevalence of individuals with a perceived
need of help in the general population. However, the fact that we could identify a substantial proportion
of participants who wanted or maybe wanted help in only one month of data collection and with a small
budget for advertisements suggests that the prevalence may not be negligible. More systematic study of
the prevalence of obsessional jealousy in the general population using probabilistic sampling methods
would be an important next step.
OBSESSIONAL JEALOUSY 309

The results of this study suggest that the development of psychological interventions for obses-
sional jealousy may be a worthwhile endeavour. In future treatment development, experiences from
previous case studies, mainly based on a cognitive–behavioural framework, are probably valuable (Cobb
& Marks, 1979; De Silva, 1997). The suffering and functional impairment caused by jealous thoughts
and behaviours bears similarities to OCD, and in many cases seems to follow a chronic course, speak-
ing for exposure and response prevention as potentially effective treatment components for jealousy
(Ecker, 2012). Treatment may also include fostering relationships skills such as identifying negative
patterns when interacting with the partner, handling conflicts in a constructive way (explicitly addressing
verbal and physical violence), increasing acceptance of each other's differences and creating more close-
ness in the relationship. In the assessment and treatment of individuals who express jealousy, aggressive
tendencies should be investigated and targeted. In addition, jealousy might be relevant to assess and
address in aggressive individuals.

Limitations

The current study had an exploratory approach, using an open survey, which is associated to several
threats to the validity of the conclusions. First, despite our efforts to recruit a representative sample of
the Swedish population, the non-probabilistic sampling method means that the sample may not have
been representative. Our sample had a higher educational level compared with the general Swedish popu-
lation, and two out of three participants reported that they at some point had sought professional help
for mental health issues, which is higher than expected in the general population in Sweden (Forslund
et al., 2020). Further, due to the self-reported nature of the study, we did not include questions on
whether the respondents believed their jealous thoughts were justified or rational, which limited us from
exploring the level of conviction or insight in jealous individuals. Although the anonymous self-reported
approach might have had a positive effect on the validity of the data (given the stigmatizing nature of
jealousy), future studies would benefit from recruiting treatment-seeking samples and using clinician-rated
measures of insight.

CONCLUSION

With these limitations in mind, the current study suggests that there is a group of individuals with impair-
ing levels of obsessional jealousy who have a perceived need for help with their difficulties. More research
is needed on the prevalence and clinical characteristics of ‘obsessional jealousy disorder’, should a new
diagnostic category emerge in the future as being clinically useful. Regardless of nosological issues, the
development of jealousy-specific psychological models and treatments is warranted.

AUTHOR CONTRIBUTIONS
Johan Ahlen: Conceptualization; formal analysis; investigation; methodology; project administration;
writing – original draft. Johan Bjureberg: Conceptualization; methodology; writing – review and edit-
ing. Fabian Lenhard: Conceptualization; writing – review and editing. Tove Wahlund: Conceptualiza-
tion; writing – review and editing. Johanna Linde: Writing – review and editing. David Mataix-Cols:
Conceptualization; methodology; supervision; writing – review and editing.

ACKNOWLEDGEMENT
This study was not preregistered. This research did not receive any specific grant from funding agencies
in the public, commercial or not-for-profit sectors.

CONFLICTS OF INTEREST
We have no conflicts of interest to disclose.
310 AHLEN et al.

DATA AVAILABILITY STATEME NT

Data can be shared upon reasonable request from collaborators. Analysis code for the study is available
by emailing the corresponding author.

ORCID
Johan Ahlen https://orcid.org/0000-0003-1415-2200
Johan Bjureberg https://orcid.org/0000-0003-2747-9990
Fabian Lenhard https://orcid.org/0000-0003-0930-6412
Tove Wahlund https://orcid.org/0000-0002-5123-2392
Johanna Linde https://orcid.org/0000-0002-1118-1359
David Mataix-Cols https://orcid.org/0000-0002-4545-0924

REFERENCES
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.
books.9780890425596. Advance online publication.
Ahlen, J., Ghaderi, P., Boyaci, R., & Mataix-Cols, D. (2022). Development and initial psychometric evaluation of the obsessional
jealousy severity scale. Brazilian Journal of Psychiatry. https://doi.org/10.1590/1516-4446-2022-2657
Barelds, D. P. H., & Barelds-Dijkstra, P. (2007). Relations between different types of jealousy and self and partner perceptions of
relationship quality. Clinical Psychology & Psychotherapy, 14(3), 176–188. https://doi.org/10.1002/cpp.532
Batinic, B., Duisin, D., & Barisic, J. (2013). Obsessive versus delusional jealousy. Psychiatria Danubina, 25(3), 334–339. http://euro-
pepmc.org/abstract/MED/24048408
Block, C. R., & Block, R. (2012). Margo Wilson's contributions to the Chicago homicide dataset: Sexual rivalry and sexual jealousy.
Homicide Studies, 16(4), 404–427. https://doi.org/10.1177/1088767912461142
Burchell, J. L., & Ward, J. (2011). Sex drive, attachment style, relationship status and previous infidelity as predictors of sex differ-
ences in romantic jealousy. Personality and Individual Differences, 51(5), 657–661. https://doi.org/10.1016/j.paid.2011.06.002
Chung, M., & Harris, C. R. (2018). Jealousy as a specific emotion: The dynamic functional model. Emotion Review, 10(4), 272–287.
https://doi.org/10.1177/1754073918795257
Cobb, J. P., & Marks, I. M. (1979). Morbid jealousy featuring as obsessive-compulsive neurosis: Treatment by behavioral psychother-
apy. The British Journal of Psychiatry: The Journal of Mental Science, 134, 301–305. https://doi.org/10.1192/bjp.134.3.301
Cohen, J. (1977). Statistical power analysis for the behavioral sciences, Rev. ed. (Chapter xv, 474 pages). Lawrence Erlbaum Associates, Inc.
Curling, L., Kellett, S., Totterdell, P., Parry, G., Hardy, G., & Berry, K. (2018). Treatment of obsessive morbid jealousy with cognitive
analytic therapy: An adjudicated hermeneutic single-case efficacy design evaluation. Psychology and Psychotherapy: Theory, Research
and Practice, 91(1), 95–116. https://doi.org/10.1111/papt.12151
Dandurand, C., & Lafontaine, M.-F. (2014). Jealousy and couple satisfaction: A romantic attachment perspective. Marriage & Family
Review, 50(2), 154–173. https://doi.org/10.1080/01494929.2013.879549
De Silva, P. (1997). Jealousy in couple relationships: Nature, assessment and therapy. Behaviour Research and Therapy, 35(11), 973–985.
https://doi.org/10.1016/S0005-7967(97)00051-X
Deans, H., & Bhogal, M. S. (2019). Perpetrating cyber dating abuse: A brief report on the role of aggression, romantic jealousy and
gender. Current Psychology, 38(5), 1077–1082. https://doi.org/10.1007/s12144-017-9715-4
Easton, J. A., Shackelford, T. K., & Schipper, L. D. (2008). Delusional disorder–jealous type: How inclusive are the DSM-IV diag-
nostic criteria? Journal of Clinical Psychology, 64(3), 264–275. https://doi.org/10.1002/jclp.20442
Ecker, W. (2012). Non-delusional pathological jealousy as an obsessive-compulsive spectrum disorder: Cognitive-behavioural
conceptualization and some treatment suggestions. Journal of Obsessive-Compulsive and Related Disorders, 1(3), 203–210. https://
doi.org/10.1016/j.jocrd.2012.04.003
Foran, H. M., & O'Leary, K. D. (2008). Problem drinking, jealousy, and anger control: Variables predicting physical aggression
against a partner. Journal of Family Violence, 23(3), 141–148. https://doi.org/10.1007/s10896-007-9136-5
Forslund, T., Kosidou, K., Wicks, S., & Dalman, C. (2020). Trends in psychiatric diagnoses, medications and psychological therapies
in a large Swedish region: A population-based study. BMC Psychiatry, 20(1), 328. https://doi.org/10.1186/s12888-020-02749-z
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., Heninger, G. R., & Charney, D. S. (1989).
The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. In Archives of general psychiatry (Vol. 46, Issue
11, pp. 1006–1011). American Medical Association. https://doi.org/10.1001/archpsyc.1989.01810110048007
Guerrero, L. K. (1998). Attachment-style differences in the experience and expression of romantic jealousy. In Personal relationships
(Vol. 5, Issue 3, pp. 273–291). Blackwell Publishing. https://doi.org/10.1111/j.1475-6811.1998.tb00172.x
Kar, H. L., & O'Leary, K. D. (2013). Patterns of psychological aggression, dominance, and jealousy within marriage. Journal of Family
Violence, 28(2), 109–119. https://doi.org/10.1007/s10896-012-9492-7
Kellett, S., & Totterdell, P. (2013). Taming the green-eyed monster: Temporal responsivity to cognitive behavioural and cogni-
tive analytic therapy for morbid jealousy. Psychology and Psychotherapy: Theory, Research and Practice, 86(1), 52–69. https://doi.
org/10.1111/j.2044-8341.2011.02045.x
OBSESSIONAL JEALOUSY 311

Kingham, M., & Gordon, H. (2004). Aspects of morbid jealousy. Advances in Psychiatric Treatment, 10(3), 207–215. https://doi.
org/10.1192/apt.10.3.207
Martínez-León, N. C., Peña, J. J., Salazar, H., García, A., & Sierra, J. C. (2017). A systematic review of romantic jealousy in relation-
ships. Terapia Psicológica, 35(2), 203–212.
Mataix-Cols, D., Cowley, A. J., Hankins, M., Schneider, A., Bachofen, M., Kenwright, M., Gega, L., Cameron, R., & Marks, I. M.
(2005). Reliability and validity of the work and social adjustment scale in phobic disorders. Comprehensive Psychiatry, 46(3),
223–228. https://doi.org/10.1016/j.comppsych.2004.08.007
Mathes, E. W., & Severa, N. (1981). Jealousy, romantic love, and liking: Theoretical considerations and preliminary scale develop-
ment. Psychological Reports, 49(1), 23–31. https://doi.org/10.2466/pr0.1981.49.1.23
Mundt, J. C., Marks, I. M., Shear, M. K., & Greist, J. H. (2002). The work and social adjustment scale: A simple measure of
impairment in functioning. The British Journal of Psychiatry: the Journal of Mental Science, 180, 461–464. https://doi.org/10.1192/
bjp.180.5.461
R Core Team. (2017). R: A language and environment for statistical computing [Internet]. http://www.r-project.org/
Rydell, R. J., & Bringle, R. G. (2007). Differentiating reactive and suspicious jealousy. Social Behavior and Personality: An International
Journal, 35(8), 1099–1114. https://doi.org/10.2224/sbp.2007.35.8.1099
Rying, M. (2007). Utvecklingen av dödligt våld mot kvinnor i nära relationer. Norstedts Juridik AB.
Sagarin, B. J., Martin, A. L., Coutinho, S. A., Edlund, J. E., Patel, L., Skowronski, J. J., & Zengel, B. (2012). Sex differences in jealousy: A
meta-analytic examination. Evolution and Human Behavior, 33(6), 595–614. https://doi.org/10.1016/j.evolhumbehav.2012.02.006
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders
identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II.
Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
Strawhun, J., Adams, N., & Huss, M. T. V. O. (2013). The assessment of cyberstalking: An expanded examination including social
networking, attachment, jealousy, and anger in relation to violence and abuse. Violence and Victims, 28, 715–2013. https://doi.
org/10.1891/0886-6708.11-00145
Tarrier, N., Beckett, R., Harwood, S., & Bishay, N. (1990). Morbid jealousy: A review and cognitive-behavioural formulation. The
British Journal of Psychiatry: The Journal of Mental Science, 157, 319–326. https://doi.org/10.1192/bjp.157.3.319

How to cite this article: Ahlen, J., Bjureberg, J., Lenhard, F., Wahlund, T., Linde, J. &
Mataix-Cols, D. (2023). Obsessional jealousy in a community sample: Association with
relationship factors, impairment and perceived treatment needs. British Journal of Clinical Psychology,
62, 298–311. https://doi.org/10.1111/bjc.12409