PSYCHIATRY & BEHAVIORAL SCIENCES
Alexandre M. ValenÅa,1,2M.D., Ph.D.; Mauro V. Mendlowicz,1M.D., Ph.D.;
Isabella Nascimento,3M.D., Ph.D.; and Antonio E. Nardi,3M.D., Ph.D.
Filicide, Attempted Filicide, and Psychotic
ABSTRACT: The objective of the study was to describe and discuss the cases of two women who faced criminal charges, one for attempting to
murder her three children and the other for killing her 1-year-old boy. After a forensic psychiatric assessment of their level of criminal responsibility,
these patients were considered not guilty by reason of insanity and were committed to forensic mental hospitals. These two patients received a diag-
nosis of paranoid schizophrenia, according to the DSM-IV-TR criteria. In both cases, psychotic symptoms were present before the manifestation of
violent behavior, in the form of persecutory delusions, auditory hallucinations, and pathological impulsivity. The investigation into cases of filicide
may contribute powerfully to expand our understanding of motivational factors underlying this phenomenon and enhance the odds for effective
KEYWORDS: forensic science, violence, crime, schizophrenia, homicide, murder
Filicide is generically defined as the killing of a child by a bio-
logic or an adoptive parent (1,2). Other terms are employed to
describe the murder of children in more specific contexts. Neonati-
cide is the killing of an infant during the first 24 h of life (3). In
criminal law, infanticide refers to the killing of an infant who is
<12 months old by a mother who has not fully recovered from
pregnancy or who suffers from some degree of mental disturbance
Psychotic symptoms can induce people with serious mental dis-
order to believe that they are in mortal danger and lead to assaults
and even murders. A study by Taylor (5) found a strong association
between psychotic symptoms and recent violent behavior, given
that 93% of her sample presented psychotic symptoms when they
committed these crimes and 47% were ‘‘probably’’ or ‘‘defini-
tively’’ motivated by these symptoms. Other studies also found an
association between persecutory delusions and auditory hallucina-
tions and the motivation to commit murder (6,7). In a study that
examined filicidal mothers, Lewis and Bunce (8) evaluated 55
women who were divided into psychotic (n = 29) and nonpsychotic
groups (n = 26). Within the first group, 18 (62.1%) women had
command hallucinations, 23 (79.3%) reported paranoid delusions,
15 (51.7%) believed their children were dangerous, and 26 (89.7%)
heard auditory hallucinations.
It has been suggested that, besides psychotic symptoms, other
factors may predispose women to kill their children. These include
financial difficulties, social isolation, being a single mother, work
problems, factors related to the upbringing and education of
the mother, history of sexual abuse during early years of life,
marital troubles, jealousy, alcohol abuse, physical illness, and mood
In fact, of 89 women who were admitted to a safeguarding hos-
pital in England during the years 1970–1975 under the charge of
having killed one or more of their children (n = 109) and diag-
nosed as suffering from a mental disorder, only 24 were diagnosed
as such at the time of the study and only 14 of them showed psy-
chotic disorders (10). None of the women who had killed newly
born babies (neonaticide) were considered to have mental disorders.
Maternal mental disorder was more frequently implicated in the
killing of children of a year or more in age. The findings of this
study reinforce the idea that there is an association between mater-
nal filicide and the presence of certain stress factors in the mother’s
life, such as having been a victim of domestic violence, early
parental separation, and record of attempted suicide.
Among the serious mental disorders that are associated with fili-
cide, schizophrenia and mood disorders are the most prevalent.
Friedman et al. (11) undertook a retrospective study of women with
mental disorders who committed filicide and were considered not
guilty by reason of insanity. The sample consisted of 39 mothers
who attempted to kill 54 of their 91 children and succeeded in kill-
ing 46. Eighty-two percent of the women received a diagnosis of a
psychotic disorder or of a mood disorder. Krischer et al. (12)
reviewed the records of 840 women who were committed to a
forensic psychiatric hospital under the charges of filicide (n = 45)
or attempted filicide (n = 12). There were seven cases of neonati-
cide, 12 of infanticide, and 37 of filicide. Sixty-three percent of the
female offenders were diagnosed with a mental disorder related to
the schizophrenic spectrum (schizophrenic, schizoaffective disorder,
and delusional disorder) and 30% to one related to the affective
spectrum. A review of 85 filicide cases in Turkey (13) showed that
nearly half of the perpetrators had been diagnosed with serious
1Department of Psychiatry and Mental Health, Universidade Federal Flu-
minense (MSM-UFF), Niter?i, RJ, Brazil.
2Universidade Severino Sombra, Vassouras, RJ, Brazil.
3Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB-
UFRJ), Rio de Janeiro, RJ, Brazil.
*Supported by the Brazilian Council for Scientific and Technological
Development (CNPq)—Grant #306290⁄2006-5; and the National Foundation
for the Development of Private Higher Education (FUNADESP)—Grant
Received 1 Nov. 2009; and in revised form 30 Jan. 2010; accepted 7 Feb.
J Forensic Sci, March 2011, Vol. 56, No. 2
Available online at: onlinelibrary.wiley.com
? 2011 American Academy of Forensic Sciences
mental disorders, including schizophrenia (61%) and major depres-
sion (22%). The majority of the victims were <12 years old (82%).
It must be noted, however, that although statistical and empirical
evidence indicates a positive relationship between severe mental
disorder and violent behavior, this association accounts for a rela-
tively small proportion of the violence that occurs in society. In
underdeveloped countries with high levels of community violence,
where criminality is usually associated with precarious socio-
economic conditions, the relative contribution of mental disorders
to homicides statistics is usually less substantial and social and
familiar factors may play a more significant role.
So far, few studies have investigated the epidemiology of child
abuse in Brazil. In a survey conducted by Ferreira (14) in a pediat-
ric unit in the city of Rio de Janeiro, most victims were girls
(70.5%) and were aged between 2 and 10 (81.7%). Intrafamilial
abuse accounted for 47.3% of the cases. In a recent report issued
by the Brazilian Multiprofessional Association for the Protection of
Children and Adolescents on 1547 cases of child abuse, 52% of
the victims were aged between 7 and 14, 37% were younger than
6 years of age, and 11% were between 15 and 18. In 76% of the
cases, the victims were girls (15). A study conducted in the city of
Campinas (Center for Reference, Studies and Interventions for
Children and Adolescent) involving 3644 cases of suspected child
abuse found that 47.1% victims had been physically harassed,
20.2% were neglected or abandoned, 10.9% had been psychologi-
cally abused, and 6% had a history of sexual molestation. In the
remaining 15.8% of the cases, the suspicions were found to be
baseless (15). The vast majority of the offenders did not meet crite-
ria for legal insanity.
Mendlowicz et al. (16) performed a retrospective study of 53
women accused of murdering their newborn children in the city of
Rio de Janeiro, Brazil, between 1900 and 1995. The authors found
that 11 neonaticidal women were referred for psychiatric evalua-
tion, but only nine had their mental health assessed. Four of them
had previously reported experiencing abnormal mental states during
the offense. While one of them was diagnosed with mental retarda-
tion, the other eight were considered mentally competent to stand
We will now present the cases of two women who faced crimi-
nal charges, one for attempting to murder her three children and
the other for killing her 1-year-old boy. After a forensic psychiatric
assessment of their level of criminal responsibility, these patients
were considered not guilty by reason of insanity and were commit-
ted to forensic mental hospitals. Information about these cases was
obtained from case records and clinical examination by the authors.
A. is a 39-year-old, divorced, illiterate black woman who was
raised by adoptive parents. According to legal records, in 2006, the
patient threw her three young children, a 4-year-old girl and two
boys, aged 3 and 1, into a river near her house. The young would-
be victims escaped unharmed as they were immediately rescued
from drowning by a bystander. The patient lived with her children
(offspring of two different partners) and an aunt. Her last compan-
ion had abandoned her approximately a year before the attempted
murder. The patient used to work as a house servant. There were
no previous reports of aggressive behavior toward the children, of
psychiatric treatment, or of alcohol and drug abuse. At the time of
the criminal deed, the patient was not undergoing any type of treat-
ment or using medications. It has been reported that in the days
preceding the crime, the patient was agitated, sleepless, mumbling,
and talking continuously to herself. She presented psychotic
symptomatology characterized by persecutory delusions, auditory
hallucinations, formal thought disorder, and poverty of speech. A.
was given a diagnosis of paranoid schizophrenia (DSM-IV-TR)
(17), found not guilty by reason of insanity, and committed for
During the forensic examination, A. stated that ‘‘I was hearing
voices telling me to kill myself and my children…it was despera-
tion, my husband drop me out and left me on my own to look after
the children…I thought I not would be able to bring up the three
children without a father’’. She denied any form of physical abuse
toward the children before the crime. At the time of our psychiatric
examination, the patient showed marked lack of personal care, dis-
organized discourse, blunted affect, persecutory delusions, and ideas
B. is a 43-year-old, single, black, elementary school dropout
woman. According to her criminal records, in 1987, the patient
killed her 1-year-old son by throwing him through the window of
the apartment where they lived. She had no companion and did not
know who the father of her child was. In the legal-psychiatric eval-
uation, the patient reported that she got into a harsh argument with
her sister, because B. wanted to go out while leaving the child
alone at home. B. told us that: ‘‘I don’t know what happened...I just
did it...it occurred to me that the suffering of bringing up a child
with difficulty had just begun...I thought that I would not have
money enough to pay for schooling and that at school they would
mistreat my child....I thought that they would abuse him because
he was dark skinned.’’ She also believed that she was being
targeted by strangers just for being black. B. had several previous
psychiatric hospitalizations. At the time of her first hospitalization,
when B. was just 19 years old, she told us that she used ‘‘to hear a
voice in my head and imagined a lot of things.’’ She often talked
to herself, walked aimlessly through the streets, and threw stones at
the bystanders. She had already been arrested several times for
assaulting people in the streets. B. also had a history of alcohol
abuse since she was 21 years old. In her hospital records, there
were several reports of physical aggression against other female
inpatients. Her psychiatrist described thought disorganization, perse-
cutory delusions, ideas of self-reference, and irritable mood. At the
time of our psychiatric examination, B. showed markedly blunted
affect and indifference. The patient told us that: ‘‘I think that they
(the female inpatients) are jealous of me, they look at me in a dif-
ferent way.’’ B. was given a diagnosis of paranoid schizophrenia
(DSM-IV-TR) (17), found not guilty by reason of insanity, and has
been committed for involuntary treatment for the last 20 years.
Relatively little is known about the factors and circumstances
predisposing to maternal filicide, and this lack of knowledge limits
our capacity to intervene effectively to prevent it. From a medico-
legal perspective, issues regarding the nature and intensity of the
mental disturbances and how they may influence the assessment of
the degree of criminal responsibility of the offender are major con-
cerns associated with the act of filicide (4).
In Brazil, the most important expert examination is the Penal
Imputability Exam, which consists of a psychiatric examination that
starts with the study of the criminal process and with interviews
with the patient. The evaluation of criminal responsibility, accord-
ing to the Brazilian Penal Code, is based on a biopsychological
concept. This implies that full penal responsibility can only be
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excluded if the offender was, at the time of the criminal deed, suf-
fering from a mental disorder (i.e., a biologic cause) and, as a con-
sequence, was completely incapable of understanding the unlawful
nature of his⁄her acts or to restrain him⁄herself from committing
them (psychological consequences). The existence of a causal link
between the mental disorder and its psychological consequences
must be established beyond doubt (18). The possibility of cases
with limited responsibility, which result from partial impairment of
cognitive or volitional functions, is also acknowledged. Those who
are deemed not responsible for their unlawful acts are committed
to involuntary treatment in forensic mental hospitals. Therefore, the
diagnosis of a serious mental disorder is an essential prerequisite to
exclude the penal responsibility of any filicidal mother and to have
her treated, rather than punished.
D’Orban (10) demonstrated that maternal mental illness was
more likely to be implicated in the killing of children older than
1 year. Our two vignettes illustrate this aspect well. They represent
cases of real or attempted pathological filicides, in which the parent
was undoubtedly suffering from a major mental disorder at the time
of the crime. Both offenders obviously lacked the psychological,
material, and social resources to cope with the significant stressors
they were facing just before the criminal event. They had limited
social support, were living in a situation of conflict with other fam-
ily members, felt overburdened as the primary caregiver of their
children, and faced worsening mental illness. In Case 1, for
instance, the patient complained that she has been abandoned by
her husband. In Case 2, B. described situations of family conflict.
In our two cases, the patients also presented persecutory delu-
sions and auditory hallucinations at the time of the crime. Patient
A. even described command hallucinations instructing her to kill.
Given the current state of knowledge showing relatively high rates
of serious psychopathology among parents who kill their children,
it has been recommended that forensic psychiatrists keep a high
index of suspicion for the presence of serious mental illness when-
ever they examine a filicide offender (2). The diagnosis of psycho-
sis has obviously important implications for treatment planning,
prognosis, and preventive efforts in filicidal women. It is critical to
acknowledge that psychotic motivation for filicide transcends cul-
tural and national boundaries; although we have reported cases that
happened in Brazil, similar cases can possibly occur in almost any
A recent study found that that the most common cause of death
was asphyxia (in 38% of the cases), followed by assault with
instruments (in 20% of the cases) (13). Beating and suffocation
were the methods most commonly employed by women to kill
their children (8,11). In contrast with the findings of previous stud-
ies on filicide, in neither of our cases were asphyxia nor any poten-
tially lethal instrument employed (19). Their atypical, nearly bizarre
actions were characteristic of the unplanned, impulsive acts evolv-
ing from high levels of situational stress, frustration and anger, and
reflecting a deeply distorted contact with reality.
A past record of aggressive behavior has consistently been con-
sidered as a forewarning of future acts of violence in several popu-
lations of patients (20,21). In our second case, the patient had a
history of markedly aggressive behavior even before killing her
child. This observation highlights the importance of adopting pre-
ventive strategies, which should include immediate intervention at
the first signs of impeding violence. A thorough investigation into
a history of alcohol or drug abuse in filicidal women is also para-
mount. Current or recent use of alcohol, as in our second case,
could negatively affect factors as mood stability or the severity
of psychotic symptoms. It could also increase refractoriness to
treatment and worsen prognosis (22).
While a number of studies found that poor attendance at outpa-
tient visits and lack of compliance with treatment frequently pre-
ceded murders committed by individuals with severe mental
disorders, others reported that homicide seems to occur soon after
the beginning of mental disorder, even before the offender has
established a contact with mental health services (23,24). In only
one of the two cases reported here, the patient had a record of previ-
ous psychiatric treatment. However, neither of them was under psy-
chiatric treatment at the time of the crime, illustrating the fact that
many patients with homicidal penchant were not undergoing regular
treatment before manifesting this kind of behavior. It is important
that the mental health services work with patients and families to
increase attendance at psychiatric outpatient clinics and to foster
treatment compliance in people with severe mental disorders.
The investigation into cases of filicide may also help establish
the risk factors for lethal when compared to nonlethal child mal-
treatment, expand our understanding of motivational factors under-
lying this phenomenon, and thus further contribute to effective
prevention. Despite the fact that prospective studies are considered
more effective for the determination of risk factors from a method-
ological point of view, the relative rarity of filicide makes this
undertaking difficult. Besides current and past psychiatric diagnosis,
studies should investigate other risk factors for filicide, such as
sociodemographic and cultural factors, level of social support, and
history of previous interpersonal violence.
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Additional information—reprints not available from author:
Alexandre Martins ValenÅa, M.D., Ph.D.
Department of Psychiatry and Mental Health
Universidade Federal Fluminense
Rua MarquÞs do Paran?, 303—3/ andar—Pr?dio Anexo ao HUAP
Niter?i, RJ 24030-210, Brazil
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