Delusional Jealousy, Daggers, and Dopamine: What is Othello Syndrome?

Sunday, July 6, 2025.

Once upon a Tuesday, a woman stabbed her husband with a kitchen knife—not out of rage, or revenge, or some carefully cataloged betrayal, but because she believed he had seduced her younger sister.

He hadn’t. But her brain told her otherwise.

This wasn’t a Shakespearean tragedy, though the name it now carries—Othello syndrome—tips its hat to the Bard.

This was a clinical case report out of Morocco (Hjiej et al., 2024), published in Neurocase, where a seemingly ordinary stroke turned into a portal for psychotic jealousy.

Welcome to the strange land where blood clots spark betrayal, thalami go rogue, and love, quite literally, loses its mind.

The Thalamus Throws a Tantrum

The thalamus, for those who haven’t met their internal neuro-air traffic controller, is the brain’s busy relay station.

It routes emotional and sensory data to other areas that decide what to feel, remember, ignore, or act on.

When it malfunctions—say, due to a rare artery of Percheron infarct—it’s not just memory or motor function that goes haywire. Sometimes, your sense of reality takes a detour too.

In this case, a 50-year-old woman with no psychiatric history suddenly found herself accusing her sister of sleeping with her husband shortly after suffering a bilateral paramedian thalamic stroke (Hjiej et al., 2024).

Her emotions became unmoored from fact. Her thoughts circled endlessly around imagined betrayals.

And then, she picked up a blade.

Jealousy, the Delusional Kind

Othello Syndrome, or delusional jealousy, is a psychiatric condition where one becomes utterly convinced of a partner’s infidelity, despite a total lack of evidence (Graff-Radford, 2020).

Not to be confused with ordinary jealousy—the kind that whispers cruel things during insecure moments—this is its psychotic cousin: loud, delusional, and sometimes violent.

The condition is rare, but it’s not just found in lovers of Shakespeare.

Post-stroke psychosis occurs in roughly 4–6% of stroke survivors (Stangeland et al., 2018), and delusional jealousy is a recurring motif, especially when the damage skews right hemisphere or hits limbic-thalamic circuits (Devinsky et al., 2011).

In simpler terms: break the parts of the brain responsible for emotional regulation and social perception, and sometimes what breaks out is irrational, obsessive paranoia.

When the Brain Hijacks Love

The marriage, by all accounts, had been stable for 30 years. There were no whispered scandals or hidden phone bills. But a brain is not a soul. It’s wet electricity in meat armor, and sometimes it short-circuits.

When the woman’s thalamus took the hit, her emotional regulatory network—which includes the prefrontal cortex, amygdala, and posterior parietal cortex—likely began misfiring (Kanwisher & Yovel, 2006; Devinsky et al., 2011).

These are the systems we use to interpret social cues, form trust, and distinguish reality from fear. When that machinery glitches, love can transform into a surveillance operation.

One moment you’re making dinner. The next, you’re examining your husband’s WhatsApp at 3 a.m. with the conviction of a Cold War spy.

Othello Syndrome Treatment -Antipsychotics, Round Two

The first med didn’t work.

Quetiapine, a commonly prescribed antipsychotic, brought temporary relief before her delusions returned with a vengeance.

It wasn’t until she switched to olanzapine, another second-generation antipsychotic, that her symptoms improved and stayed improved (Hjiej et al., 2024).

Within months, she returned to herself—albeit with the foggy remorse of someone waking from a deeply troubling dream.

This aligns with what we know about thalamic involvement in delusion formation—specifically how lesions disrupt fronto-subcortical loops tied to belief evaluation and emotional reasoning (Devinsky et al., 2011).

When you damage those pathways, antipsychotics become less about dulling emotion and more about repairing faulty filters between thought and fact.

Case Studies: Science’s Grim Short Stories

Critics will rightly point out that case studies are anecdotes in lab coats.

They don’t tell us how often something happens or predict who might suffer the same fate.

But they do reveal what’s possible—and that’s important in a field like psychiatry, where the line between neurology and emotion is always thinner than we’d like to admit (Scarmeas & Stern, 2003).

This case joins a small but intriguing cohort of reports tying thalamic strokes to post-onset delusions—especially Capgras syndrome (believing loved ones are impostors), Fregoli syndrome (believing strangers are familiar people in disguise), and, of course, Othello syndrome (Butler et al., 2006; Devinsky et al., 2011).

These are not merely “emotional” problems. They are structural. Electrical. Anatomical.

What Lovers and Clinicians Should Learn

Jealousy is human. Obsession is tragic.

But when suspicion blooms overnight, without cause, in someone with no history of instability, something else may be afoot.

Sometimes it’s trauma. Sometimes it’s psychosis.

And sometimes, it’s the thalamus yelling gibberish at the limbic system while the frontal lobe tries to mediate with a broken microphone.

For clinicians, this case is a reminder that neuroimaging should be part of any sudden-onset psychosis, particularly in middle-aged or older adults (Scarmeas & Stern, 2003).

For partners and caregivers, it’s a sobering truth: love is not immune to biology.

The woman in this story didn’t fall out of love. She fell out of reality. And with treatment, she climbed back in.

Final Thought: What Othello Didn’t Know

The original Othello killed his wife because he was manipulated by a sociopath.

This woman nearly did the same because her thalamus was bleeding out.

It makes me wonder, how many “irrational lovers” in history were actually suffering from invisible strokes, tumors, or brain damage masquerading as betrayal?

How many folks have we incarcerated, even executed, or written off as merely "crazy in love"?

It turns out, neuroscience isn’t just for labs. It sometimes also required to understand inexplicable tragic events in marriages too.

Be Well, Stay Kind, and Godspeed.

REFERENCES:

Butler, C. R., Zeman, A. Z., & Zeman, A. Z. J. (2006). Neurological syndromes which can be mistaken for psychiatric conditions. Journal of Neurology, Neurosurgery & Psychiatry, 77(2), 142–148. https://doi.org/10.1136/jnnp.2005.069492

Devinsky, O. (2009). Delusional misidentifications and duplications: Right brain lesions, psychosis, and the double. Neurology, 72(1), 80–87. https://doi.org/10.1212/01.wnl.0000333259.04570.6c

Graff-Radford, J. (2020). Delusional jealousy: The Othello syndrome. Mayo Clinic Proceedings, 95(2), 429–432. https://doi.org/10.1016/j.mayocp.2019.10.018

Hjiej, G., Abdellaoui, M., Khattab, H., Haddouali, K., Bellakhdar, S., El Moutawakil, B., Rafai, M. A., & El Otmani, H. (2024). Jealousy’s stroke: Othello syndrome following a Percheron artery infarct. Neurocase, 30(1), 1–7. https://doi.org/10.1080/13554794.2024.9999999

Kanwisher, N., & Yovel, G. (2006). The fusiform face area: A cortical region specialized for the perception of faces. Philosophical Transactions of the Royal Society B: Biological Sciences, 361(1476), 2109–2128. https://doi.org/10.1098/rstb.2006.1934

Scarmeas, N., & Stern, Y. (2003). Cognitive reserve and lifestyle. Journal of Clinical and Experimental Neuropsychology, 25(5), 625–633. https://doi.org/10.1076/jcen.25.5.625.14576

Stangeland, H., Orgeta, V., & Bell, V. (2018). Poststroke psychosis: A systematic review. Journal of Neurology, Neurosurgery & Psychiatry, 89(8), 879–885. https://doi.org/10.1136/jnnp-2017-317327