An Empirically Informed Cognitive‑Behavioral Formulation of Obsessional Jealousy and Implications for Treatment Development

Obsessional jealousy is characterized by intrusive and ego-dystonic preoccupations about a partner’s perceived infidelity, accompanied by behaviors aimed at reducing uncertainty or preventing relational threat. In contrast to delusional or personality-disorder-based pathological jealousy, individuals with obsessional jealousy typically retain good insight into the excessive or maladaptive nature of their responses. Despite its clinical significance, systematic research on obsessional jealousy remains scarce. The aim of this study was to characterize psychological patterns linked to obsessional jealousy and to translate these findings into a preliminary cognitive-behavioral formulation to guide intervention development. Thirty-four adults meeting research criteria for obsessional jealousy participated in semi‑structured interviews. Interview content was categorized into triggers, appraisals, emotional, and physiological reactions, behaviors, and short and long term consequences. Recurring themes were integrated with existing theoretical frameworks through a series of clinician workshops. Participants described obsessional jealousy as a rapidly escalating emotional process involving anxiety but also anger and sadness as prominent emotional responses. Attempts to reduce distress through mental effort or actions within the relationship tended to offer only transient relief before renewing preoccupation and interpersonal strain. Findings indicate that the mechanisms involved in obsessional jealousy are broader and more relationally embedded than those typically addressed in potentially related conditions, such as obsessive-compulsive disorder, supporting the need for a more tailored approach. A preliminary cognitive-behavioral formulation identified key treatment components (exposure and response prevention, reducing anger related reactivity, strengthening constructive interpersonal responses, and broadening engagement beyond the relationship), providing a basis for developing and evaluating targeted interventions for obsessional jealousy.