A meta-synthesis of filicide classification systems: psychosocial and psychodynamic issues in women who kill their children

Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder

Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around "pregnancy denial," "pregnancy concealment," "neonaticide," and "dissociation" were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.

A Qualitative Study of Mentally Ill Women Who Commit Filicide in Gauteng, South Africa

Introduction: Filicide is the deliberate act of a parent killing his/her own child and a major contributor to child homicide rates. In order to prevent future homicides of this nature and aid in the rehabilitation of those mentally ill women who perpetrate these crimes, it is important to gain a better understanding of the dynamics that may result in filicide and the association of the mental illness with filicide. It is also important to explore how the rehabilitation processes are experienced and the impact they have had. The purpose of this study was to examine the perceptions of women regarding their offenses and their perceptions about their treatment and rehabilitation in a South African context. Method: This was a qualitative study which followed a naturalistic paradigm. The data from the semistructured interviews conducted were analyzed using thematic analysis. The use of subjective experiences and descriptions by the participants aimed to give a representation of the participants' lived experience. This allowed the authors to explore the emerging themes, subthemes, and concepts and organize the most replicated information into a hierarchical assessment. The semistructured interviews were conducted with seven filicidal women with mental illness between July 2016 and April 2017 at Sterkfontein Hospital, Gauteng, South Africa. Results: Most filicidal mothers were psychotic at the time of the offense and perceived trauma and remorse for their offenses. Support from the community and empathy and unconditional positive regard from the staff, notably psychologists, and occupational therapists were overwhelmingly present. Conclusion: Filicide is tragic and largely understudied, particularly from the perpetrator's perspective. When perpetrators are mentally ill, rehabilitation within a nonjudgmental and empathetic environment is necessary.

Maternal filicide in a cohort of English Serious Case Reviews

A national mixed-methods study of English Serious Case Reviews (SCRs) was carried out to better understand the characteristics and circumstances of maternally perpetrated filicides, to compare these with paternally perpetrated cases, and to identify learning points for mental health professionals. Published reports for all SCRs of children in England dying as a result of abuse or neglect from 2011 to 2014 were subject to qualitative analysis using a system of layered reading and inductive thematic analysis, along with descriptive and comparative quantitative analysis. There were 86 deaths directly attributable to child maltreatment within the immediate family. The mother was the suspected perpetrator in 20. Twelve of the mother perpetrators were victims of domestic violence, while 15 of the father perpetrators were known to be perpetrators of domestic violence. Those deaths resulting from impulsive violence or severe, persistent cruelty are almost exclusively perpetrated by males, while those with an apparent intent to kill the child are slightly more likely to be perpetrated by mothers. Four key themes were identified through the qualitative analysis: domestic violence, maternal mental illness, separation and maternal isolation, and the invisibility of the child. These findings highlight the important role of domestic violence and its interaction with maternal mental health. Professionals working with mothers with mental health problems need to adopt a supportive but professionally curious stance, to be alert to signs of escalating stress or worsening mental ill-health, and to provide supportive and accessible structures for at-risk families.

Death by starvation. Seeking a forensic psychiatric understanding of a case of fatal child maltreatment by the parent

In the Western world, cases of fatal child neglect due to starvation are extremely rare. When they do occur, particularly at the hands of a parent, such crimes are considered to be caused by mental disorders or personality disorders with severe affective impairment. The present report describes the peculiar case of a couple with a total of four children to care for, who starved a 16-month-old female to death, while all the other children were found to be healthy. After a forensic psychiatric assessment of their criminal responsibility, the couples were both judged guilty and sentenced to 30 years in prison. After a brief overview of the scientific knowledge about filicide, the authors propose a framework that may help to understand and explain the motivations underlying this dreadful crime that shocked the nation, and emphasize the role of the forensic psychiatric investigation into cases of filicide, which may contribute to gain a greater insight into the different motivational factors underlying this phenomenon.

Mother’s filicide with suicide attempt

Introduction. Filicide is the killing of a son or daughter by a parent. The paper examines interaction between stress and maternal psychopathology that led to the killing. Case Outline. After prolonged conflict with her ex-husband and father of her only child, the respondent committed filicide. Two years before committing filicide, after she had divorced the father of the child, the respondent attempted suicide and had to be hospitalized. On that occasion, she was diagnosed with depressive disorder, which was not treated after hospitalization. Having killed her daughter by cutting her throat, she tried to commit suicide in the same manner, by slitting her throat. During further observation, the respondent was found to suffer from acute psychotic disorder, depressive disorder and histrionic personality disorder. These disorders in interaction with stress do not provide us with an explanation for an unusual and psychopathological motivation analysis of killing the child. Conclusion. Filicide is a violent act, most frequently multifactorial in its nature. Histrionic personality disorder in mother cannot explain the filicide act. Only interactive and dynamic evaluation of this psychiatric disorder in its longitudinal, development aspects and its potentiality to enable the expression of some other psychiatric disorders, especially dissociative states, as well as the importance of prolonged and acute stress and its subjective importance for the individual can shed some more light on the mental state of the mother at the time of filicide.