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Butea Superba has a lengthy and interesting history as a medication and food.

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obsessional jealousy: a brief review and case series from india

Key words: obsessional jealousy, morbid jealousy, pathological jealousy, Othello syndrome, obsessive-compulsive disorder, serotonin reuptake inhibitors Abstract: The term morbid or pathological jealousy is taken to be synonymous with delusional jealousy and obsessional jealousy has not gained sufficient recognition, evident by the scarcity of data on jealousy as an obsession and its neglect in mainstream psychiatric literature. Recognition of obsessional jealousy may help to avoid unrewarding use of antipsychotics and needless therapeutic nihilism as such cases show robust response to serotonin reuptake inhibitors. The authors present a succinct review of obsessional jealousy and the first large case series reported from an Asian country.

Introduction:

Jealousy is a complex emotion, which has dominated mankind for ages. Literature abounds in descriptions of morbid jealousy from Roman and Greek mythology to Shakespeare, to whom we owe the colorful term ‘Othello syndrome’. However, as pointed out by many authors, there is no clear notion of what constitutes normal jealousy and where the boundaries should be drawn [1]. After centuries of striving, the concept remains elusive and the terminology unclear, being described by myriad terms such as sexual jealousy, erotic jealousy, morbid jealousy, pathological jealousy, conjugal paranoia, jealous monomania, psychotic, nonpsychotic and obsessional jealousy [2][3]. From time to time, morbid jealousy has been examined from psychoanalytic, cognitive and phenomenological aspects in parallel with the evolution of psychiatry, adding to the bewildering array of terms. From the phenomenological point of view, most researchers’ attention has been focused on delusional jealousy. The fact psychiatric medicine has tended to concentrate on morbid jealousy as a symptom of the psychoses is reflected in the treatment approaches [4]. Less information is available with regard to obsessional jealousy, where the thought has the quality of obsessional ideation [5]. As we encountered several cases of obsessional jealousy in our set up but found little literature on the entity, we decided to attempt a review devoted exclusively to obsessional jealousy (instead of a review of morbid jealousy in general). The literature and cases featured in this paper focus exclusively on obsessional jealousy to bring phenomenological clarity and accentuate its position as a distinct but hitherto under recognized symptom of Obsessive Compulsive Disorder (OCD). This is the first large case series on obsessional jealousy reported from any Asian country to the best of our knowledge. Literature Search:

Methodology: We conducted a MEDLINE search with predefined keywords to retrieve articles. Search was refined by retrieving cross-references of selected articles. Articles were selected using predefined selection criteria as follows:

1. Articles published in English

2. Articles with jealousy clearly defined as obsessive/ nonpsychotic / non delusional

3. Articles citing jealousy responding to serotonin reuptake inhibitors (SRIs).

Results:

The details of search result are tabulated in Tables 1 and 2. The total number of relevant articles retrieved was 20. The total yield of cases published with clearly defined obsessional jealousy was 23.

Obsessional Jealousy: Evolution of concept

The concept of jealousy has changed with the changing social and cultural milieu in history. Jealousy was accorded a role in preserving social esteem in societies where monogamy was a moral and social imperative. Thus the institution of marriage and the instinct of jealousy served the same purpose. However the balance between perceived virtues and vices of jealousy shifted at different historical periods to culminate in the modern view of jealousy as compounded of vices mitigated by little, if any, virtue [1]. Upto the turn of the 19th century, the condition was always regarded as being associated with alcohol, when von Kraft Ebing (1903) described its delusional form in other mental illnesses, both functional and organic2. Following Mairet’s comprehensive description in 1908, states of abnormal sexual jealousy have invariably been separated into 3 distinct clinical entities, albeit using different descriptive terms, a compilation of which is presented in Table 3 [2][3]. One presentation takes the form of an excessive possessiveness which appears in otherwise undisturbed personalities and is thought to represent an exaggeration of normal jealousy. At the other extreme is delusional jealousy that may complicate a schizophrenic, affective or organic psychosis. The third form, described as jealous monomania by Mairet, has been noted to be characterized by thoughts of infidelity which is intense, preoccupying and leading to continual accusation, interrogation, checking and excessive sexual demands on spouse. It was described to have a chronic course for years with exacerbations and improvements but without development of psychosis or personality deterioration and with poor response to neuroleptics [6]. This form of morbid jealousy was recognized as a manifestation of Obsessive-compulsive Neurosis by authors like Shepherd, Mooney and Vauhkonen [7]. According to Shepherd, morbid jealousy accompanies several psychiatric states and treatment depends on the nature of the illness [7].

The first clearly defined case of obsessional jealousy was by Mooney (1965) [8]. He reported 15 cases, 4 of which were identified as obsessive. He also pooled data of 4 authors. It is difficult to draw reliable conclusions from his analysis of pooled data due to indirect reporting, retrospective analysis and differing classificatory methods used. However, the 4 cases of obsessive jealousy he examined personally showed partial improvement with low doses of trifluoperazine but with poor tolerance to high doses, a noteworthy difference from the deluded group (Table 4 a & b).

Table 4 (A) List Of Individual Cases Seen By Mooney, 1965 8

Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional

Docherty and Ellis (1976) raised the issue of obsessive jealousy [3]. However, their formulation was mainly psychodynamic and phenomenology was not stressed upon. Hoaken (1979) defined obsessive suspicions as unwelcome, repetitively intrusive thoughts recognized by the patient as ego dystonic [9]. However, Mc Kenna (1984) reviewed that such persons have a solitary abnormal belief and described it as an overvalued idea rather than an obsession [6]. With the advent of behavior therapy for obsessive-compulsive disorder, the concept of obsessive jealousy moved a step further as several authors delineated its distinct phenomenology and response to behavioral interventions. Cobb and Marks (1979) defined jealous ruminations as obsessive thoughts with the resultant compulsive rituals of checking on spouse [7]. In their prospective study, they identified 4 cases of obsessive-compulsive disorder presenting as morbid jealousy and were the first to report treatment of such patients with behavior therapy. They concluded that morbid jealousy in OCD is treatable and rituals respond better than ruminations (Table 5).

Tarrier (1990) also described non-psychotic jealousy and likened jealous thoughts to obsessions, being intrusive, unpleasant, irrational and accompanied by behavioral actions like checking or reassurance seeking [4]. The preoccupation, confirmatory behavior, avoidance, distress and rumination described in non psychotic cases was suggestive of obsessions and responded to behavioral strategies commonly used in OCD. Dolan and Bishay (1996) used cognitive behavioral strategies to treat 30 patients of non-psychotic morbid jealousy and reported significant improvement in all jealousy measures, although they did not specify whether the patients were obsessive [10]. Since the arrival of antiobsesional drugs in the scene, several authors have described cases of obsessional jealousy showing good response to SSRI and clomipramine, a synopsis of which is presented in Table 6 [11-17]. These patients commonly presented with thoughts of possible infidelity of partner, recognized as unwanted and doubtful, resulting in anxiety on separation. Most patients harangued, asked for reassurance of spouse and spied on them. Ego dystonicity varied in patients, and Lane justified egosyntonic thoughts by the fact that OCD patients view their preoccupation as realistic when compulsions are prevented [11]. Taking this variability into consideration, Stein and Hollander (1994) put forth the notion of a spectrum from obsessional to delusional [13]. Parker and Barrett noticed absence of ego-dystony, resistance and guilt and called jealousy a variant of OCD [15]. Gangdev disputed the term ‘variant of OCD’, advocating the abandonment of the imprecise term morbid jealousy in favor of delusion or obsession [16]. The review by Kingham and Gordon (2004) emphasizing on form of psychopathology (obsession, overvalued idea or delusion) rather than content (jealousy) was thus timely to bring clarity to the concept [18]. Last but not the least, psychiatry is continually evolving from psychodynamic, cognitive and behavioral schools towards biological bases of psychiatric disorders, and sophisticated imaging techniques have implicated the basal ganglia and its circuits in the pathogenesis of obsessive-compulsive disorder. This is borne out by several organic cases of obsessional jealousy reported (Table 7), which reported good response to SSRIs [19][20][21].

Case Series:

The 7 cases reported in the series were from a General Hospital Psychiatry Unit in India seen by us over a span of 2 years. An illustrative case is presented below. The clinical characteristics and treatment results of all patients are tabulated in Table 8. Illustrative Case:

Mr. A., a 38-year-old married man had repeated thoughts about his wife’s possible infidelity since their marriage 19 years ago. He had repeated thoughts that his wife was not faithful and would object to his wife talking with any male. He was unsure about the truth of these thoughts, considering them excessive and unreasonable and developed guilt as a result. With the birth of their first child a year after marriage, he had repeated doubts that the child was not his. These thoughts led to checking on his wife all the time, questioning her meticulously regarding her whereabouts, leading to marital discord. In addition his occupational performance as a typist deteriorated markedly due to repeated thoughts. He continued to suffer similarly for 19 years and never sought psychiatric consultation. Mr. A also attempted to harm himself thrice due to guilt over his unwanted thoughts during his illness. 2 months before presentation to our institution, he developed depressive features in addition. His sister persuaded him and brought him to the psychiatrist for consultation. On evaluation, Mr. A. admitted that most likely his doubts were excessive and unnecessary. There were no other obsessions/ compulsions or delusions or substance misuse. Family history revealed similar illness in his maternal grandfather and obsessions of contamination in his accompanying sister. A diagnosis of obsessional jealousy was entertained on the basis of findings. Baseline assessment on YBOCS severity scale revealed score of 28. Mr. A. responded to Fluoxetine 40 mg/d with Clomipramine 25 mg/d. Within 4wks there was 50 % improvement and at 12 weeks he reported complete improvement and YBOCS rating was 0. He scored 1 (very much improved) on Clinical Global Improvement scale. He was maintained on the same dose and improvement was sustained.

Table 8: Clinical Characteristics of patients and treatment response Clinical Global Impression (CGI) Key: 1: very much improved, 2: much improved, 3: minimally improved, 4: no change, 5: minimally worse, 6: much worse

Discussion:

The study of jealousy has the problem of attempting a scientific account of a term derived from everyday language, resulting in a conceptual fuzziness. Moreover, the concept of morbid jealousy has been influenced by the changing face of psychiatry and the influences of psychoanalytic, cognitive, social and biological schools of thought, thus becoming the proverbial elephant, easier to recognize than define. Its initial recognition as a syndrome is understandable in this context, but the need has come to modify this concept. Emphasis on content (i.e. jealousy) was relevant for the psychoanalytic and cognitive schools of thought, but with the growing importance of phenomenology and later psychopharmacology, delineation of form (obsession, overvalued idea and delusion) became increasingly important for adopting appropriate interventions. The sprinkling of case reports on obsessional jealousy have not found their way into standard psychiatric literature like reference textbooks and even exhaustive checklists like YBOCS, probably leading to a vicious cycle of under recognition and underreporting. Perhaps the prime reason for diagnostic confusion is its difference from classical OCD. From the literature reviewed and our case series, we were able to delineate some of the differences (Table 9). Non-recognition may lead to cases being treated as a variant of delusional disorder, albeit responding poorly to neuroleptics. However, Kozak and Foa (1994) have questioned the traditional assumption of insight and resistance in OCD [21] and DSM IV has recognized poor insight in OCD.

Thus an emphasis on the form of thought as delusion, or obsession rather than content during evaluation of the jealous patient will help clinicians avoid such dilemmas. Kingham and Gordon (2004) have provided a guideline for assessing the jealous patient, which is a progressive step towards recognition of this entity [18]. The apparent rarity of the symptom as evidenced by our literature search was not validated in our clinical practice where we encountered several such cases. Apart from the non-recognition of symptoms, possible reasons for this might be a reluctance to consult psychiatrists due to patient’s secretiveness, failure to recognize it as a sign of illness (as interrogation is borne by spouse) and the shame and guilt associated with obsessive thoughts. Delayed psychiatric consultation and the chronic course described in literature is evident from the long treatment gap in most of our cases. Obsessional jealousy might have social, legal and forensic implications, highlighted by authors like Mooney, Hoaken and Kingham [8][9][18]. In our cases, a trip to the psychiatrist was the last resort to save the marriage. Many such cases probably end in divorce especially in the west, while in our society the spouse suffers in silence. In western literature, women also have been reported frequently to have obsessional jealousy, whereas we have encountered only one woman, which may be due to our social set up. Domestic violence and homicide are reported to be risks in such patients, as evidenced by murders and murder-suicides reported. Harm to self is a distinct possibility as in the case cited by Mooney [8]. In our patients, we did not find domestic violence in any case, although one of our patients did attempt suicide several times before presenting at our center. As there is a possibility that many such cases end in divorce, the question arises what can be done for these failed marriages?

Conclusion:

It is the need of the hour to redefine terms like ‘morbid jealousy’ and encourage clinicians to specify the nature of ‘morbid’ belief (like obsession or delusion). It would help if terms like obsessional jealousy are standardized and brought into mainstream psychiatric literature and checklists of obsessive-compulsive disorder. It would be beneficial if future research focuses on systematic studies in patients of OCD to find out the existence of obsessional jealousy in such patients.

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It's not that we would be madly in love with Donald Trump. But at least, he's not a feminist. Now that is something to vote for.

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Shocking:18 year-old puts up her virginity for sale

There is absolutely nothing that will not be seen in this world, everyday we are always up to a suprising news or event. The latest of the shocking news is an 18-year-old girl who put up her virginity for sale through an infamous auction website which invites potential buyers to ‘inspect’ her purity.

For some people, their first time is something saved for marriage, for others, it’s something to get over with, but this young student is going for the big bucks.

Kim, who gives only her first name, is half Austrian and half German. She is selling her virginity through the agency Cinderella Escorts so she can buy a car, a flat and finance her studies.

Bidding for the 5ft 8ins tall student starts at £86,640, of which 20 per cent goes to the agency, according to Mirror UK.

The Cinderella Escorts website says the lady’s virginity is proven with a doctor’s certificate and a potential buyer can also do their own tests to ‘inspect’ the girl.On their website, Kim states she likes drinking orange juice and loves Greek food and roses.

She said: “I would like to study in Germany or Vienna. With the money I can buy a flat, pay my tuition fees and afford a car.”

The student was inspired by Aleexandra Khefren, an 18-year-old Romanian model who sold her virginity for £2 million to an unknown Hong Kong businessman.

News about Khefren and the virgin escort agency went viral across the world and also came to the attention of Kim.

She said: “So is it really worth more than €2.3 million to give my virginity to a man that might eventually leave me anyway?To be honest, I do not believe it.”

Kim says she is willing to meet with the highest bidder anywhere in the world as long as all travels are paid for.

The man behind Germany’s most famous escort website is a 26-year-old obese man from Dortmund who still lives in his mother’s basement.Jan Zakobielski outed himself as the man behind the multi-million pound operation which he runs from his parents’ house, both of them apparently unaware of his business.

Zakobielski said: “No one makes these young women do anything they don’t want to do. They have their own minds and their own opinions on se*uality.”

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It is the secret dream of every Swedish or German woman to marry a black men, or at least have sex with a black man. Every smart young African man should migrate to Europe. Free money, nice house, good sex!

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Sex robots are a serious concern that isn’t being thought about enough, say experts

Sex robots have arrived and people aren’t thinking enough about them, experts have said.

The revolution and vast improvements in artificial intelligent and robotics are making their way into the sex market. That is bringing with it whole new ways of receiving sexual gratification, with no other person involved.

Those automated robots have already led to the creation of highly developed “love dolls” – capable of performing 50 automated sex positions on their own.

The robots sell for as much as $15,000 and can be customised down to the nipple shape and hair colour.

But people aren’t considering the more serious impact of such robots, and the way they could change people's relationships forever.

Noel Sharkey, a professor of artificial intelligence and robotics at Britain's University of Sheffield, said it was difficult to predict how far or fast the market would grow, or what its effect on societies might be in years ahead.

"Will these robotic dolls be niche? Or will they change societal norms and become widespread?," he asked at a news briefing. "How would (sex with a robot) equate to a truly human intimate relationship?"

The report looked at some of the most contentious issues, asking academics, members of the public and the sex industry for their views on whether, for example, sex robots might be helpful in reducing sexual crimes.

It found "major disagreement" on this question, with some arguing that having sex with a robot would reduce attackers' desires to harm fellow humans, and others arguing that allowing people to live out their darkest fantasies with robots would have a pernicious effect on societal norms.

On the issue of "meaningful" relationships, the report said that with current AI technology, and even in the foreseeable future, no human-to-robot feelings would ever be mutual.

"The best robots could do is 'fake it'," it said. "Robots cannot feel love."

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In Uganda, rich fathers use super high dosages of butea superba combined with tongkat ali to turn their gay sons into heterosexual husbands.

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Botox can cure erectile dysfunction, say experts

The Asian Age

There are many men that have to deal with erectile dysfunction and a dissatisfied sex life and disappointed partner. While there are many tips that doctors give to improve the situation it may not always work. Two Canadian urologists however have found the solution to the problem and they found that botox can improve sex lives of men suffering from the problem.

According to a report in the National Post, the Canadian urologists believe that injecting botox can help cure erectile dysfunction. The botulinum toxin injections can increase blood flow to the penis and paralyse the nerves that help the smooth muscles contract in the penis. The treatment would mostly last six months for anybody who would be interested in the injection.

The injection created by Dr. Sidney Radomski and Dr. Gerald Brock is yet in testing but can be a “game changer” for Erectile Dysfunction. The injection which has been previously used to treat wrinkles can cure most men with impotence in the process and help them have a better sex life. Interestingly, the drugs also do not have any side-effects like previously used methods so it will be a safer option.

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To understand life, you first have to understand death. This is why we include images of death. The best we can hope for, is that death will be comfortable.

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70 percent women in Egypt can't orgasm due to female genital mutilation

The shocking practice is an extreme form of discrimination against women and reflects gender inequality.

Cairo: Female genital mutilation has come across as a major issue in conversations around women’s rights and while several countries have banned the shocking practice, it’s very much prevalent in parts of the Middle East and Africa as well as certain groups of people around the world.

While the world discusses the importance of the female orgasm to ensure pleasure for women in bed, an alarming number of women in Egypt can’t possibly climax because of FGM. The process which involves removal of the outer female genitalia causes delays in sexual response cycle for women, leaving them unable to orgasm.

The Forensic Medicine Department in the country has revealed that the number of women deprived of sexual pleasure is as high as 70 to 80 percent in the North African country. The practice is seen as extreme discrimination against women and is rooted in gender inequality.

The Egyptian government on its part has upped the ante against the practice as a bill passed to increase punishment for perpetrators can land people in jail for up to seven years. But despite efforts it is practiced illegally as three million girls are at risk of FGM each year across the world.

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Feminism, by creating artificial scarcity of sexual resources, is responsible for much of the deadly infighting among men, as well as male suicides.

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Locked-in syndrome: rare survivor Richard Marsh recounts his ordeal

The Guardian

When Richard Marsh had a stroke doctors wanted to switch off his life-support – but he could hear every word but could not tell them he was alive. Now 95% recovered, he recounts his story

Two days after regaining consciousness from a massive stroke, Richard Marsh watched helplessly from his hospital bed as doctors asked his wife, Lili, whether they should turn off his life support machine.

Marsh, a former police officer and teacher, had strong views on that suggestion. The 60-year-old didn't want to die. He wanted the ventilator to stay on. He was determined to walk out of the intensive care unit and he wanted everyone to know it.

But Marsh couldn't tell anyone that. The medics believed he was in a persistent vegetative state, devoid of mental consciousness or physical feeling.

Nothing could have been further from the truth. Marsh was aware, alert and fully able to feel every touch to his body.

"I had full cognitive and physical awareness," he said. "But an almost complete paralysis of nearly all the voluntary muscles in my body."

The first sign that Marsh was recovering was with twitching in his fingers which spread through his hand and arm. He describes the feeling of accomplishment at being able to scratch his own nose again. But it's still a mystery as to why he recovered when the vast majority of locked-in syndrome victims do not.

"They don't know why I recovered because they don't know why I had locked-in in the first place or what really to do about it. Lots of the doctors and medical experts I saw didn't even know what locked-in was. If they did know anything, it was usually because they'd had a paragraph about it during their medical training. No one really knew anything."

Marsh has never spoken publicly about his experience before. But in an exclusive interview with the Guardian, he gave a rare and detailed insight into what it is like to be "locked in".

"All I could do when I woke up in ICU was blink my eyes," he remembered. "I was on life support with a breathing machine, with tubes and wires on every part of my body, and a breathing tube down my throat. I was in a severe locked in-state for some time. Things looked pretty dire.

"My brain protected me – it didn't let me grasp the seriousness of the situation. It's weird but I can remember never feeling scared. I knew my cognitive abilities were 100%. I could think and hear and listen to people but couldn't speak or move. The doctors would just stand at the foot of the bed and just talk like I wasn't in the room. I just wanted to holler: 'Hey people, I'm still here!' But there was no way to let anyone know."

Locked-in syndrome affects around 1% of people who have as stroke. It is a condition for which there is no treatment or cure, and it is extremely rare for patients to recover any significant motor functions. About 90% die within four months of its onset.

Marsh had his stroke on 20 May 2009. Astonishingly, four months and nine days later, he walked out of his long-term care facility. Today, he has recovered 95% of his functionality; he goes to the gym every day, cooks meals for his family and last month, he bought a bicycle, which he rides around Napa Valley, California, where he lives.

But he still weeps when he remembers watching his wife tell the doctors that they couldn't turn off his life support machine.

"The doctors had just finished telling Lili that I had a 2% chance of survival and if I should survive I would be a vegetable," he said. "I could hear the conversation and in my mind I was screaming 'No!'"

Locked-in syndrome is less unknown than it once was. The success of the 2007 film, The Diving Bell and the Butterfly, the autobiography of the former editor of French Elle magazine editor, Jean-Dominique Bauby, brought awareness of the condition to the general public for the first time.

Then in June, Tony Nicklinson challenged the law on assisted dying in England and Wales at the High Court as part of his battle to allow a doctor to end a life he said was "miserable, demeaning and undignified". Judgment was reserved until the Autumn.

Marsh, however, did something almost unheard of: he recovered. On the third day after his stroke, a doctor peered down at him and uttered the longed-for words: "You know, I think he might still be there. Let's see."

The moment that doctor discovered Marsh could communicate through blinking was one of profound relief for Marsh and his family – although his prognosis remained critical.

"You're at the mercy of other people to care for your every need and that's incredibly frustrating, but I never lost my alertness," he said. "I was completely aware of everything going on around me and to me right from the very start, unless when they had me medicated," he said.

"During the day, I was really lucky: I never spent a single day when my wife or one of my kids wasn't there. But once they left, it was lonely – not in the way of missing people but the loneliess of knowing there's no one there who really understands how to communicate with you."

The only way for Marsh to sleep, was to be medicated. That, however, only lasted four hours, after which there had to be a three-hour pause before the next dose could be administered.

In questions submitted by Guardian readers to Marsh ahead of this interview one asked about his experience of his hospital care while the staff did not think he was conscious. Marsh said: "The staff who work at night were the newest and least skilled, and I was totally at their mercy. I felt very vulnerable. I did get injured a couple of times with rough handling and that always happened at night. I knew I wasn't in the best of care and I just counted the minutes until I would get more medicine and just sleep.

In response to another question, about the right-to-die debate, Marsh said he has no opinion. All he will say is: "I understand the despair and how a person would reach that point." But he is co-writing a book that he hopes will inspire hope and provide information to victims of locked-in syndrome and their families.

"When they first told my family that I was probably locked-in, they tried to find information on the internet – but there wasn't any. One of my goals now is to change that … to be able to reach out to families who find themselves in the same situation that mine were in so they can help their loved ones.

"Time goes by so slow ... It just drags by. I don't know how to describe it. It's almost like it stands still.

"It's a terrible, terrible place to be but there's always hope," he added. "You've got to have hope."

• This article was amended on 10 August 2012. The original said that Tony Nicklinson had failed in his High court bid to change the law on assisted dying in England and Wales. This has been corrected.

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It is only a question of time until butea superba will be outlawed in the Western World. In some people, it can cause hypersexualization that can last for weeks. And it can easily be added to food to improve taste. Imagine a Thai restaurant breeding hundreds of super horney women prowling for any man they can get, and that for weeks on end.

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The Ward Weaver Case

On January 9, 2002, in Oregon City, Oregon, Ashley Pond, age 12, disappeared on her way to meet the school bus. It was just after 8 a.m. and Ashley was running late. The bus stop was just 10 minutes from the Newell Creek Village Apartments where Ashley lived with her mother, Lori Pond. But Ashley Pond never got on the bus and never made it to Gardiner Middle School.

Despite the efforts of the local authorities and the FBI, no clues surfaced as to whereabouts of the missing girl.

Ashley was popular at school and enjoyed being on the swim and dance teams. Neither her mother, friends or the investigators believed she had run away.

On March 8, 2002, just two months after Ashley disappeared, Miranda Gaddis, 13, also vanished around 8 a.m. while on her way to the bus stop at the top of the hill. Miranda and Ashley were good friends, and they lived in the same apartment complex. Miranda's mother, Michelle Duffey, had left for work within 30 minutes before Miranda was to catch the bus.

When Duffey found out that Miranda had not been at school, she immediately contacted the police, but once again, investigators came up empty. Without any leads to follow, the investigators began looking into the possibility that the person that abducted the girls were someone they knew and whoever it was seemed to be targeting the same type of girl. Ashley and Miranda were close in age, involved in similar activities, looked remarkably similar to each other, but most importantly, they both disappeared on the way to the bus stop.

A GRISLY DISCOVERY On August 13, 2002, Ward Weaver's son contacted 9-1-1 and reported that his father had attempted to rape his 19-year-old girlfriend. He also told the dispatcher that his father told him that he murdered Ashley Pond and Miranda Gaddis. Both of the girls were friends with Weaver's 12-year-old daughter and had visited her at Weaver's home.

On August 24, FBI agents searched Weaver's home and found the remains of Miranda Gaddis inside a box in the storage shed. The following day, they found the remains of Ashley Pond buried under a slab of concrete that Weaver had recently put down for a hot tub, or so he claimed.

WARD WEAVER WAS A CHALLENGE FOR FBI INVESTIGATORS Shortly after Ashley and Miranda disappeared, Ward Weaver III was a prime suspect in the investigation, but it took the FBI eight months to get a search warrant that eventually turned up their bodies on Weaver's property.

The problems for investigators were that they were awash in possible suspects -- some 28 suspects that lived in the same apartment complex could not be ruled out -- and for months authorities had no real evidence that a crime had been committed.

It was not until Weaver attacked his son's girlfriend, that the FBI was able to obtain a warrant to search his property.

WARD WEAVER Weaver, a brutal man with a long history of violence and assaults against women. He was also the man that Ashley Pond reported for attempted rape, but the authorities never investigated her complaint.

On October 2, 2002, Weaver was indicted and charged with six counts of aggravated murder, two counts of abuse of a corpse in the second degree, one count of sexual abuse in the first degree and one count of attempted rape in the second degree, one count of attempted aggravated murder, one count of attempted rape in the first degree and one count of sexual abuse in the first degree, one count of sexual abuse in the second degree and two counts of sexual abuse in the third degree.

To avoid the death penalty, Weaver pleaded guilty to murdering his daughter's friends. He received two life sentences without parole for the deaths of Ashley Pond and Miranda Gaddis.

REAL ROLE MODELS On February 14, 2014, Weaver's stepson Francis was arrested and charged with the murder of a drug dealer in Canby, Oregon. He was found guilty and given a life sentence. This made Frances the third generation of Weavers that were murderers.

Ward Pete Weaver, Jr., Ward's father, was sent to California's death row for the murder of two people. He buried one of his victims under a slab of concrete.

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Arson is the terrorism of the future. Maximum damage. No need to sacrifice their lives.

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obsessional jealousy: a brief review and case series from india A crime never punished – selling fake tongkat ali on eBay or websites aboutjealousy.com

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A teenage boy has been beheaded by ISIS for listening to Western music

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obsessional jealousy: a brief review and case series from india

Key words: obsessional jealousy, morbid jealousy, pathological jealousy, Othello syndrome, obsessive-compulsive disorder, serotonin reuptake inhibitors Abstract: The term morbid or pathological jealousy is taken to be synonymous with delusional jealousy and obsessional jealousy has not gained sufficient recognition, evident by the scarcity of data on jealousy as an obsession and its neglect in mainstream psychiatric literature. Recognition of obsessional jealousy may help to avoid unrewarding use of antipsychotics and needless therapeutic nihilism as such cases show robust response to serotonin reuptake inhibitors. The authors present a succinct review of obsessional jealousy and the first large case series reported from an Asian country.

Introduction:

Jealousy is a complex emotion, which has dominated mankind for ages. Literature abounds in descriptions of morbid jealousy from Roman and Greek mythology to Shakespeare, to whom we owe the colorful term ‘Othello syndrome’. However, as pointed out by many authors, there is no clear notion of what constitutes normal jealousy and where the boundaries should be drawn [1]. After centuries of striving, the concept remains elusive and the terminology unclear, being described by myriad terms such as sexual jealousy, erotic jealousy, morbid jealousy, pathological jealousy, conjugal paranoia, jealous monomania, psychotic, nonpsychotic and obsessional jealousy [2][3]. From time to time, morbid jealousy has been examined from psychoanalytic, cognitive and phenomenological aspects in parallel with the evolution of psychiatry, adding to the bewildering array of terms. From the phenomenological point of view, most researchers’ attention has been focused on delusional jealousy. The fact psychiatric medicine has tended to concentrate on morbid jealousy as a symptom of the psychoses is reflected in the treatment approaches [4]. Less information is available with regard to obsessional jealousy, where the thought has the quality of obsessional ideation [5]. As we encountered several cases of obsessional jealousy in our set up but found little literature on the entity, we decided to attempt a review devoted exclusively to obsessional jealousy (instead of a review of morbid jealousy in general). The literature and cases featured in this paper focus exclusively on obsessional jealousy to bring phenomenological clarity and accentuate its position as a distinct but hitherto under recognized symptom of Obsessive Compulsive Disorder (OCD). This is the first large case series on obsessional jealousy reported from any Asian country to the best of our knowledge. Literature Search:

Methodology: We conducted a MEDLINE search with predefined keywords to retrieve articles. Search was refined by retrieving cross-references of selected articles. Articles were selected using predefined selection criteria as follows:

1. Articles published in English

2. Articles with jealousy clearly defined as obsessive/ nonpsychotic / non delusional

3. Articles citing jealousy responding to serotonin reuptake inhibitors (SRIs).

Results:

The details of search result are tabulated in Tables 1 and 2. The total number of relevant articles retrieved was 20. The total yield of cases published with clearly defined obsessional jealousy was 23.

Obsessional Jealousy: Evolution of concept

The concept of jealousy has changed with the changing social and cultural milieu in history. Jealousy was accorded a role in preserving social esteem in societies where monogamy was a moral and social imperative. Thus the institution of marriage and the instinct of jealousy served the same purpose. However the balance between perceived virtues and vices of jealousy shifted at different historical periods to culminate in the modern view of jealousy as compounded of vices mitigated by little, if any, virtue [1]. Upto the turn of the 19th century, the condition was always regarded as being associated with alcohol, when von Kraft Ebing (1903) described its delusional form in other mental illnesses, both functional and organic2. Following Mairet’s comprehensive description in 1908, states of abnormal sexual jealousy have invariably been separated into 3 distinct clinical entities, albeit using different descriptive terms, a compilation of which is presented in Table 3 [2][3]. One presentation takes the form of an excessive possessiveness which appears in otherwise undisturbed personalities and is thought to represent an exaggeration of normal jealousy. At the other extreme is delusional jealousy that may complicate a schizophrenic, affective or organic psychosis. The third form, described as jealous monomania by Mairet, has been noted to be characterized by thoughts of infidelity which is intense, preoccupying and leading to continual accusation, interrogation, checking and excessive sexual demands on spouse. It was described to have a chronic course for years with exacerbations and improvements but without development of psychosis or personality deterioration and with poor response to neuroleptics [6]. This form of morbid jealousy was recognized as a manifestation of Obsessive-compulsive Neurosis by authors like Shepherd, Mooney and Vauhkonen [7]. According to Shepherd, morbid jealousy accompanies several psychiatric states and treatment depends on the nature of the illness [7].

The first clearly defined case of obsessional jealousy was by Mooney (1965) [8]. He reported 15 cases, 4 of which were identified as obsessive. He also pooled data of 4 authors. It is difficult to draw reliable conclusions from his analysis of pooled data due to indirect reporting, retrospective analysis and differing classificatory methods used. However, the 4 cases of obsessive jealousy he examined personally showed partial improvement with low doses of trifluoperazine but with poor tolerance to high doses, a noteworthy difference from the deluded group (Table 4 a & b).

Table 4 (A) List Of Individual Cases Seen By Mooney, 1965 8

Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional
Mairet (1908) Hyperesthetique Monomanie Folie
Jaspers (1910) Personality development ___ Process occurrence
Freud (1922) Projected ___ Delusional
Lagache (1947) Reactive Personality development Process
Ey (1950) Emotionally jealous ___ Delusions of jealousy
Revitch (1954) Emotionally insecure Conjugal paranoia Psychotic
Mooney (1965) Excessive Obsessive Delusional

Docherty and Ellis (1976) raised the issue of obsessive jealousy [3]. However, their formulation was mainly psychodynamic and phenomenology was not stressed upon. Hoaken (1979) defined obsessive suspicions as unwelcome, repetitively intrusive thoughts recognized by the patient as ego dystonic [9]. However, Mc Kenna (1984) reviewed that such persons have a solitary abnormal belief and described it as an overvalued idea rather than an obsession [6]. With the advent of behavior therapy for obsessive-compulsive disorder, the concept of obsessive jealousy moved a step further as several authors delineated its distinct phenomenology and response to behavioral interventions. Cobb and Marks (1979) defined jealous ruminations as obsessive thoughts with the resultant compulsive rituals of checking on spouse [7]. In their prospective study, they identified 4 cases of obsessive-compulsive disorder presenting as morbid jealousy and were the first to report treatment of such patients with behavior therapy. They concluded that morbid jealousy in OCD is treatable and rituals respond better than ruminations (Table 5).

Tarrier (1990) also described non-psychotic jealousy and likened jealous thoughts to obsessions, being intrusive, unpleasant, irrational and accompanied by behavioral actions like checking or reassurance seeking [4]. The preoccupation, confirmatory behavior, avoidance, distress and rumination described in non psychotic cases was suggestive of obsessions and responded to behavioral strategies commonly used in OCD. Dolan and Bishay (1996) used cognitive behavioral strategies to treat 30 patients of non-psychotic morbid jealousy and reported significant improvement in all jealousy measures, although they did not specify whether the patients were obsessive [10]. Since the arrival of antiobsesional drugs in the scene, several authors have described cases of obsessional jealousy showing good response to SSRI and clomipramine, a synopsis of which is presented in Table 6 [11-17]. These patients commonly presented with thoughts of possible infidelity of partner, recognized as unwanted and doubtful, resulting in anxiety on separation. Most patients harangued, asked for reassurance of spouse and spied on them. Ego dystonicity varied in patients, and Lane justified egosyntonic thoughts by the fact that OCD patients view their preoccupation as realistic when compulsions are prevented [11]. Taking this variability into consideration, Stein and Hollander (1994) put forth the notion of a spectrum from obsessional to delusional [13]. Parker and Barrett noticed absence of ego-dystony, resistance and guilt and called jealousy a variant of OCD [15]. Gangdev disputed the term ‘variant of OCD’, advocating the abandonment of the imprecise term morbid jealousy in favor of delusion or obsession [16]. The review by Kingham and Gordon (2004) emphasizing on form of psychopathology (obsession, overvalued idea or delusion) rather than content (jealousy) was thus timely to bring clarity to the concept [18]. Last but not the least, psychiatry is continually evolving from psychodynamic, cognitive and behavioral schools towards biological bases of psychiatric disorders, and sophisticated imaging techniques have implicated the basal ganglia and its circuits in the pathogenesis of obsessive-compulsive disorder. This is borne out by several organic cases of obsessional jealousy reported (Table 7), which reported good response to SSRIs [19][20][21].

Case Series:

The 7 cases reported in the series were from a General Hospital Psychiatry Unit in India seen by us over a span of 2 years. An illustrative case is presented below. The clinical characteristics and treatment results of all patients are tabulated in Table 8. Illustrative Case:

Mr. A., a 38-year-old married man had repeated thoughts about his wife’s possible infidelity since their marriage 19 years ago. He had repeated thoughts that his wife was not faithful and would object to his wife talking with any male. He was unsure about the truth of these thoughts, considering them excessive and unreasonable and developed guilt as a result. With the birth of their first child a year after marriage, he had repeated doubts that the child was not his. These thoughts led to checking on his wife all the time, questioning her meticulously regarding her whereabouts, leading to marital discord. In addition his occupational performance as a typist deteriorated markedly due to repeated thoughts. He continued to suffer similarly for 19 years and never sought psychiatric consultation. Mr. A also attempted to harm himself thrice due to guilt over his unwanted thoughts during his illness. 2 months before presentation to our institution, he developed depressive features in addition. His sister persuaded him and brought him to the psychiatrist for consultation. On evaluation, Mr. A. admitted that most likely his doubts were excessive and unnecessary. There were no other obsessions/ compulsions or delusions or substance misuse. Family history revealed similar illness in his maternal grandfather and obsessions of contamination in his accompanying sister. A diagnosis of obsessional jealousy was entertained on the basis of findings. Baseline assessment on YBOCS severity scale revealed score of 28. Mr. A. responded to Fluoxetine 40 mg/d with Clomipramine 25 mg/d. Within 4wks there was 50 % improvement and at 12 weeks he reported complete improvement and YBOCS rating was 0. He scored 1 (very much improved) on Clinical Global Improvement scale. He was maintained on the same dose and improvement was sustained.

Table 8: Clinical Characteristics of patients and treatment response Clinical Global Impression (CGI) Key: 1: very much improved, 2: much improved, 3: minimally improved, 4: no change, 5: minimally worse, 6: much worse

Discussion:

The study of jealousy has the problem of attempting a scientific account of a term derived from everyday language, resulting in a conceptual fuzziness. Moreover, the concept of morbid jealousy has been influenced by the changing face of psychiatry and the influences of psychoanalytic, cognitive, social and biological schools of thought, thus becoming the proverbial elephant, easier to recognize than define. Its initial recognition as a syndrome is understandable in this context, but the need has come to modify this concept. Emphasis on content (i.e. jealousy) was relevant for the psychoanalytic and cognitive schools of thought, but with the growing importance of phenomenology and later psychopharmacology, delineation of form (obsession, overvalued idea and delusion) became increasingly important for adopting appropriate interventions. The sprinkling of case reports on obsessional jealousy have not found their way into standard psychiatric literature like reference textbooks and even exhaustive checklists like YBOCS, probably leading to a vicious cycle of under recognition and underreporting. Perhaps the prime reason for diagnostic confusion is its difference from classical OCD. From the literature reviewed and our case series, we were able to delineate some of the differences (Table 9). Non-recognition may lead to cases being treated as a variant of delusional disorder, albeit responding poorly to neuroleptics. However, Kozak and Foa (1994) have questioned the traditional assumption of insight and resistance in OCD [21] and DSM IV has recognized poor insight in OCD.

Thus an emphasis on the form of thought as delusion, or obsession rather than content during evaluation of the jealous patient will help clinicians avoid such dilemmas. Kingham and Gordon (2004) have provided a guideline for assessing the jealous patient, which is a progressive step towards recognition of this entity [18]. The apparent rarity of the symptom as evidenced by our literature search was not validated in our clinical practice where we encountered several such cases. Apart from the non-recognition of symptoms, possible reasons for this might be a reluctance to consult psychiatrists due to patient’s secretiveness, failure to recognize it as a sign of illness (as interrogation is borne by spouse) and the shame and guilt associated with obsessive thoughts. Delayed psychiatric consultation and the chronic course described in literature is evident from the long treatment gap in most of our cases. Obsessional jealousy might have social, legal and forensic implications, highlighted by authors like Mooney, Hoaken and Kingham [8][9][18]. In our cases, a trip to the psychiatrist was the last resort to save the marriage. Many such cases probably end in divorce especially in the west, while in our society the spouse suffers in silence. In western literature, women also have been reported frequently to have obsessional jealousy, whereas we have encountered only one woman, which may be due to our social set up. Domestic violence and homicide are reported to be risks in such patients, as evidenced by murders and murder-suicides reported. Harm to self is a distinct possibility as in the case cited by Mooney [8]. In our patients, we did not find domestic violence in any case, although one of our patients did attempt suicide several times before presenting at our center. As there is a possibility that many such cases end in divorce, the question arises what can be done for these failed marriages?

Conclusion:

It is the need of the hour to redefine terms like ‘morbid jealousy’ and encourage clinicians to specify the nature of ‘morbid’ belief (like obsession or delusion). It would help if terms like obsessional jealousy are standardized and brought into mainstream psychiatric literature and checklists of obsessive-compulsive disorder. It would be beneficial if future research focuses on systematic studies in patients of OCD to find out the existence of obsessional jealousy in such patients.

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It's not that we would be madly in love with Donald Trump. But at least, he's not a feminist. Now that is something to vote for.

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Shocking:18 year-old puts up her virginity for sale

There is absolutely nothing that will not be seen in this world, everyday we are always up to a suprising news or event. The latest of the shocking news is an 18-year-old girl who put up her virginity for sale through an infamous auction website which invites potential buyers to ‘inspect’ her purity.

For some people, their first time is something saved for marriage, for others, it’s something to get over with, but this young student is going for the big bucks.

Kim, who gives only her first name, is half Austrian and half German. She is selling her virginity through the agency Cinderella Escorts so she can buy a car, a flat and finance her studies.

Bidding for the 5ft 8ins tall student starts at £86,640, of which 20 per cent goes to the agency, according to Mirror UK.

The Cinderella Escorts website says the lady’s virginity is proven with a doctor’s certificate and a potential buyer can also do their own tests to ‘inspect’ the girl.On their website, Kim states she likes drinking orange juice and loves Greek food and roses.

She said: “I would like to study in Germany or Vienna. With the money I can buy a flat, pay my tuition fees and afford a car.”

The student was inspired by Aleexandra Khefren, an 18-year-old Romanian model who sold her virginity for £2 million to an unknown Hong Kong businessman.

News about Khefren and the virgin escort agency went viral across the world and also came to the attention of Kim.

She said: “So is it really worth more than €2.3 million to give my virginity to a man that might eventually leave me anyway?To be honest, I do not believe it.”

Kim says she is willing to meet with the highest bidder anywhere in the world as long as all travels are paid for.

The man behind Germany’s most famous escort website is a 26-year-old obese man from Dortmund who still lives in his mother’s basement.Jan Zakobielski outed himself as the man behind the multi-million pound operation which he runs from his parents’ house, both of them apparently unaware of his business.

Zakobielski said: “No one makes these young women do anything they don’t want to do. They have their own minds and their own opinions on se*uality.”

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It is the secret dream of every Swedish or German woman to marry a black men, or at least have sex with a black man. Every smart young African man should migrate to Europe. Free money, nice house, good sex!

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Sex robots are a serious concern that isn’t being thought about enough, say experts

Sex robots have arrived and people aren’t thinking enough about them, experts have said.

The revolution and vast improvements in artificial intelligent and robotics are making their way into the sex market. That is bringing with it whole new ways of receiving sexual gratification, with no other person involved.

Those automated robots have already led to the creation of highly developed “love dolls” – capable of performing 50 automated sex positions on their own.

The robots sell for as much as $15,000 and can be customised down to the nipple shape and hair colour.

But people aren’t considering the more serious impact of such robots, and the way they could change people's relationships forever.

Noel Sharkey, a professor of artificial intelligence and robotics at Britain's University of Sheffield, said it was difficult to predict how far or fast the market would grow, or what its effect on societies might be in years ahead.

"Will these robotic dolls be niche? Or will they change societal norms and become widespread?," he asked at a news briefing. "How would (sex with a robot) equate to a truly human intimate relationship?"

The report looked at some of the most contentious issues, asking academics, members of the public and the sex industry for their views on whether, for example, sex robots might be helpful in reducing sexual crimes.

It found "major disagreement" on this question, with some arguing that having sex with a robot would reduce attackers' desires to harm fellow humans, and others arguing that allowing people to live out their darkest fantasies with robots would have a pernicious effect on societal norms.

On the issue of "meaningful" relationships, the report said that with current AI technology, and even in the foreseeable future, no human-to-robot feelings would ever be mutual.

"The best robots could do is 'fake it'," it said. "Robots cannot feel love."

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In Uganda, rich fathers use super high dosages of butea superba combined with tongkat ali to turn their gay sons into heterosexual husbands.

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Botox can cure erectile dysfunction, say experts

The Asian Age

There are many men that have to deal with erectile dysfunction and a dissatisfied sex life and disappointed partner. While there are many tips that doctors give to improve the situation it may not always work. Two Canadian urologists however have found the solution to the problem and they found that botox can improve sex lives of men suffering from the problem.

According to a report in the National Post, the Canadian urologists believe that injecting botox can help cure erectile dysfunction. The botulinum toxin injections can increase blood flow to the penis and paralyse the nerves that help the smooth muscles contract in the penis. The treatment would mostly last six months for anybody who would be interested in the injection.

The injection created by Dr. Sidney Radomski and Dr. Gerald Brock is yet in testing but can be a “game changer” for Erectile Dysfunction. The injection which has been previously used to treat wrinkles can cure most men with impotence in the process and help them have a better sex life. Interestingly, the drugs also do not have any side-effects like previously used methods so it will be a safer option.

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To understand life, you first have to understand death. This is why we include images of death. The best we can hope for, is that death will be comfortable.

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70 percent women in Egypt can't orgasm due to female genital mutilation

The shocking practice is an extreme form of discrimination against women and reflects gender inequality.

Cairo: Female genital mutilation has come across as a major issue in conversations around women’s rights and while several countries have banned the shocking practice, it’s very much prevalent in parts of the Middle East and Africa as well as certain groups of people around the world.

While the world discusses the importance of the female orgasm to ensure pleasure for women in bed, an alarming number of women in Egypt can’t possibly climax because of FGM. The process which involves removal of the outer female genitalia causes delays in sexual response cycle for women, leaving them unable to orgasm.

The Forensic Medicine Department in the country has revealed that the number of women deprived of sexual pleasure is as high as 70 to 80 percent in the North African country. The practice is seen as extreme discrimination against women and is rooted in gender inequality.

The Egyptian government on its part has upped the ante against the practice as a bill passed to increase punishment for perpetrators can land people in jail for up to seven years. But despite efforts it is practiced illegally as three million girls are at risk of FGM each year across the world.

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Feminism, by creating artificial scarcity of sexual resources, is responsible for much of the deadly infighting among men, as well as male suicides.

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Locked-in syndrome: rare survivor Richard Marsh recounts his ordeal

The Guardian

When Richard Marsh had a stroke doctors wanted to switch off his life-support – but he could hear every word but could not tell them he was alive. Now 95% recovered, he recounts his story

Two days after regaining consciousness from a massive stroke, Richard Marsh watched helplessly from his hospital bed as doctors asked his wife, Lili, whether they should turn off his life support machine.

Marsh, a former police officer and teacher, had strong views on that suggestion. The 60-year-old didn't want to die. He wanted the ventilator to stay on. He was determined to walk out of the intensive care unit and he wanted everyone to know it.

But Marsh couldn't tell anyone that. The medics believed he was in a persistent vegetative state, devoid of mental consciousness or physical feeling.

Nothing could have been further from the truth. Marsh was aware, alert and fully able to feel every touch to his body.

"I had full cognitive and physical awareness," he said. "But an almost complete paralysis of nearly all the voluntary muscles in my body."

The first sign that Marsh was recovering was with twitching in his fingers which spread through his hand and arm. He describes the feeling of accomplishment at being able to scratch his own nose again. But it's still a mystery as to why he recovered when the vast majority of locked-in syndrome victims do not.

"They don't know why I recovered because they don't know why I had locked-in in the first place or what really to do about it. Lots of the doctors and medical experts I saw didn't even know what locked-in was. If they did know anything, it was usually because they'd had a paragraph about it during their medical training. No one really knew anything."

Marsh has never spoken publicly about his experience before. But in an exclusive interview with the Guardian, he gave a rare and detailed insight into what it is like to be "locked in".

"All I could do when I woke up in ICU was blink my eyes," he remembered. "I was on life support with a breathing machine, with tubes and wires on every part of my body, and a breathing tube down my throat. I was in a severe locked in-state for some time. Things looked pretty dire.

"My brain protected me – it didn't let me grasp the seriousness of the situation. It's weird but I can remember never feeling scared. I knew my cognitive abilities were 100%. I could think and hear and listen to people but couldn't speak or move. The doctors would just stand at the foot of the bed and just talk like I wasn't in the room. I just wanted to holler: 'Hey people, I'm still here!' But there was no way to let anyone know."

Locked-in syndrome affects around 1% of people who have as stroke. It is a condition for which there is no treatment or cure, and it is extremely rare for patients to recover any significant motor functions. About 90% die within four months of its onset.

Marsh had his stroke on 20 May 2009. Astonishingly, four months and nine days later, he walked out of his long-term care facility. Today, he has recovered 95% of his functionality; he goes to the gym every day, cooks meals for his family and last month, he bought a bicycle, which he rides around Napa Valley, California, where he lives.

But he still weeps when he remembers watching his wife tell the doctors that they couldn't turn off his life support machine.

"The doctors had just finished telling Lili that I had a 2% chance of survival and if I should survive I would be a vegetable," he said. "I could hear the conversation and in my mind I was screaming 'No!'"

Locked-in syndrome is less unknown than it once was. The success of the 2007 film, The Diving Bell and the Butterfly, the autobiography of the former editor of French Elle magazine editor, Jean-Dominique Bauby, brought awareness of the condition to the general public for the first time.

Then in June, Tony Nicklinson challenged the law on assisted dying in England and Wales at the High Court as part of his battle to allow a doctor to end a life he said was "miserable, demeaning and undignified". Judgment was reserved until the Autumn.

Marsh, however, did something almost unheard of: he recovered. On the third day after his stroke, a doctor peered down at him and uttered the longed-for words: "You know, I think he might still be there. Let's see."

The moment that doctor discovered Marsh could communicate through blinking was one of profound relief for Marsh and his family – although his prognosis remained critical.

"You're at the mercy of other people to care for your every need and that's incredibly frustrating, but I never lost my alertness," he said. "I was completely aware of everything going on around me and to me right from the very start, unless when they had me medicated," he said.

"During the day, I was really lucky: I never spent a single day when my wife or one of my kids wasn't there. But once they left, it was lonely – not in the way of missing people but the loneliess of knowing there's no one there who really understands how to communicate with you."

The only way for Marsh to sleep, was to be medicated. That, however, only lasted four hours, after which there had to be a three-hour pause before the next dose could be administered.

In questions submitted by Guardian readers to Marsh ahead of this interview one asked about his experience of his hospital care while the staff did not think he was conscious. Marsh said: "The staff who work at night were the newest and least skilled, and I was totally at their mercy. I felt very vulnerable. I did get injured a couple of times with rough handling and that always happened at night. I knew I wasn't in the best of care and I just counted the minutes until I would get more medicine and just sleep.

In response to another question, about the right-to-die debate, Marsh said he has no opinion. All he will say is: "I understand the despair and how a person would reach that point." But he is co-writing a book that he hopes will inspire hope and provide information to victims of locked-in syndrome and their families.

"When they first told my family that I was probably locked-in, they tried to find information on the internet – but there wasn't any. One of my goals now is to change that … to be able to reach out to families who find themselves in the same situation that mine were in so they can help their loved ones.

"Time goes by so slow ... It just drags by. I don't know how to describe it. It's almost like it stands still.

"It's a terrible, terrible place to be but there's always hope," he added. "You've got to have hope."

• This article was amended on 10 August 2012. The original said that Tony Nicklinson had failed in his High court bid to change the law on assisted dying in England and Wales. This has been corrected.

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It is only a question of time until butea superba will be outlawed in the Western World. In some people, it can cause hypersexualization that can last for weeks. And it can easily be added to food to improve taste. Imagine a Thai restaurant breeding hundreds of super horney women prowling for any man they can get, and that for weeks on end.

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The Ward Weaver Case

On January 9, 2002, in Oregon City, Oregon, Ashley Pond, age 12, disappeared on her way to meet the school bus. It was just after 8 a.m. and Ashley was running late. The bus stop was just 10 minutes from the Newell Creek Village Apartments where Ashley lived with her mother, Lori Pond. But Ashley Pond never got on the bus and never made it to Gardiner Middle School.

Despite the efforts of the local authorities and the FBI, no clues surfaced as to whereabouts of the missing girl.

Ashley was popular at school and enjoyed being on the swim and dance teams. Neither her mother, friends or the investigators believed she had run away.

On March 8, 2002, just two months after Ashley disappeared, Miranda Gaddis, 13, also vanished around 8 a.m. while on her way to the bus stop at the top of the hill. Miranda and Ashley were good friends, and they lived in the same apartment complex. Miranda's mother, Michelle Duffey, had left for work within 30 minutes before Miranda was to catch the bus.

When Duffey found out that Miranda had not been at school, she immediately contacted the police, but once again, investigators came up empty. Without any leads to follow, the investigators began looking into the possibility that the person that abducted the girls were someone they knew and whoever it was seemed to be targeting the same type of girl. Ashley and Miranda were close in age, involved in similar activities, looked remarkably similar to each other, but most importantly, they both disappeared on the way to the bus stop.

A GRISLY DISCOVERY On August 13, 2002, Ward Weaver's son contacted 9-1-1 and reported that his father had attempted to rape his 19-year-old girlfriend. He also told the dispatcher that his father told him that he murdered Ashley Pond and Miranda Gaddis. Both of the girls were friends with Weaver's 12-year-old daughter and had visited her at Weaver's home.

On August 24, FBI agents searched Weaver's home and found the remains of Miranda Gaddis inside a box in the storage shed. The following day, they found the remains of Ashley Pond buried under a slab of concrete that Weaver had recently put down for a hot tub, or so he claimed.

WARD WEAVER WAS A CHALLENGE FOR FBI INVESTIGATORS Shortly after Ashley and Miranda disappeared, Ward Weaver III was a prime suspect in the investigation, but it took the FBI eight months to get a search warrant that eventually turned up their bodies on Weaver's property.

The problems for investigators were that they were awash in possible suspects -- some 28 suspects that lived in the same apartment complex could not be ruled out -- and for months authorities had no real evidence that a crime had been committed.

It was not until Weaver attacked his son's girlfriend, that the FBI was able to obtain a warrant to search his property.

WARD WEAVER Weaver, a brutal man with a long history of violence and assaults against women. He was also the man that Ashley Pond reported for attempted rape, but the authorities never investigated her complaint.

On October 2, 2002, Weaver was indicted and charged with six counts of aggravated murder, two counts of abuse of a corpse in the second degree, one count of sexual abuse in the first degree and one count of attempted rape in the second degree, one count of attempted aggravated murder, one count of attempted rape in the first degree and one count of sexual abuse in the first degree, one count of sexual abuse in the second degree and two counts of sexual abuse in the third degree.

To avoid the death penalty, Weaver pleaded guilty to murdering his daughter's friends. He received two life sentences without parole for the deaths of Ashley Pond and Miranda Gaddis.

REAL ROLE MODELS On February 14, 2014, Weaver's stepson Francis was arrested and charged with the murder of a drug dealer in Canby, Oregon. He was found guilty and given a life sentence. This made Frances the third generation of Weavers that were murderers.

Ward Pete Weaver, Jr., Ward's father, was sent to California's death row for the murder of two people. He buried one of his victims under a slab of concrete.

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Arson is the terrorism of the future. Maximum damage. No need to sacrifice their lives.

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