Parents Who Kill Their Children Not Psychopaths but Have Emotional Dysfunction

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May 29, 2009 — Unlike other murderers, parents who kill their own children are not typically psychopathic, socially isolated substance abusers with a long criminal record but may have distinct emotional problems that include the inability to feel remorse or empathy, according to a new study.

Researchers in Finland who compared men and women who commit filicide with an age- and sex-matched group of people accused of homicide found that filicide offenders are also more likely to attempt suicide.

This research is important because it underlines the differences among people who commit murder, said study author, Hanna Putkonen, MD, PhD, from Vanha Vaasa Hospital, in Finland. "If you want to prevent violence, you need to know the details. It's important to know subgroups to help focus on distinct ways to prevent the crimes and also to help the offenders to not reoffend," Dr. Putkonen told Medscape Psychiatry.

Providing help to struggling parents might decrease the risk for filicide, she added. "Healthcare and social services professionals should be aware of the demise of some families and support the parents before their despair becomes too deep. Given the economical situation at present, there are families with severe difficulties who need support to survive, so this might be an increasingly important task."

The study is published online May 29 in BMC Psychiatry.

No Evidence of Psychopathology

Based on forensic psychiatric reports for all 749 people accused of homicide in Finland between 1995 and 2004, researchers identified 25 cases of filicide committed by 20 offenders, 13 female and 7 male. The mean age of the offenders was 36 years (25 for females and 40 for males). The mean age of the 25 child victims was 4 years, and 7 were less than a year old.

A control group consisted of a random sample of 20 age- and sex-matched homicide offenders taken from the national database. In this control group, 12 offenders were parents. The mean age of their victims was 47 years.

Investigators used the Hare Psychopathy Checklist-Revised (PCL-R), a 20-item scale based on a semistructured interview and other relevant information. A score of 30 or more out of a possible 40 indicates psychopathology, although a cutoff of 25 is sometimes used.

Among other attributes, the PCL-R checklist assesses glibness, grandiose sense of self worth, need for stimulation, pathological lying, cunning, failure to accept responsibility, lack of remorse, lack of empathy, impulsivity, and level of behavioral control.

The study found that the mean PCL-R score for the filicide group was 10.2 compared with 21.9 for the comparison group. None of the filicide offenders had a score at or above 30, and only 2 had a score of 25 or more, while 3 of the comparison group scored 30 or more and 7 scored 25 or more.

Might Be Treatable

These findings provide evidence that filicide offenders are not true psychopaths and so might be treatable, said Dr. Putkonen. "It may be that the prognosis is better when you're not a psychopath. In general, psychopathy is not something that we are able to treat very well."

However, in some psychopathology assessments — for example, lack of remorse, lack of empathy, and failure to accept responsibility — the filicide group's scores increased, suggesting individuals who commit filicide have an emotional dysfunction.

Emotional problems might render vulnerable parents incapable of handling even everyday difficulties, according to Dr. Putkonen. She cited another of her studies that found that being separated from their family was the most common situation faced by filicidal fathers. Twelve of the filicide offenders in the current study had lost custody of a child at some point.

Underprivileged families need help to cope, especially when facing current or imminent separation issues, stressed Dr. Putkonen. "It does seem that [improved] general welfare decreases filicide. Another proof of this is the fact that the killing of small children has decreased in Finland during the past 50 years — in line with societal development."

Dr. Putkonen suggested that adding more questions along the lines of "how do you feel?" might be useful when screening for psychopathology.

The researchers found other differences between the filicide and homicide groups. Filicide offenders, for example, were more likely to have attempted suicide immediately after the offense (50% vs 0%). According to Dr. Putkonen, this suggests that in addition to an antisocial dysfunctional group, there is also another suicidal group that makes up filicide offenders.

Urgent Need for Larger Studies

Although the study sample included more women than men, the sex distribution among all Finnish filicide offenders is about equal. "It's just that fathers kill themselves more often than do mothers," said Dr. Putkonen

Compared with the controls, filicide offenders were also more likely to be employed at the time of the offense (53% vs 15%) and less likely to be intoxicated with alcohol (40% vs 80%), to have offended previously (20% vs 65%), and to have been hospitalized for a psychiatric disorder (30% vs 65%).

Three of the filicide offenders suffered from psychotic depression, a diagnosis that might play a larger role in filicide than this statistic suggests, as other offenders with this diagnosis might have committed suicide.

In Finland, as elsewhere, an offender who was psychotic during an offense — and so did not realize the consequences of or could not control her or his actions — is deemed not criminally responsible. In this case, the offender usually receives psychiatric treatment. "I do agree with our legislation; someone who is ill has to be treated, not punished," said Dr. Putkonen.

Rare Phenomenon

The authors note that prevention of filicide should not be the role of psychiatry alone. "Healthcare and society at large must work to forestall the danger of filicide," they write. They also highlighted the urgent need for international cooperation to study filicide in a large-scale database.

Previous studies had shown a connection between filicide and parental psychiatric illness, specifically major depression with psychotic features. Research has also found personality disorders, particularly borderline personality disorder, to be frequent in both male and female filicide offenders.

Filicide is a rare phenomenon — ranging from 0.6 per 100,000 children under 15 years to 2.5 per 100,000 children under 18 years. However, these rates may be underestimated, as coroner rulings may be inadequate, the authors note.

As for homicide in general, Finland has a relatively high rate — 2.5 per 100,000 in 2005 — due in part to a large, marginalized male population who get into altercations while intoxicated, said Dr. Putkonen. In Finland, she said, 10% of the population is responsible for 50% of all alcohol consumed.

Study Looked Only at Living Offenders

When asked by Medscape Psychiatry to comment on the study, Phillip Resnick, MD, from Case Western Reserve University, in Cleveland, Ohio, said 1 of strengths of the research is that it included all cases of filicide in Finland and was not restricted to prison or psychiatric populations.

However, he added, 1 of the study's drawbacks is that it looked only at living filicide offenders and not at the very high number who committed suicide. "That's a distortion of the conclusion that filicide offenders are no sicker than homicide offenders, because the sickest ones are killing themselves, and they're not in the study."

Another way to study filicide would be to carry out a psychological autopsy on those who do kill themselves and include that information in the study, he said. Dr. Resnick said he has probably seen as many filicide offenders as anyone in the United States.

Of the study investigators, Dr. Nina Linberg has received travel funds from Novartis and Bristol-Myers Squibb during 2008; Dr. Markku Eronen has received speaker's honoraria from Bristol-Myers Squibb, AstraZeneca, Orion, and Novartis; and Dr. Helina Hakkanen from Bristol-Myers Squibb. These are single occasions with minor economic significance. All other authors report no competing interests.

BMC Psychiatry. Published online May 29, 2009.
Authors and Disclosures
Journalist
Pauline Anderson

Pauline Anderson is a freelance writer for Medscape.