Intimate partner violence during pregnancy: case report of a forensic psychiatric evaluation

Abstract

ReferencesIntimate partner violence (IPV), also known as domestic violence, is defined by the World Health Organization 1 as ''any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship.'' While IPV may be perpetrated by women against men or in homosexual relations of both sexes, most cases (85%) consist of men victimizing women. This produces a worldwide problem with serious implications for women's health and well-being. 2,3 Special populations of women are at increased risk of IPV, including pregnant women (especially in unplanned pregnancies), those living in low-income settings, rural women, and older, indigenous, military, and immigrant women. Within this context, a study on the prevalence of IPV among Japanese women noted that all those victimized before pregnancy continued to suffer violence during pregnancy. 4 A prospective cohort study conducted by Silva et al. in Recife, state of Pernambuco, Brazil, found a high incidence of IPV in the postpartum period (9.3%), with predominance of psychological violence. 5Lévesque & Chamberland investigated IPV in the perinatal period in young women and warned about the difficulty these women experience in identifying themselves as victims and categorizing the acts of their partners as domestic violence. The fear of family separation and the victims' desire to protect their children contribute to the complexity of violence experienced during maternity. 6 In addition to the sequelae experienced by non-pregnant women victimized by conjugal violence, IPV can have additional negative effects when perpetrated against pregnant women, increasing the risk of inappropriate antenatal care, poor weight gain, anemia, infections, bleeding, maternal depression, and suicidal ideation and suicide attempts.We illustrate the aspects listed above with the case of a young couple from the Southern region of Brazil. The husband was an unemployed man with a criminal record who kept his wife (5 months along a planned pregnancy) under false imprisonment while causing her grievous bodily harm. A complaint to police was made by neighbors who noticed the false imprisonment. Although there was a previous history of domestic violence, the victim and the perpetrator minimized the aggressive acts to the police, judge, and forensic psychiatrists who evaluated the case. The victim did not report any concerns about the baby's health or physical integrity during any of the psychiatric interviews. Surprisingly, both the wife and the husband attributed the responsibility of the facts to the victim, including in a handwritten letter by the wife, directed to the judge in the case, blaming herself for having received such treatment from her husband. Forensic psychiatric evaluation of the offender identified controlling behavior and narcissistic personality traits. He was considered fully capable of understanding the nature of his offense and of controlling his actions voluntarily.This report demonstrates the pathological family dynamics c...

Intimate partner violence among postpartum women: associated factors

“…In Brazil, a recent prospective cohort study showed a prevalence of 9.3% in the Northeast region and 25.6% (9) in São Paulo (6) . In both periods and in all the studies, the most frequent violence category was the psychological one, followed by physical and sexual (3)(4)(5)(6)(7)(8)(9) . Violence, in all its forms, implies several consequences to maternal and neonatal health.…”

“…The most common type of abuse, carried out by an intimate partner (intimate partner violence or IPV) (1) , is present in every period of women's lives, including pregnancy and postpartum, and may cause severe consequences to the health of mothers and people who depend on them (2) . Recent studies performed in Vietnam and Japan identified that the prevalence of IPV during pregnancy was 35.4% and 20.7%, respectively (3)(4) . In an investigation with 232 pregnant women in a public maternity hospital in the countryside of the state of São Paulo, Brazil, 15.5% of the participants reported suffering IPV during pregnancy (5) .…”

Sociodemographic, criminal and forensic characteristics of a sample of female children and adolescents murdered in Brazil. 2010-2016

“…Few national surveys have addressed dating violence and intimate partner violence in adolescents and young people. (33)(34)(35) However, international organizations have described the problem that early marital unions and child marriages represent, for domestic violence, mainly against girls, may begin in the early stages of the relationship. (36,37) The cultural acceptance of dating violence and jealousy behaviors leads to the establishment of subordination relationships based on the use of violence.…”

“…(36,37) The cultural acceptance of dating violence and jealousy behaviors leads to the establishment of subordination relationships based on the use of violence. (33)(34)(35)(36)38) Finally, three victims were pregnant at the time of their death, in two of them the presence of a fetus was reported, while the third one was killed due to her suspected pregnancy.…”

Psiquiatria Forense e Avaliação Pericial da Imputabilidade Penal no Brasil

“…Após a devida aplicação do critério biopsicológico, as avaliações forenses poderão concluir pela integridade das capacidades de entendimento e de determinação (imputabilidade) ou por algum grau de prejuízo na autodeterminação do indivíduo no momento do delito (semi-imputabilidade). A avaliação psiquiátrica de situações criminais violentas, sejam casos de violência doméstica 15 , tentativas de neonaticídio 16 ou até homicídio sexual 17 , deve sempre considerar a possibilidade da existência de aspectos desadaptativos na personalidade do agressor.…”