Delusions of infidelity
DR. S. MOHAN RAJ
People with delusional disorder, schizophrenia and other psychotic illnesses may have trouble in maintaining relationships.
THE first six months of marriage was blissful for Tejas and Vasan (not real names). Gradually, she noticed that Vasan became irritable whenever she interacted with other men. He would ask her about her colleagues and past classmates and indirectly ask if she was close to them. While driving, he would snap, "Look straight, don't look at the guys". One day, she found him meddling with her mobile phone, looking into the SMSs and call history.
A few weeks later, he accused her of having an affair. He started coming back home at odd hours and would search the house for the presumed person. He would examine the bedspread for `evidence' like hair, flowers and stains. In spite of her denials and protests, he kept interrogating and accusing her.
Suspicion about spouse's fidelity can wreck a marriage. This suspicion could be due to many reasons. At one end of the spectrum, there could be an actual extramarital affair and the spouse having a hunch about it. At the other end of the spectrum, it could be due to delusions.
Delusions of infidelity could occur in delusional disorder, schizophrenia and other psychotic illnesses. In schizophrenia, the presence of many other delusions and hallucinations helps the family recognise the illness earlier.
In delusional disorder, the delusion of infidelity makes a person constantly accuse the spouse of infidelity, repeatedly interrogate them about their daily activities and presumed relationships and search for evidence. He/she would examine the house for evidence and, at times, stalk the spouse or have them investigated by detective agencies.
Persons with delusional disorder may have just a single delusion and their behavioural abnormalities may be confined to this particular one. They will be able to function very well in other settings. For example, if a person has only delusion of infidelity, the home atmosphere would be vicious with spying, accusations and arguments. The same person would function normally in his/her office. Often the person's parents and siblings may believe his/her accusations about the spouse. Contrary to common perception that it is predominant in women, delusional disorder occurs more in men. Prolonged alcohol dependence can induce delusional disorder where delusion of infidelity is the main symptom.
In between the ends of the spectrum lie personality traits like "possessiveness" or "suspiciousness".
Persons with paranoid personality disorder are suspicious of others' motives. They are sensitive and perceive insults when none was intended. They hold grudges for a long period. There is a strong conviction about spouse's infidelity but not amounting to a delusional level. Persistent accusations and taunts are similar to that in delusional disorder. Maintaining mutually intimate relationships like marriage is difficult due to the personality traits. Paranoid personality disorder is more prevalent in men.
Possessiveness is a desire to control or dominate another person, especially in order to limit that person's relationships with others. Initially, the partner might enjoy the attention and possessiveness but gradually it can become suffocating, when the person becomes suspicious and restricts them.
People with delusional disorder or Paranoid personality disorder are very resistant to treatment, as they lack an insight into their problem. Anti-psychotic medicines are helpful in delusional disorder but the challenge is in convincing the person to take medicines regularly. Their adherence to medicine is poor and they invariably drop out of treatment, despite family's effort. Surreptitious medicines have often been used in good faith and are fraught with legal and ethical implications.
For personality disorder, psychotherapy plays a major part and medicines are used only during behavioural crisis. Again, adherence to treatment is a major challenge, like in delusional disorder.
The writer is a Consultant Psychiatrist based in Chennai. E-mail: firstname.lastname@example.org
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