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Received: 7 February 2021    Revised: 13 May 2021    Accepted: 20 May 2021

DOI: 10.1111/1556-4029.14780

PAPER
Psychiatry & Behavioral Science

Maternal filicide and mental illness: A descriptive study of 17

women hospitalized in a French secure unit over a 24-­year
period

Sophie Raymond MD1 | Marie-­Victoire Ducasse MD2 | Marion Azoulay MD1 |

Ivan Gasman MD3

1
SMPR, GHU Paris Psychiatrie et
Neurosciences, Paris, France
2
Liaison Maternité –­CH Gonesse,
Gonesse, France
3
UMD –­GH Paul Guiraud, Villejuif, France
Correspondence
Sophie Raymond, MD, SMPR –­GHU
Paris Psychiatrie et Neurosciences, Paris,
France.
Email: s.raymond@ghu-paris.fr
Abstract
Maternal filicide is defined as the murder of a child by its mother. Many classifications
have been elaborated based on underlying motives such as altruism, mental pathology,
fatal maltreatment, spousal revenge, or an unwanted child. Pathological filicide refers
to cases in which the perpetrator has a major psychiatric illness. Related literature is
sparse. The present work proposes to identify the main characteristics of mentally ill
filicidal mothers. This study was based on data gathered through a retrospective chart
review of all filicidal women admitted to the Henri Colin secure unit (France) between
1996 and 2019 (N = 17). Most filicidal mothers had a dysfunctional childhood marked
by emotional neglect, intrafamilial violence, or social isolation. They were often mar-
ried, on average about 32 years old. We found a history of attempted filicide in 3 cases,
and abuse or neglect in 3 other cases. The victim's average age was 6.2 years old, and
in several cases, multiple siblings were murdered. Half of the filicidal mothers had a his-
tory of psychiatric disorders. Three different diagnoses were found in our study: bipo-
lar or depressive disorders (41.2%); schizophrenia or other psychotic disorders (41.2%);
personality disorders (17.6%). We identified two subgroups, as having different moti-
vational profiles. In the first group, filicide is a defensive reaction to a perceived threat:
The murder is committed under the influence of hallucinations or delusions. In the sec-
ond group, filicide is linked to a context of separation, real or imagined. Several forensic
and psychopathologic features associated with each profile are detailed.

KEYWORDS
child murder, filicide, forensic psychiatry, homicide, infanticide, psychopathology

Highlights
• The goal of this study is to provide an analysis of maternal filicide and to identify the main
characteristics of mentally ill filicidal mother.
• This study is limited to a small group of patients hospitalized in a French secure unit.

Presented at the 72nd Annual Scientific Meeting of the American Academy of Forensic
Sciences, February 17–­22, 2020, in Anaheim, CA.

© 2021 American Academy of Forensic Sciences     1

J Forensic Sci. 2021;00:1–11. wileyonlinelibrary.com/journal/jfo |
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2      RAYMOND et al.
• This work completes the classifications established from larger samples, by describing two
psychopathological profiles.
• This article may impact the forensic science community by improving the understanding of
maternal filicide.
1  |  I NTRO D U C TI O N
Different terms exist to describe the murder of a child. Infanticide
is used either in the general meaning of a child murder regardless
of its age, or more specifically when the child is more than a day
old, but under 12 months. The word's origins are to be found in the
Latin infans meaning “child” and caedere meaning “kill,” and the term
designates both the act of committing such a crime and the person
who commits it, without presuming any relationship between victim
and murderer. In 1969, Resnick [1] presented two other terms: neo-
naticide, which referred to the killing of a newborn child within the
first 24 h of its life, and filicide—­from the Latin filius, in the sense of
filiation—­defined as the killing of a son or of a daughter.
If the murder of a child by its own parent is seen today as an
unthinkable act of violence, this has not always been the case.
Historically, infanticide has been tolerated for two specific reasons:
the killing of an unwanted child or that of a disabled child [2]. During
antiquity, suffocating, starving, or “exposing” one's child (leaving it
abandoned in a public place for instance) were permissible under
Roman law [3,4].
Many examples of infanticide exist in Greek mythology—­often
with a sacrificial dimension—­where the male protagonist seeks
to protect or save his throne or his glory. Kronos for example de-
vours his children to make sure they will not dethrone him, while
Agamemnon kills his daughter Iphigenia so that he may travel to
Troy. In other instances, we find a female protagonist who mur-
ders her children out of spite or for revenge. Such is the case with
Medea who kills her own children when Jason leaves her for an-
other woman.
We can see further examples of infanticide in the Bible,
where children are sacrificed so that, as is the case with
Abraham and his son Isaac, one may prove one's faith in and
loyalty to God.
Fairytales also abound with similar plots where parents aban-
don their children, most of the time because they can no longer
feed or care for them, such as the story of Little Poucet and his
brothers or of Hansel and Gretel. Finally, infanticide is also de-
picted in classic literature where maidservants who fell pregnant
would kill their unwanted child in order not be dismissed [5].
If from time immemorial infanticide has always existed as a cross-­
cultural issue [6–­10], the punishment for such a crime has varied.
Historically, the death penalty was meant to be the rule, but was ac-
tually not often carried out as most judges and jurors did not want to
hand down guilty sentences and condemn women who killed their
children, regardless of the overwhelming evidence against them
[2]. The question of the murderer's insanity was raised in the 19th
and 20th centuries in many European countries [2,11]. For example,
The Infanticide Act was written into English Law in 1922: It basically
stated that women were strongly affected and mentally disturbed by
child birth, transforming infanticide into a less serious criminal offense
than murder [2,4].
2  |  R E V I E W O F TH E LITE R AT U R E
2.1  |  General data on filicide
Filicide is generally described as a relatively rare crime. In France,
a controversy has emerged due to differences between estima-
tions made by the national observatory of delinquency and penal
responses (ONDRP) and those made by the center for epidemiol-
ogy on the medical causes of death (CépiDC). In 2015 for instance,
the former estimated that 72 children under 15 were murdered,
while the latter recorded 31  homicides against minors under 15
during the same period. Such a significant difference has led some
authors to claim that infanticide is greatly underestimated and that
instances of SIDS (sudden infant death syndrome), particularly those
of children “found dead,” could in fact be homicides not identified as
such [12,13]. Tursz conducted a 5-­year retrospective study in three
French departments between 1996 and 2000 and estimated the
average annual number of infanticides to be about 255 nationwide.
In Canada, Bourget & Gagné [14] reported that approximately
15% of homicide victims are children under 18, and in most cases,
the parents are the perpetrators. Children under the age of one seem
to be at much greater risk of becoming victims than children of any
other age groups [14]. In the United States, a study based on FBI’s
supplementary homicide reports (SHR) for a period of 32 years, from
1976 to 2007, recorded a relatively stable incidence of filicide with
an average of 2942 filicides occurring annually [15].
Several infanticide classifications have been suggested, with
descriptive axes, concentrating mostly on the motives behind the
crime. The first major study was published in 1957 by Delay et al.; it
covered 452 cases spanning 90 years. They identified four distinct
categories of infanticide: melancholic, impulsive (due to severe and
transitory ailments such as “epilepsy or postpartum or alcoholic in-
toxication”), secondary to acute or chronic states of delusion, and
accidental [16].
In 1969, Resnick [1] wrote a review of the existing international lit-
erature from 1751 to 1967, covering 131 cases of infanticide described
by prison or hospital psychiatrists and by investigators from coroner's
RAYMOND et al.
offices. He differentiated neonaticide and filicide, demonstrating psy-
chodynamic differences: Mothers committing neonaticide were more
likely to be young, under 20, single, immature, often still living with
their parents, rarely mentally ill, and even more rarely hospitalized after
the act [3]. This concept of neonaticide as a particular subgroup is to
be found in other later publications where mothers are described as
having killed their newborn for social reasons [17,18].
Resnick further created a classification of filicides, identifying
five different criminal motivations [1]. Altruistic filicide, which ac-
cording to Resnick is the most widespread (56%), can be either a
murder–­suicide or euthanasia to relieve the victim's suffering (real
or imagined). The psychotic filicide (24%) is described as following
hallucinations, epilepsy, or delirium, the murderer suffering from
a major psychiatric disorder at the time of the offense and lacking
a rational motive. The other filicides Resnick classified are the un-
wanted child filicide (11%), the result of illegitimacy, extramarital pa-
ternity, or financial pressure, the accidental filicide (7%), secondary
to abuse—­battered child syndrome—­without homicidal intent, and
finally the spousal revenge (2%), the killing of a child as a deliberate
means to make the husband–­father suffer, often with multiple vic-
tims. In 1948, Stern described this last situation as the “Medea com-
plex” [19], referring to a specific psychic structure, a form of severe
parental alienation, where the child is not considered as a subject
itself, but as an object of retaliation.
In 1979, D’Orban focused on maternal filicide by presenting a
6-­year study (1970–­1975) on 89 women incarcerated for infanticide
[20]. He classified murderers under six categories, based on different
psychopathological elements. The most frequent are “the battering
mothers” (36 cases). These are usually young abusive women and im-
pulsive murderers from large and unstable families, suffering from re-
current depression, personality disorder, or mental retardation. The
second category concerns mentally ill women (24 cases) suffering
from either a psychotic illness, an acute depression, or a personality
disorder with severe depressive symptoms. These women—­whose
victims are usually over one year old—­are married and have a his-
tory of suicidal thoughts or actual attempts. Next, we find women
who have committed neonaticide (11 cases): They are younger, sin-
gle and described as immature and without any history of mental
illness. Revenge filicides (9 cases) are defined as retaliations against
their husbands. These women have personality disorders character-
ized by impulsive or aggressive behavior and have sometimes been
hospitalized after an attempted suicide. The fifth category concerns
women who have killed unwanted children (8 cases). In instances
of passive neglect, they are young, immature, socially impaired, and
separated from their husbands. In cases of active aggression, they
are older, impulsive and have antisocial personalities with a history
of delinquency. Finally, in the last category D’Orban described one
case of mercy killing, to end a child's suffering (when there was ab-
solutely no secondary benefit for the mother).
In 1990, Bourget & Bradford [21], based on a study of 13 fili-
cides hospitalized over a period of 8 years (1978–­1986) in a foren-
sic psychiatric service in Canada, drew a classification in order to
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incorporate clinical situations and motives. They listed five catego-
ries: accidental filicide, including battered child syndrome (46%);
pathological filicide, including altruistic features and extended
homicide–­suicide (13%); retaliatory filicide, often characterized
by severe personality disorder, chaotic spousal relationships, and
a history of previous self-­injury; neonaticide, including instances of
unwanted children; and a new category, paternal filicide. Filicidal
fathers are more likely to have history of marital instability, to be
separated or at risk of separation, and to have a history of domestic
violence prior to their crime. They have fewer psychiatric histories,
less psychosis but often suffer from personality disorders with a
substance abuse or dependency, and are more likely to commit sui-
cide after the act or attempt to kill their partner at the same time
as the filicide [22–­24].
Thus, most classifications are not based on psychiatric diagno-
ses of filicidal mothers, but according to criminal motives or the
victim's age. Some authors underline the fact that, more often than
not, these classifications do not represent the multifactorial nature
of filicide. Instead, these authors describe multiple risk factors and
stressors which include financial problems, limited education, un-
employment, lack of social and marital support, work-­related stress,
housing problems, alcohol abuse, physical illness, and psychiatric is-
sues [10,25–­27].
Putkonen [27] proposed a study of filicide taking into consid-
eration all relevant variables covering the social, environmental,
criminal, and gender domains. This new classification includes five
categories: homicidal–­suicidal fathers; violent, impulsive parents;
single, sober parents; prosocial, psychotic parents; and infanticidal
mothers.
2.2  |  Specific data concerning filicides and
mental illness
Pathological filicide is one of the categories mentioned above: It re-
fers to cases of parental filicide in which the offense is related to the
parent's psychiatric illness. This category does not make any distinc-
tion between specific diagnoses.
According to different studies, a psychiatric motive is held ac-
countable for 36% to 85% of all cases of filicide [14,17,21,25]. These
various rates of mental illness in filicidal offenders may be explained
by differences in study designs (general population, forensic cohort,
and prison sample).
Scientific articles are often written from case reports, or descrip-
tive retrospective studies with small cohorts in most cases. Unlike
other types of murders—­for example, parricides [28] or neonaticides
[3]—­for which typical profiles emerge, results are heterogeneous
when it comes to pathological filicides in terms of sociodemographic
characteristics or type of mental illness.
The most common diagnosis in maternal offenders is a major de-
pressive disorder with psychotic features, suicidality, or schizophre-
nia [8,14,17,21,24,25,29].
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4      RAYMOND et al.
Personality disorders are more often associated with retaliatory
or paternal filicides [22].
Most of the filicidal mothers described in psychiatric samples
have altruistic or acutely psychotic motives. Psychotic mothers often
kill suddenly, whereas depressed mothers may have planned the fil-
icide for days to weeks [30]. Krischer et al. [29] described severely
depressed mothers as having a history of childhood abuse, killing
older child by stabbing, and trying to commit suicide right after the
filicide. Lewis and Bunce [31] found psychotic filicidal mothers to be
older, more educated, and often separated.
We have found only one study tracing the evolution of filicidal
mothers over a long-­term period [32].
Our study's objectives are to explore pathological filicides (both
attempted and committed) by analyzing the characteristics of men-
tally ill mothers and their victims. We will also compare our findings
with the literature.
3  |  M ATE R I A L A N D M E TH O DS
3.1  |  Inclusion criteria
This retrospective and descriptive study includes all the filicidal
mothers hospitalized in the Henri Colin secure unit over a 24-­year
period between January 1996 and December 2019. Located in the
suburbs of Paris, the Henri Colin secure unit specializes in forensic
psychiatry and, as such, enables us to explore the role of psychiatric
disorders in filicides. Our study was presented to the hospital's eth-
ics committee.
Maternal filicide is defined as the murder of a child by their
mother. An essential criterion for inclusion in our study was the
presence of hard evidence in all cases. We also decided to include
attempted filicide if the assault could have resulted in the child's
death, and its survival was only due to factors not dependent on the
mother, such as an immediate medical response or the presence of a
bystander. We excluded men from our study due to the differences
found in the literature concerning the dynamics of paternal filicides,
as mentioned above.
Our study covers data going back to 1996, which corresponds to
the beginning of the archiving of admission folders, thus allowing for
a standardized gathering of all cases.
Of the 345 female admissions to the secure unit during the
study's 24-­year span, we selected all the filicidal mothers, that is,
18 patients and then examined every file. Only one patient was ex-
cluded because it was a case of violence against a child without a
clear homicidal intention. Thus, a total of 17 patients met the inclu-
sion criteria.
3.2  |  Study conduct
The same investigator anonymously collected and analyzed the
data. Information was gathered from a variety of sources: medical
records, written expert opinions, autopsy and police reports, and
court transcripts. The existing literature on pathological filicide
framed the choice of relevant features and characteristics to seek
and collect. We then systematically reviewed all records with a sum-
mary sheet to obtain the identified sociodemographic, clinical, and
forensic features.
First, we reported the sociodemographic characteristics of the
perpetrator such as age, marital status, social skills, education, fi-
nancial situation, employment status, and the place of residence at
the time of the assault. Then we looked at the offenders’ clinical fea-
tures, including familial violence or childhood abuse, criminal history,
and substance use. We also looked for any physical illness or psychi-
atric history with diagnosis, clinical description, type of treatment
and follow-­up, and history of suicidal thoughts or attempts (before
and after the filicide). We examined the detailed circumstances of
the acting out: previous death threats or assaults against the victim,
premeditation, precipitating factors, psychopathological dynamics,
crime scene, weapon used, presence of a witness or other family
member, immediate reaction, and description of the alert. Finally, we
obtained details about the number of victims and their identity: age,
sex, and relationship to the offender.
4  |  R E S U LT S
4.1  |  Offenders’ social and demographic features
On average, the mothers were 31.8 years old at the time of the of-
fense (between 22 and 51). Two age groups were dominant: 20–­
25 years old (29.4%) and 36–­4 0 years old (29.4%).
The majority of patients reached high school, though not all of
them graduated, and only one had a university degree. In terms of
employment, more than half (nine patients) held a permanent job.
52.9% of them were not born in continental France, 35.3% of which
were born in a foreign country.
Five patients came from large families (more than three children).
Most patients had a dysfunctional childhood, marked by emotional
deprivation (52.9%), parental neglect or abandonment, or family
breakup. Placement in foster care accounted for 35.3% of all cases and
the death of the father for 17.6%. Also, filiation taboos (such as the tardy
revelation of a “biological father” or an adoption) represented 17.6%.
A 70.6% were victims of family violence during childhood and
29.4% of sexual abuse; 11.8% had post-­traumatic symptoms, having
lived in war zones.
Of 17 patients, 47% were married, 11.8% lived maritally, 17.6%
were single, 17.6% were separated or divorced, and 5.9% were
widowed.
Patients had between one and six children, with an average of
two. In two out of three cases, filicide occurred in a family of one or
two children. Prior to the offense, 94.1% of the patients had their
own home: 52.9% lived with their partner and child(ren), 35.3% lived
alone with their child(ren), 5.9% lived alone, and 5.9% lived in her
husband's family (Table 1).
RAYMOND et al.       5|
TA B L E 1  Offender's social and demographic features
The psychiatric diagnoses at the time of the offense were bi-
N (%) polar or depressive disorders for seven patients (41.2%)—­including
Dysfunctional childhood depressive disorders with melancholic features (29.4%), bipolar dis-

Emotional deprivation 9 (52.9%) order (5.9%), or major depressive episode (5.9%)—­and schizophrenia
or other psychotic disorders for another seven patients, including
Family violence 12 (70.6%)
schizophrenia (35.3%) and delusional disorder (5.9%). Three patients
Employed (permanent job) 9 (52.9%)
(17.6%) were diagnosed with borderline personality disorder, with
Marital status
sadistic features for two of them.
Married 8 (47%)
In terms of addiction comorbidity, 41.2% of the cases (seven pa-
Living maritally 2 (11.8%)
tients) had no history of substance use. Three patients (17.6%) were
Single 3 (17.6%) addicted to psychotropic drugs, one (5.9%) to alcohol and cannabis,
Separated or divorced 3 (17.6%) and two (11.8%) to cannabis alone. No information was available for
Widowed 1 (5.9%) the four other patients (Table 2).
Home status In most of the cases (12 patients, or 70.6%), the filicide was directly
Living with partner and child(ren) 9 (52.9%) related to delusions, with such themes as: persecutory (six patients, or
Living alone with child(ren) 6 (35.3%) 35.3%); religious (four patients, or 23.5%); delusional identity or filia-
Living alone 1 (5.9%) tion (one patient, or 5.9%); or delusional perception of victim's body

Living in husband's family 1 (5.9%)

4.2  |  Clinical features
While three patients (17.6%) had a history of chronic somatic disease
(diabetes, high blood pressure, rheumatoid arthritis, and partial epi-
lepsy), the majority (58.8%) had no history of any significant somatic
illness.
Most patients had histories of obstetrical problems: Four pa-
tients (23.5%) had miscarried, nine (52.9%) described difficult preg-
nancies with complications due to dysmorphophobia, bereavement,
unwanted intrusive thoughts of harming one's infant, doubts about
the child's paternity, an unwanted child, the loss of a fetus during a
twin pregnancy, and a premature or home delivery.
There was a previous history of psychiatric illness, with an aver-
age duration of four years, requiring in-­or outpatient treatment in nine
cases (52.9%). Most patients showed poor acceptance of their mental
illness and frequent nonadherence to the prescribed medication.
Some cases (23.5%) may not have received prior psychiatric care
although they had symptoms before the events. These may have
been noticed by family members but not shared with healthcare
services.
Among patients with a psychiatric history, eight (88.9%) were
transformation (one patient, or 5.9%). In addition to delusions, ten
patients (58.8%) described auditory hallucinations at the time of the
assault—­four patients had command hallucinations in which they were
“ordered” to kill their child—­and four patients (23.5%) had erroneous
interpretations of reality and abnormal perceptions. For five patients
(29.4%), delusions were accompanied by depressive symptoms.
In four other cases (23.5%), the filicide was not based on delu-
sions. Here, the patients assaulted in a context of real or perceived
separation, for two of them in a dynamic of extended suicide.
Concerning the latter, the mother decided, following the child's fa-
ther's departure, to kill her children and commit suicide in order to
put an end to their respective suffering.
One case stands apart: The mother had sadistic traits and filicide
occurred in a context of repeated physical and sexual abuse.
Regarding the history of violent behavior, 14 patients (82.4%)
had no previous criminal record. Three patients (17.6%) had a history
of attempted filicide: All were reported to child protective services,
TA B L E 2  Clinical features
N (%)
Previous history of psychiatric illness 9 (52.9%)
Psychiatric diagnoses
Bipolar or depressive disorders 7 (41.2%)

hospitalized at least once for various reasons: four for delusional Depressive disorder with melancholic features 5 (29.4%)
episodes; three for major depressive episodes (one with a suicide at- Bipolar disorder 1 (5.9%)
tempt and one with psychotic characteristics); one for an attempted Major depressive episode 1 (5.9%)
filicide. One patient was seen on an outpatient basis for delusional Schizophrenia or other psychotic disorders 7 (41.2%)
persecution ideas. Schizophrenia 6 (35.3%)
Among delirious patients, two had a history of delusional epi- Delusional disorders 1 (5.9%)
sodes focused on the child (filiation themes), and two others pre-
Borderline personality disorder 3 (17.6%)
sented delusions with homicidal ideation on a subject other than the
Addiction comorbidity
child (stepfather or stepmother).
No history of substance use 7 (41.2%)
Finally, there was a family history of psychiatric disorder in five
Alcohol and/or cannabis and/or psychotropic drugs 6 (35.3%)
cases (29.4%): psychotic disorder, alcohol abuse, mood disorder, and
Information not available 4 (23.5%)
suicide.
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6      RAYMOND et al.
but only one had criminal charges brought against her. Two other
patients were reported for child endangerment or neglect; another
was abusing her child but not reported.
Two patients had a criminal record: The one mentioned above
was convicted of attempted child poisoning and another of theft.
4.3  |  Characteristics of the offense
4.3.1  |  Period prior to the filicide
Half of the cases (nine patients, or 52.9%) lacked premeditation, the
filicide happening suddenly, as a paroxysmal action. Eight patients
(47.1%) had planned the act for hours (more than 24  h before the
assault for five of them).
As for treatments, five patients (29.4%) had stopped taking their
medication before the act. In addition, three patients (17.6%) had
consumed cannabis, and one was going through codeine withdrawal.
We found precipitating factors, potentially acting as impulse-­
triggering catalysts for some patients: Four of them (23.5%) were in the
process of separating from their husbands; one had recently lost her
father (5.9%), and another her husband (5.9%); in one case, the midwife
had commented on the child's dark complexion; one case saw the child's
father move far away for work while another patient had just been fired.
Moreover, six patients (35.3%) had had suicidal thoughts in the
days leading up to the filicide. One had even attempted to commit
suicide several times in the preceding weeks.
Finally, three patients (17.6%) premedicated their child before
the assault, two with sedatives and one with analgesics.
4.3.2  |  Crime scene
A large majority of the filicides occurred at home (64.7%). 23.5%
took place in a public area, another in the child's grandmother's
house, and one in a postnatal care unit.
The most common modus operandi was stabbing (29.4%), fol-
lowed by poisoning (5.9%), arson (5.9%), battering (5.9%), strangulation
(5.9%), defenestration (5.9%), purposely running over with the family
car (5.9%), and drowning (5.9%). In 29.4% of cases, several different
lethal means were used concomitantly. In one instance, death was due
to exhaustion following sexual abuse and multiple acts of torture.
In three cases of overkill (17.6%), an excessive amount of ex-
treme violence was used, such as multiple stabbings (34 times) or
running over the victim five times.
In 16 of the 17 cases, the mother acted alone. In only one in-
stance was there a co-­perpetrator, namely the victim's stepfather.
4.3.3  |  Post-­filicide period
In the majority of cases (12 patients, or 70.6%), mothers remained at
the crime scene or nearby. Five patients attempted suicide (29.4%).
The others displayed various different behaviors, ranging from
harming oneself (one case) to hiding the body (one case). Other reac-
tions include sideration (one), alerting a neighbor (one), going home
(one), or visiting a friend (one). Two mothers tried, unsuccessfully, to
save their children.
In five cases (29.4%), the alert was given by the mother herself
(fire department, emergency services, family members, or neigh-
bors). In three cases (17.6%), the father or another family member
called for help. In six cases (35.3%), a third party reported the crime.
Nine patients (52.9%) did not express any feeling of guilt or re-
gret whatsoever. 29.4% of the patients admitted to the offense while
23.5% denied it and 11.8% accused a third party. One patient (5.9%)
claimed amnesia, and another (5.9%) remained mute; no information
was gathered in 23.5% of the cases.
Finally, 82.4% (14 patients) had suicidal thoughts in the days
following the filicide. One patient attempted suicide while another
killed herself within 5 days of the filicide. A total of 3 patients died
by suicide (Table 3).
4.4  |  Victims’ features
There were 24 victims in our study. 20 were deceased (83.3%) and
four were still alive at the time the study was conducted. As none of
the subjects attacked their husbands or any third party, there were
no other victims.
We did not have any neonaticides, which is concordant with the
literature (most neonaticide cases are not associated with mental ill-
ness and therefore require no psychiatric hospitalization).
There were one to three victims per act in families of one to
six children. We can highlight that in six families, just over a third
of cases (35.3%), the filicide took place in a single-­child family. In
ten cases (58.8%), every single sibling of the same household was
attacked.
Gender differences mattered little, as we found 13 boys (54.2%)
and 11  girls (45.8%) among the victims. Ranging from six days to
16 years old at the time of the filicide, the victims’ average age was
6.2 years old, the majority being between one and three.
The position of the sibling was quite similar: Six victims were the
eldest, five the second, seven were the youngest. Six victims were
single children.
In almost half of the cases, victims lived with both parents. Nine
lived with their single mother and one with his single father. Another
child was in hospital at the time of the act, and one was placed in
foster care.
We found no somatic or psychiatric pathologies for 19 of the
victims (79.1%). For the other victims, two of them were premature,
one suffered from heart rhythm disorder, one was treated for ag-
gressiveness, and one was diagnosed with autism.
In most cases (20 out of 24, or 83.3%), the victims’ fathers had
acknowledged paternity at birth. For two children (8.4%), there was
a doubt concerning filiation. One victim was born to an unknown
father (4.2%), and only one was not recognized by his father (4.2%).
RAYMOND et al. |
      7

TA B L E 3  Characteristics of the filicide

custody to several family members before regaining it. A delusional
N (%) mother had rejected early one victim, another patient idealized her
No premeditation 9 (52.9%) child, two patients saw themselves as “bad mothers.” One victim was

Motives violent toward her mother.

Filicide directly related to delusions 12 (70.6%)

Themes
4.5  |  Patient outcome after the filicide
Persecutory 6 (35.3%)
Religious 4 (23.5%)
Two patients (11.8%) were directly hospitalized in our secure unit
Delusional identity or filiation 1 (5.9%)
immediately after the assault. The rest were either sent to jail (nine
Delusional perception of victim's body 1 (5.9%) patients -­ 52.9%) or to local mental health institutes (six patients
transformation
-­ 35.3%). The average waiting period for patient admission to our
Auditory hallucinations 10 (58.8%)
secure unit was 19.4 months after the act, ranging from one day to
Erroneous interpretations of reality, abnormal 4 (23.5%)
201 months. For the later, the patient had been jailed and was only
perceptions
sent to us after she had tried to commit suicide. We estimated the
Associated with depressive symptoms 5 (29.4%)
average length of the hospitalization to be around 11 months, rang-
Filicide secondary to a context of real or perceived 4 (23.5%)
ing from four days—­the patient then killed herself—­to 2.4 years.
separation
After hospitalization in our secure unit, 11 patients (64.7%) were
Extended suicide 2 (11.8%)
transferred to local mental health services and five patients (29.5%)
Context of repeated physical and sexual abuse 1 (5.9%)
were sent to jail.
Crime scene It was estimated that 29.4% of the patients could not be held
Home 11 (64.7%) accountable for their acts for reasons of insanity: They were con-
Public area 4 (23.5%) sidered unable of controlling their actions and incapable of appre-
Child's grandmother's house 1 (5.9%) ciating the wrongfulness of their decisions. 23.5% of our patients
Postnatal care unit 1 (5.9%) were found guilty and condemned to sentences ranging from 12 to
Lethal means 30 years’ imprisonment. Six patients left the secure unit before their
Stabbing 5 (29.4%) final judgment, and for one patient, no legal action was taken as she

Poisoning 1 (5.9%) committed suicide just days after the filicide.

Arson 1 (5.9%)
Battering 1 (5.9%)
5  |  D I S C U S S I O N
Strangulation 1 (5.9%)
Defenestration 1 (5.9%)
5.1  |  Sociodemographic features
Running over with a car 1 (5.9%)
Drowning 1 (5.9%) Our study highlights distinctive characteristics concerning patholog-
Several different lethal means 5 (29.4%) ical maternal filicides. The women in our cohort were young, 94.2%
Overkill 3 (17.6%) between the ages of 20 to 40, which is concordant with a woman's
Post-­filicide period childbearing years. These women came from families marked by in-
Suicidal thoughts 14 (82.4%) stability (foster care, separations, death, secrets about filiation, and
Attempted suicide 5 (29.4%) immigration) and were also often victims of violence during their

Committed suicide 3 (17.6%)
We had no information on the father–­child relationship, except
for one of them, where it was obvious the victim had been physically
and sexually abused by both parents.
We looked for elements carrying information concerning
offender–­victim relationships. Six mothers were abusive (35.3%),
23.5% of who repeatedly so, the molested child usually being the
victim of the infanticide. We found filicide attempts in 17.6% of these
cases. Five mothers were reported to child protective services. Two
children were placed in residential child care facilities (8.2%) and the
other three in foster families (12.5%). One mother (5.9%) had given
childhood: 70.6% had suffered from physical and/or sexual and/
or psychological violence, most often intra-­familial. We thus found
several factors of stress, ranging between traumatic elements and
emotional deprivation.
However, and this could seem paradoxical considering what has
been said above, filicidal mothers usually succeeded in creating a
rather classic family nucleus: Most were married or living maritally
with one or more children. Thus, at some point, they had the ability
to create and maintain a relationship, seeking to build their own nor-
mative lives.
Most often high school dropouts, the patients were nonetheless
relatively well integrated professionally, thus standing out from the
rest of the female patients hospitalized in our secure unit who are
 |
8      RAYMOND et al.
mostly single (60%), childless (70%), and unemployed (100%) [33].
We can also point out differences with neonaticidal mothers, usually
described in the literature as young immature women, unemployed
and often living in precarious conditions.
The biographical elements of our cohort are consistent with our
literature review, and in particular with the description of filicidal
parents given by Verschoot: “They certainly have passed through
painful tribulations and a great sense of loneliness, but they have
apparently overcome them. They have done everything possible to
build their lives according to their aspirations. They have a job they
like and have created a family far different from the one they were
born into.”[34]
5.2  |  The maternity process
The psychic process of becoming a mother is described by Racamier
[35] as follows: During pregnancy, the mother invests her baby si-
multaneously as a part of herself and as an external object. She be-
gins to fantasize not only about her future child and its becoming,
but about her motherness as well.
Among the patients in our study, we identified several elements
of fragility that interfere with this process of becoming a mother.
First, more than half of our patients had a history of obstetrical prob-
lems (miscarriages and premature births) or difficulties during preg-
nancy (dysmorphophobia, unwanted child, doubts about the child's
paternity, isolation due to cultural differences and language barri-
ers, etc.). None of them were in pregnancy denial, underlining again
the difference between filicide and neonaticide. We can hypothe-
size that complications or difficulties during pregnancy impact the
psychic aspect of the maternity process. On one hand, the unborn
child may not be fantasized about or even imagined, thus merely per-
ceived as an extension of herself, and not as a subject unto itself,
leading to a child–­mother undifferentiation and the formation of a
pathological dyad. On the other hand, the lack of fantasy or internal-
ization can drive the mother to perceive the future child as nothing
more than a stranger, with absolutely no filiation to her.
In addition, according to the environment in which the patients
grew up (domestic violence, instability, foster care, etc.), we can ques-
tion the existence of an insecure attachment that persisted into adult-
hood, making the mother–­child bond fragile and uncomfortable: Either
the investment is too strong, resulting in a fusional relationship and
idealization, or it is too fragile and ultimately leads to rejection. These
pathological interactions can also develop pathological attachments in
children, which may increase preexisting relational difficulties.
Furthermore, pregnancy is also a time of “psychological transpar-
ency,” as described by Bydlowski [36]: Pregnant women lower their
usual resistance to subconscious repression and overinvest their
personal histories and childhood conflicts. Memories of childhood
then return, in dreams or thoughts. Expectant mothers also identify
with their own mothers. Given our patients’ family environment, we
can assume that their identification with a positive mother figure can
easily be undermined by past traumatic experiences, thus generating
anxiety and difficulties in projecting themselves beyond what they
describe as “bad mothering.”
The history of attempted filicide for some of our patients seems
to demonstrate that it is part of a complex mother–­child relation-
ship. Indeed, recidivism proves that homicidal intent is not linked to
an isolated triggering event, “a moment of madness,” but to a set of
intertwined factors, which seems to come from unfinished access to
the maternity process.
5.3  |  Clinical features
Concerning the diagnostic, we found three subgroups in our cohort:
bipolar or depressive disorders (41.2%); schizophrenia or delusional
disorders (41.2%); and borderline personality disorders (17,6%), with
sadistic features for two of them. Half of the patients were seen on
an outpatient basis or had been hospitalized before the filicide. The
act can also initiate or reveal a psychiatric pathology.
At the time of the assault, the symptomatology was varied and
the patient group heterogeneous. There was an addictive comorbid-
ity in some cases, but it also seemed nonspecific. So, unlike patho-
logical parricide (for which we find a typical profile in more than 90%
of cases [28]), there is no pathognomonic pathology of filicide.
Lastly, our study's patients were not suffering from any specific
somatic pathology. We did not find any mental retardation, whereas
some studies describe it [8].
5.4  |  Filicide dynamics
According to our study, most of the time, pathological filicide occurs
in the mother's home. Premeditation might be possible (one to several
days before the act), but it is far from being the rule. Lack of com-
pliance, or even discontinuation of treatment in cases of psychiatric
follow-­up, is frequent and can be considered a contributing factor.
In the majority of cases, the victim's suffering was not taken into
account. However, three patients did premedicate their children,
probably with the purpose of avoiding them any pain. In almost
every case, we found no evidence of overkill, except for three pa-
tients whose modus operandi was extremely violent (two of them
displayed sadistic features).
In the vast majority of cases, there was no attempt to hide their
victims’ bodies, which is concordant with the literature. After the
act, the patients in our cohort generally remained close to the prem-
ises where their crime was committed, with varying reactions: Some
readily admitted their guilt, some called the authorities themselves,
and others seemed to have been under acute stress or suffered
from other symptoms (mutism, sideration, disorganized or delusional
speech, amnesia, and denial) that effectively disconnected them from
the extreme seriousness of their actions. In these cases, the alert was
given by a third party. Most patients did not verbalize any regret in
the immediate aftermath of the filicide, as if the crime were the only
alternative to protect themselves or, paradoxically, their child.
RAYMOND et al.
If the psychiatric disorders found in our cohort are heteroge-
neous and therefore nonspecific, the dynamic of the filicide can be
divided in two subgroups, with different characteristics.
5.4.1  |  Delusional context (12 patients)
Patients with psychotic symptoms, such as delusions or hallucina-
tions (including patients suffering from severe depressive disorders
with melancholic features), act—­in more than half of the cases—­
during intense productive episodes, where they do not recognize
their child as such (7 out of 12 patients). Sometimes they see it as
a messiah who must be sacrificed, sometimes as a stranger who
has come to persecute them, thus threatening their very survival,
or sometimes as being possessed by the devil—­and the only way to
free them is to kill the child. Finally, sometimes they can even see
it as a child whose (delusional) filiation is unbearable to them, thus
causing hallucinatory injunctions, major anxiety, and depressive
thoughts. We can hypothesize that these patients had not been able
to fantasize their child during pregnancy; filiation does not appear
to be included in the mother's psyche. The child then represents a
danger that threatens the psychic survival of the patient, the only
possible alternative being death. This dynamic corresponds to what
Resnik or d’Orban described as “psychotic infanticide,” or Bourget
and Bradford's “pathological infanticide” [1,20,21].
For four other patients suffering from delirium, the child seems
completely undifferentiated from its mother, stuck in a pathological
dyad. The persecution comes from outside the dyad, and the only
way to protect the child (and therefore the mother, in this symbiotic
relationship) is to kill it. Here again, this act seems to be the only
alternative for the mother's survival.
For another patient in our study, infanticide was the only means
to deliver children from “delirious” suffering, the mother seeing
them as skinny and sickly. The last two situations correspond to the
“altruistic infanticide” described by Resnick [1].
Regarding the murder weapon, we note that filicide patients
with delusional disorder at the time of the offense most often used a
knife—­and sometimes arson—­which both remain very violent lethal
methods.
5.4.2  |  Context of separation (4 patients)
In this second subgroup, infanticide is secondary to a separation
with the father/husband. This separation—­real or imaginary in the
mother's mind—­quickly evolves into an unbearable situation. The
four patients were diagnosed with borderline personality disorder,
major depressive episode and bipolar disorder, but if these diagno-
ses were heterogeneous, all of them suffered from separation anxi-
ety, with a fear of being abandoned. We find two types of filicides
associated with this context.
First, filicides including an altruistic suicide plan, where the
suicidal mother kills her child to prevent it from suffering from the
|
      9
separation, and then tries to kill herself. This is the case of two pa-
tients in the cohort. Here again, we can question what happened
during the maternity process: Indeed, the real suffering is that of the
mother, with the children being mere extensions of their mothers,
and not separate individuals. The filicide can thus be understood as
an “extended suicide,” as formulated by McKee and Egan [26].
For two other patients, infanticide is a form of “control” over the
mother–­child relationship to prevent a possible separation. According
to Verschoot [34], the child is perceived as an object whose main pur-
pose is to fill a void and prevent the mother from being alone again:
“[she] does not exist on an identity and narcissistic level, except as com-
pletely dependent on her entourage and especially her children. That is
why, when the family unit breaks up or is likely to do so, it is her very
existence that is at risk.” Therefore, “resorting to the deed” appears to
be the only solution to avoid being the victim of yet another separation.
We can point out the fact that this dynamic does not correspond to any
subgroup of the different classifications mentioned earlier.
Finally, we find in the literature another category, revenge fili-
cides (“Medea complex”), defined as retaliations, in the context of
a separation, against fathers/husbands. No patient in our cohort
seems to correspond to this dynamic.
In this second subgroup, the women committed their crime with
bare hands and not the use of specific weapons.
5.4.3  |  Isolated case
For one of the patients in our study, the act does not correspond to
any of the categories mentioned above. The infanticide was part of
a series of sadistic acts and severe battering. It could be identified
as an accidental filicide, as described in some classifications. But the
daily repetition and seriousness of the physical and sexual abuses
the child suffered, could only lead to a fatal issue: Death was prob-
ably expected. It is the only case in our study, contrary to what is
indicated in d'Orban's article [20].
5.5  |  Victims
The filicide victims in our study have various characteristics and
seem different from the victims described in other articles found
on this subject.
In our cohort, victims are almost equally male or female and the
average age of death is 6.2  years old, which is much older than in
most studies on filicide [14]. In addition, several of these studies
find an increased risk for children during their first twelve months
whereas from our results, there seems to be a slightly higher risk for
children aged one to three.
The birth order, or position of the victim among the siblings, is
variable. However, it appears that being an only child can increase
the risk (one fourth of the victims in our study).
Victims usually live in the family home, either with both parents
or with their single mother. However, we can note that in about one
 |
10      RAYMOND et al.
fourth of the cases, the victims were separated from their mother
at some point—­either placed in residential child care facilities or
in foster families by decision of the court (following the mother's
infanticide attempt or because of her psychiatric pathology), or by
being informally entrusted to other members of the family (when
the mother rejected her child). Quite often, these victims had been
repeatedly mistreated before the infanticide. We observe here a
certain repetition of family patterns during the childhood of these
mothers, characterized by instability, abuse, and rejection.
5.6  |  Suicide
The literature highlights the high suicide rate among filicidal patients
[9,21]. In our study, more than one-­third of the mothers had suicidal
thoughts before the filicide. This seems to underline the experience
of a situational impasse, the only perceived alternative being death.
Suicidal thoughts may persist and lead patients to altruistic suicide,
killing their child because they are extensions of themselves. The
suicidal thoughts can also turn into aggressiveness directed at the
child, as described by Resnick [1].
After the filicide, the vast majority of patients verbalized suicidal
thoughts, even though they had no regrets about the killing. We can
see here the sign that the filicide ultimately failed to resolve the psy-
chological conflicts that initiated the crime. But the fact that the ma-
jority did not try to kill themselves seems to suggest that the crime
did, however, reduce their internal tension.
In our study, three patients committed suicide in the aftermath
of their infanticide; two suffered from bipolar or depressive dis-
orders and one from schizophrenia. We can see that each time
the chosen method was extremely violent (obstruction of the air-
ways with toilet paper, defenestration from the 9th floor of an
apartment building). Suicides occurred at different periods during
treatment (from five days to several years after the filicide). This
suggests that constant vigilance is of the utmost importance, even
long after the act.
5.7  |  Limitation of our study
In this study, we have characterized mentally ill filicides in terms of
socio-­clinical and forensic aspects. While these elements may prove
useful as risk indicators of potential filicide for clinicians, several bi-
ases in our study do limit the generalization of our findings.
The first limitation is the small size of our sample. This is due to
the fact that it is difficult to gather an adequate sample, as patholog-
ical filicides remain rare. The second limitation is found in the retro-
spective nature of the study which impacts the scrupulous accuracy
and precision of the collected data.
All patients included in the cohort were hospitalized in a secure
psychiatric unit and were mentally ill. We did not consider cases
of infanticide committed by mentally healthy offenders, nor those
committed by patients hospitalized in local psychiatric services
whose condition did not require they be admitted in a secure unit.
Our data are thus restricted to a forensic cohort, and our sample
is not representative of all women who commit child homicides.
Moreover, infanticide in itself is not reason enough for an offender
to be systematically admitted to a secure unit, as such a placement
would require that there be additional evidence of a patient's per-
sistent dangerousness. This explains the overrepresentation of
schizophrenia in our cohort and an underrepresentation of depres-
sive disorders. Furthermore, for obvious reasons, there is a lack of
representation of filicide–­suicides.
Finally, a further in-­depth study would require the use of a con-
trol group to better identify the specificity of the risk indicators ob-
served in our cohort.
5.8  |  Toward preventing filicide?
If we consider filicide from a preventive point of view, it seems that
some elements should be added to clinicians’ formation. Although
the various classifications pre-­cited in our review of literature are
helpful in identifying the types of filicide, they do not represent the
multifactorial nature of the act. This study highlights some nonspe-
cific characteristics of filicide mothers: a childhood marked by signif-
icant emotional deprivation, familial instability and multiple traumas
(physical and sexual), and issues during pregnancies that compli-
cated the maternity process. In our study, there was no pathogno-
monic symptomatology. Two subgroups were identified: filicide in a
delusional context vs. filicide during a separation.
Half of the cases had a history of psychiatric monitoring, which
is concordant with the literature [14,23]. Some mothers had even
openly talked of suicide, which suggests that in such situations, a
case-­by-­case approach might be necessary to assess the filicidal po-
tential, but it would have to be systematic. As stated by Resnick [1],
“a direct question about the fate of the children may be helpful in
assessing the inseparability of the parent-­child bond. Absolute in-
dication to hospitalizing these patients are their fears about harm-
ing their children and over-­concern about their children's health.”
In cases of delusion, Friedman & Resnick [25] advised to look for
delusions regarding the child's suffering, improbable concerns about
the child's health or fears that children may suffer a fate worse than
death due to persecutory delusions.
As a general rule, precipitating factors such as discontinuation of
psychotropic medication or substance abuse should not be neglected.
Four mothers had been reported to child protective services.
Some authors [1,25] do recommend immediate intervention at the
very first report of child abuse. Prevention should integrate a mul-
tidisciplinary approach with collaboration between health and child
protection actors in order to be able to propose close follow-­up and
help mothers during the maternity process. It also seems import-
ant to ask the mothers about the existence of infanticidal thoughts,
current or past, to enable appropriate care and close monitoring.
Vigilance must be increased in cases of preexisting histories of at-
tempted filicide, because of the risk of recidivism.
RAYMOND et al.
This is a descriptive preliminary study highlighting clinical and
forensic features of filicidal mothers. Several biases in our study do
limit the generalization of our findings. The issue of preventing fili-
cides remains open.
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How to cite this article: Raymond S, Ducasse M-­V,
Azoulay M, Gasman I. Maternal filicide and mental illness:
A descriptive study of 17 women hospitalized in a French
secure unit over a 24-­year period. J Forensic Sci. 2021;00:​
1–­11. https://doi.org/10.1111/1556-­4029.14780