Pathological Jealousy in Borderline Personality Disorder

Borderline personality disorder is a severe illness for which the recommended treatment is psychotherapy.

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Jealousy is a normal human emotion, but pathological jealousy, also known as delusional jealousy or morbid jealousy, is a psychiatric symptom in which the afflicted person is irrationally preoccupied with a partner's unfaithfulness based on unfounded evidence.

Pathological jealousy is considered by most theorists to be a delusional state, and the phenomenon is encountered not uncommonly in older adults with paraphrenia, a form of psychotic disorder that develops later in life and is marked by a strong delusional component with preservation of thought and personality. However, pathological jealousy can also be seen in obsessive-compulsive disorder and in certain personality disorders.

A borderline personality organization is an important predisposing condition in any form of delusional jealousy (Kingham & Gordon, 2018); nevertheless, the presence of pathological jealousy in individuals with borderline personality disorder has been an understudied subject. While many borderline patients exhibit extreme jealousy in the context of interpersonal relationships, jealousy in any form is not included in the DSM-5 criteria for the disorder.

Borderline personality disorder is characterized by intense fears of abandonment and rejection, an unstable sense of self, chaotic interpersonal relationships, and self-contradictory and self-defeating behavior. Since many patients with borderline personality disorder experience micropsychotic episodes, the disorder was historically considered to exist on the border between neurosis and psychosis. In the past, the term pseudoneurotic schizophrenia was used to describe the condition.

Given the great difficulty borderline patients have in developing trust in other persons—owing to their insecure attachment styles—jealousy often becomes a central theme in their romantic relationships. During periods of intense devaluation or micropsychosis, the jealous feelings may reach delusional proportions.

Jealousy in borderline personality can manifest in the patient frequently accusing the partner of cheating or hiding things; extreme suspiciousness of the partner's behavior, whereabouts, and communications; a constant need for reassurance of the partner's fidelity; and, in extreme cases, stalking and abusive or controlling behavior. At delusional levels, the patient becomes wholly convinced of the partner's unfaithfulness.

Pathological jealousy in borderline personality disorder almost inevitably results in further interpersonal conflict, since the partner comes to feel doubted, mistrusted, and unfairly accused. It is as if the patient says to the partner, "There is nothing you can do to show me that you really love me. I don't believe you." Paradoxically, this can eventually lead the partner to leave the borderline person—the outcome the patient so desperately seeks to avoid. In this sense, jealousy becomes yet another manifestation of a generally self-defeating relational pattern.

A psychodynamic explanation of pathological jealousy in borderline personality disorder is that the phenomenon represents a failure of early object relations to sufficiently provide the patient with a stable and consistent feeling of love. Instead, the early lives of these patients are usually marked by abuse, neglect, and traumatic abandonment. Indeed, a recent meta-analysis found that over 70 percent of borderline patients have a history of childhood trauma (Porter et al., 2020). Jealousy arises from the patient's inability to form trusting relationships with other persons as well as their characteristic use of splitting and projection as defenses against anxiety.

While medications can help manage some of the mood symptoms associated with borderline personality disorder, pathological jealousy generally responds poorly to pharmacotherapy. The treatment of choice is psychotherapy, which aims to address the underlying personality dynamics that give rise to jealous feelings and beliefs.

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