Obsessions of infanticide and imminent psychosis

Abstract

-In young mothers an obsession of infanticide, that is, fear that they may murder their children, may be coupled with an obsession of imminent psychosis, that is, fear that the first obsession is a sign of approaching insanity. Sixteen mothers with this clinical picture were evaluated in interviews. Seven of them entered psychotherapy and improved. The causative factors in childhood and adolescence wich led to the later development of these obsessive difficulties are analyzed. Even when psychotherapy was not possible, as was the case in nine patients, they should be strongly reassured and explanations should be given about the nature of the problem, for such encouragement and clarification helps them to improve to a significant extent. The prognosis of patients who have systematic psychoterapy is good.KEY WORDS: obsession, infanticide, psychotherapy.A special type of obsession in women is the persistent fear that they will kill their children. This is usually accompanied by a fear of suddenly becoming insane. These two obsessions reinforce each other. These mothers fear that the thought of killing their children indicates psychosis, and that a consenquence of abruptly ocurring psychosis will be the murder of them 2 .It should be emphasized that these patients do not have urges to kill their children; they have instead an ever present dread, that they may do so 7 . None of the patients reported here had a history of violent acts against persons, animals or things; they had never attacked people, or abused pets or broken household objects. In addition, none of them had ever directed violence against themselves in suicidal threats, gestures or attempts. They were, on the contrary, passive women who rarely resorted to even mild verbal expressions of anger or resentment. Deciding whether a woman has urges to kill her children or obsessive fears that she will do so is usually not a difficult decision for the clinician when both the patient and a near relative are carefully interviewed.*From the Samur Hospital and the Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista, Bahia, Brazil. Aceite: 27-novembro-1195.Dr. A H Chapman -Hospital Samur -Caixa Postal 98 -45100-000 Vitória da Conquista BA -Brasil Obsessões de infanticídio e psicose iminenteRESUMO -Em mães jovens, uma obsessão de infanticídio, ou seja, medo de que possam vir a matar seus próprios filhos pode estar associada a uma outra obsessão, de uma psicose iminente, isto é medo de que a primeira obsessão esteja sinalizando um perigo iminente de psicose. Dezesseis mães com este quadro foram avaliadas por meio de entrevistas clínicas. Sete puderam submeter-se a psicoterapia e melhoraram bastante. São analisados os fatores interativos que, na infância e adolescência, concorrem para o desencadeamneto desses comportamentos obsessivos; mesmo quando não seja possível a situação ideal de uma psicoterapia mais extensa, como ocorreu com nove pacientes, elas devem ser tranqüilizadas e animadas por meio de explicações quanto à natureza do problema, pois...

The Relationship Between Obsessive-Compulsive Disorder and Psychosis

“…The other possibility is that she first developed obsessions, which triggered a psychotic episode. Chapman et al 20 pointed out that in young mothers an obsession of harming the baby may be coupled with an obsession of imminent psychosis and may perhaps lead to a psychotic episode.…”

“…Obsessions may be misdiagnosed as a hallucination (as in Case 6) or a delusion. 20,21 5. Obsessions may lead to the development of explanatory delusions.…”