Oct 2, 2019
Susan Hatters Friedman, MD, joins Lorenzo
Norris, MD, host of the MDedge Psychcast and editor in chief of
MDedge Psychiatry, to talk about family murder.
Dr. Hatters Friedman is the Phillip J. Resnick Professor of
Forensic Psychiatry at Case Western Reserve University in
Cleveland. She also is professor of pediatrics and reproductive
biology, and adjunct professor of law at Case Western.
In addition, Dr. Hatters Friedman is editor of Family Murder: Pathologies of
Love and Hate, which was written by the Group for the
Advancement of Psychiatry’s Committee on Psychiatry & Law.
Show notes by Jacqueline Posada, MD, consultation-liaison
psychiatry fellow with the Inova Fairfax Hospital/George Washington
University program in Falls Church, Va.
Overview of family murder
- Family murder is defined as situations in which any member of a
family kills another family member. It encompasses a wide scope of
violence that includes intimate partner homicide; infanticide,
including purposeful feticide; neonaticide (murder in first day of
life); siblicide; and parricide (a child killing a
- The book, Family
Murder: Pathologies of Love and Hate, discusses the
epidemiology and public health implications of family murder,
various motivations, and pertinent psychiatric assessments,
including risk assessments and sanity evaluations. It was written
to prompt better screening and risk assessments, with the goal of
Motivating factors leading to murder
Phillip J. Resnick, MD, who also works in forensic psychiatry
at Case Western, identified five main motives of parent-child
- Fatal maltreatment is the result of fatal
neglect or abuse by a parent. This type of family murder is common
and is most likely to be prevented, especially with intervention by
Child Protective Services.
- Altruistic murder occurs in three categories
in which a parent wants to spare a child from perceived
- Psychotic parents with delusions about their children being
- Murder-suicide, such as when a severely depressed and suicidal
parent kills their child to avoid leaving them without a parent
after their suicide.
- Parents who kill a child with serious, chronic physical illness
as a means of “saving” the child from a “worse” fate.
- Acutely psychotic murder occurs in the context
of serious mental illness such as schizophrenia, bipolar disorder,
or postpartum psychosis. Preventing this type of murder means
monitoring the content of delusions and hallucinations related to
family members. The Andrea
Yates murders are a prime example of this type of murder.
- Unwanted child motive is most common in
neonaticide cases. The child is considered a hindrance to something
the parent wants, such as a relationship. To screen for this risk,
physicians can ask whether the pregnancy was planned and observe
the interaction between child and parent, especially during the
first hours to days of life.
- Partner revenge is rare but is most likely to
occur in context of a custody battle, with one partner seeing
murder as a means of revenge. Psychiatrists can observe
interactions between partners and inquire about threats from
Screening and preventing violence
- Psychiatrists can screen for violence by asking: “How are
disagreements handled in your family?” This broad, neutral question
elucidates family dynamics about partner violence, anger, and
negative parental practices. It can generate information aimed at
preventing fatal outcomes.
- Strong human emotions, such as anger, jealousy, and pride,
combined with risk factors such as a history of violence and access
to weapons, drive family murder.
- Psychoeducation about childhood development can decrease the
risk of violence, especially in the fatal maltreatment
Addressing countertransference issues
- Family murder stimulates strong countertransference in response
to the perpetrator. Working as a team can diffuse these emotions
and allows a venue for processing.
- Building rapport with patients and recognizing their humanity
by using phrases such as “When he died,” rather than “When you
Pathologies of Love and Hate. Group for the Advancement of
Hatters Friedman S. Filicide-suicide: Common factors in parents
who kill their children and themselves. J Am Acad Psychiatry Law. 2005
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