The under-diagnosed green-eyed monster: Otello syndrome and how to manage it

Abstract

Otello syndrome derives its name from Shakespeare's drama (character) and, clinically, describes a person with delusions of the partner's infidelity. A variety of other psychopathology may present: obsessive-compulsive features, alcohol dependency, voyeurism, sadism, possessiveness and domineering, hyper-sexuality, paranoid attitude, abuse of different nature, violent behaviour, including, occasionally, homicide. Yet, in the author's opinion, the syndrome, unless it presents itself as obviously absurd, is frequently missed.

Management is rather difficult and does not always result in recovery but, if not treated with neuroleptics, it would render any other means of treatment useless. The condition could pose a diagnostic challenge. Moreover, it also poses an ethical dilemma whether to warn the spouse of the psychotic condition of the partner, the poor prognosis and possible implications of its existence. Moreover, the long-term partners of such patients frequently present with the symptoms of dependency, submissiveness or even masochism.

The paper discusses the abovementioned issues, including the likely psychodynamics, biological background, historical and social elements and possible effective management.

Disclosure of interest

The author has not supplied his/her declaration of competing interest.