Pathological Altruism, Narcicissm, and Dissociation as Prerequisite for Infanticide

The international literature about neonaticide, infanticide, and familicide has arrived at a tripartite classification on the basis of the typical pathogenesis and the therapeutic and forensic challenges connected with the emerging situation. The categories can be characterized by altruistic or narcissistic attitudes and those of unawareness and dissociative states towards imminent delivery or the postpartum situation. The psychopathological counterparts to these attitudes are major depressive disorder with melancholia, narcissistic personality disorder, and an immature personality, often in socially disadvantaged environments equivalent to borderline personality disorder with dissociative states and diminished impulse control. Aspects of perinatal bonding disturbances between mother and child play a major role for the focus of psychotherapy and forensic assessment in all three categories. They need differential characterization according to the different pathogenetic pathways of inadequate experience of guilt, inadequate self-esteem regulation, and dissociative neglect and diminished impulse control. Preventive and therapeutic perspectives of intervention are discussed.