Abstract
Pervasive pregnancy denial is a misunderstood reproductive anomaly which compromises the health of both mother and the developing fetus. Because in extreme cases, the death of the neonate at the hands of his/her mother has criminal repercussions, research has attempted to explain the origins of this clinical phenomenon. The purpose of this review is to analyze the evolution of understanding the association between pregnancy denial and neonaticide. This paper identifies the consistent similarities in symptom presentation, particularly dissociation, when a denied pregnancy ends with the death of the newborn. The common thread across the progression of the literature over time serves as a foundation for considering the development of diagnostic criteria for future inclusion in the Diagnostic and Statistical Manual of Mental Disorders. This paper reviews the seminal research from 1969 to current research up to 2020 addressing pregnancy denial and its connection to neonaticide. Peer reviewed and published articles related to key terms around “pregnancy denial,” “pregnancy concealment,” “neonaticide,” and “dissociation” were retrieved from major databases such as PubMed, PsychINFO, JSTOR, ProQEST, ScienceDirect, and Google Scholar. Reference lists of relevant articles were also scanned to search for further papers pertaining to similarities in symptom presentation across demographic profiles. Papers were excluded if they were not available in English, or if they did not contribute to identifying consistencies in clinical presentation when a pregnancy is denied. There are clear repetitive markers that occur across studies which pertain not only to the frequent absence of certain expected indicators of pregnancy, (i.e. no morning sickness, weight gain, or sensations of fetal movement), but also the misattribution of pregnancy-related symptoms, and the consistent experience of a dissociative episode while giving birth that can unintentionally result in neonaticide. This paper concludes that dissociation is a consistently seen symptom in pervasive pregnancy denial. Dissociation, in addition to other commonly seen symptoms across cases, suggests specific diagnostic criteria that lend themselves to inclusion in the Diagnostic and Statistical Manual of Mental Disorders.
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References
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association
Akbarzadeh M, Dokuhaki A, Joker A et al (2016) Teaching attachment behaviors to pregnant women: a randomized controlled trial of effects on infant mental health from birth to the age of three months. Ann Saudi Med 36:175–183. https://doi.org/10.5144/0256-4947.2016.175
Alhusen JL, Hayat MJ, Gross D (2013) A longitudinal study of maternal attachment and infant developmental outcomes. Arch Womens Ment Health 16:521–529. https://doi.org/10.1007/s00737-013-0357-8
Amon S, Putkonen H, Weizmann-Henelius G et al (2012) Potential predictors in neonaticide: the impact of the circumstances of pregnancy. Arch Womens Ment Health 15:167–174. https://doi.org/10.1007/s00737-012-0268-0
Amon S, Klier CM, Putkonen H et al (2020) Neonaticide in the courtroom – room for improvement? Conclusions drawn from Austria and Finland’s Register Review. Child Abuse Rev 29:61–72. https://doi.org/10.1002/car.2589
Barnes D (2020) Understanding the mysteries of pregnancy denial. In: Wong G, Parnham G (eds) Infanticide and filicide: foundations in maternal mental health forensics. American Psychiatric Association Publishing, Arlington, VA
Barnes D (ed) (2014) Women’s reproductive mental health across the lifespan. Springer International Publishing
Beier KM, Wille R, Wessel J (2006) Denial of pregnancy as a reproductive dysfunction: a proposal for international classification systems. J Psychosom Res 61:723–730. https://doi.org/10.1016/j.jpsychores.2005.11.002
Beyer K, Mack SM, Shelton JL (2008) Investigative analysis of neonaticide: an exploratory study. Crim Justice Behav 35:522–535. https://doi.org/10.1177/0093854807313410
Bonnet C (1993) Adoption at birth: prevention against abandonment or neonaticide. Child Abuse Negl 17:501–513. https://doi.org/10.1016/0145-2134(93)90025-z
Brezinka C, Brezinka C, Biebl W, Kinzl J (1994) Denial of pregnancy: obstetrical aspects. J Psychosom Obstet Gynaecol 15:1–8. https://doi.org/10.3109/01674829409025623
Crittenden PM, Ainsworth MDS (1989) Child maltreatment and attachment theory. In: Cicchetti D, Carlson V (eds) Child maltreatment, 1st ed. Cambridge University Press, pp 432–463
Cross D, Fani N, Powers A, Bradley B (2017) Neurobiological development in the context of childhood trauma. Clin Psychol Sci Pract 24:111–124. https://doi.org/10.1111/cpsp.12198
d’Orban PT (1979) Women who kill their children. Br J Psychiatry 134:560–571. https://doi.org/10.1192/bjp.134.6.560
Dua D, Grover S (2019) Delusion of denial of pregnancy: a case report. Asian J Psychiatr 45:72–73. https://doi.org/10.1016/j.ajp.2019.09.002
Finlay F, Baverstock A, Marcer H (2016) G293(P) Management of a concealed pregnancy. Arch Dis Child 101:A164.2-A165. https://doi.org/10.1136/archdischild-2016-310863.284
Foley S, Hughes C (2018) Great expectations? Do mothers’ and fathers’ prenatal thoughts and feelings about the infant predict parent-infant interaction quality? A meta-analytic review. Dev Rev 48:40–54. https://doi.org/10.1016/j.dr.2018.03.007
Friedman SH, Heneghan A, Rosenthal M (2007) Characteristics of women who deny or conceal pregnancy. Psychosomatics 48:117–122. https://doi.org/10.1176/appi.psy.48.2.117
Friedman SH, Horwitz SM, Resnick PJ (2005) Child murder by mothers: a critical analysis of the current state of knowledge and a research agenda. AJP 162:1578–1587. https://doi.org/10.1176/appi.ajp.162.9.1578
Friedman SH, Resnick PJ (2009) Parents who kill. Psychiatric Times 26:
Green CM, Manohar SV (1990) Neonaticide and hysterical denial of pregnancy. Br J Psychiatry 156:121–123. https://doi.org/10.1192/bjp.156.1.121
Jenkins A, Millar S, Robins J (2011) Denial of pregnancy – a literature review and discussion of ethical and legal issues. J R Soc Med 104:286–291. https://doi.org/10.1258/jrsm.2011.100376
Kenner WD, Nicolson SE (2015) Psychosomatic disorders of gravida status: false and denied pregnancies. Psychosomatics 56:119–128. https://doi.org/10.1016/j.psym.2014.09.004
Klier CM, Amon S, Putkonen H et al (2019) Repeated neonaticide: differences and similarities to single neonaticide events. Arch Womens Ment Health 22:159–164. https://doi.org/10.1007/s00737-018-0850-1
Mendlowicz MV, Rapaport MH, Mecler K et al (1998) A case-control study on the socio-demographic characteristics of 53 neonaticidal mothers. Int J Law Psychiatry 21:209–219. https://doi.org/10.1016/S0160-2527(98)00003-X
Meyer CL, Oberman M (2001) Mothers who kill their children: understanding the acts of moms from Susan Smith to the “Prom Mom.” NYU Press, New York
Miller LJ (2003) Denial of pregnancy. In: Spinelli MG (ed) Infanticide: psychosocial and legal perspectives on mothers who kill. American Psychiatric Publishing Inc, Arlington, VA, pp 81–104
Milne E (2019) Concealment of birth: time to repeal a 200-year-old “Convenient Stop-Gap”? Fem Leg Stud 27:139–162. https://doi.org/10.1007/s10691-01909401-6
Milstein KK, Milstein PS (1983) Psychophysiologic aspects of denial in pregnancy: case report. J Clin Psychiatry 44:189–190
Mugavin ME (2005) A meta-synthesis of filicide classification systems: psychosocial and psychodynamic issues in women who kill their children. J Forensic Nurs 1:65–72. https://doi.org/10.1111/j.1939-3938.2005.tb00016.x
Murphy-Tighe S, Lalor JG (2016) Concealed pregnancy: a concept analysis. J Adv Nurs 72:50–61. https://doi.org/10.1111/jan.12769
Neifert PL, Bourgeois JA (2000) Denial of Pregnancy: a case study and literature review. Mil Med 165:566–568. https://doi.org/10.1093/milmed/165.7.566
Oberman M (2003) Mothers who kill: cross-cultural patterns in and perspectives on contemporary maternal filicide. Int J Law Psychiatry 26:493–514. https://doi.org/10.1016/S0160-2527(03)00083-9
Oshri A, Sutton TE, Clay-Warner J, Miller JD (2015) Child maltreatment types and risk behaviors: associations with attachment style and emotion regulation dimensions. Pers Individ Dif 73:127–133. https://doi.org/10.1016/j.paid.2014.09.015
Overpeck MD, Brenner RA, Trumble AC et al (1998) Risk factors for infant homicide in the United States. N Engl J Med 339:1211–1216. https://doi.org/10.1056/NEJM199810223391706
Pitt SE, Bale EM (1995) Neonaticide, infanticide, and filicide: a review of the literature. J Am Acad Psychiatry Law 23:375
Porter T, Gavin H (2010) Infanticide and neonaticide: a review of 40 years of research literature on incidence and causes. Trauma Violence Abuse 11:99–112. https://doi.org/10.1177/1524838010371950
Putkonen H, Amon S, Weizmann-Henelius G, Pankakoski M, Eronen M, Almiron MP, Klier CM (2016) Classifying filicide. Int J Forensic Ment Health 15(2):198–210. https://doi.org/10.1080/14999013.2016.1152616
Putkonen H, Weizmann-Henelius G, Collander J et al (2007) Neonaticides may be more preventable and heterogeneous than previously thought – neonaticides in Finland 1980–2000. Arch Womens Ment Health 10:15–23. https://doi.org/10.1007/s00737-006-0161-9
Putkonen H, Collander J, Honkasalo M-L, Lönnqvist J (1998) Finnish female homicide offenders 1982–92. J Forensic Psychiat 9(3):672–684. https://doi.org/10.1080/09585189808405381
Resnick PJ (1970) Murder of the newborn: a psychiatric review of neonaticide. AJP 126:1414–1420. https://doi.org/10.1176/ajp.126.10.1414
Resnick PJ (1969) Child murder by parents: a psychiatric review of filicide. AJP 126:325–334. https://doi.org/10.1176/ajp.126.3.325
Riley L (2006) Neonaticide: a grounded theory study. J Hum Behav Soc Environ 12:1–42. https://doi.org/10.1300/J137v12n04_01
Sadoff RL (1995) Mothers who kill their children. Psychiatr Ann 25:601–605. https://doi.org/10.3928/0048-5713-19951001-04
Schultz MJ, Bushati T (2015) Maternal physical morbidity associated with denial of pregnancy. Aust N Z J Obstet Gynaecol 55:559–564. https://doi.org/10.1111/ajo.12345
Schwartz LL, Isser NK (2001) Neonaticide: an appropriate application for therapeutic jurisprudence? Behav Sci Law 19:703–718. https://doi.org/10.1002/bsl.466
Şar V, Aydın N, van der Hart O et al (2017) Acute dissociative reaction to spontaneous delivery in a case of total denial of pregnancy: diagnostic and forensic aspects. J Trauma Dissociation 18:710–719. https://doi.org/10.1080/15299732.2016.1267685
Shelton JL, Corey T, Donaldson WH, Dennison EH (2011) Neonaticide: a comprehensive review of investigative and pathologic aspects of 55 cases. J Fam Violence 26:263–276. https://doi.org/10.1007/s10896-011-9362-8
Shelton JLE, Muirhead Y, Canning KE (2010) Ambivalence toward mothers who kill: an examination of 45 U.S. cases of maternal neonaticide. Behav Sci Law 28:812–831. https://doi.org/10.1002/bsl.937
Simermann M, Rothenburger S, Auburtin B, Hascoët J-M (2018) Outcome of children born after pregnancy denial. Arch Pediatr 25:219–222. https://doi.org/10.1016/j.arcped.2018.01.004
Slovenko R (2011) The DSM in litigation and legislation. J Am Acad Psychiatry Law 39:6–11
Spinelli MG (2001) A systematic investigation of 16 cases of neonaticide. Am J Psychiatry 158:811–813. https://doi.org/10.1176/appi.ajp.158.5.811
Spinelli MG (2003) Neonaticide: A systematic investigation of 17 cases. In: Spinelli MG (ed) Infanticide: Psychosocial and legal perspectives on mothers who kill. American Psychiatric Publishing Inc, Arlington, VA, pp 105–118
Spinelli MG (2010) Denial of pregnancy: a psychodynamic paradigm. J Am Acad Psychoanal Dyn Psychiatry 38:117–131. https://doi.org/10.1521/jaap.2010.38.1.117
Stenton S, Cohen MC (2020) Assessment of neonaticide in the setting of concealed and denied pregnancies. Forensic Sci Med Pathol 16:226–233. https://doi.org/10.1007/s12024-019-00212-
Stokes J, Forster M, Geary M (2020) Concealed Pregnancy in the 21st Century. Ir Med J 113
Stotland NE, Stotland NL (1998) Denial of pregnancy. Primary Care Update for OB/GYNS 5:247–250. https://doi.org/10.1016/S1068-607X(98)00158-9
Tanaka CT, Berger W, Valença AM et al (2017) The worldwide incidence of neonaticide: a systematic review. Arch Womens Ment Health 20:249–256. https://doi.org/10.1007/s00737-016-0703-8
van der Kolk BA (2003) The neurobiology of childhood trauma and abuse. Child Adolesc Psychiatr Clin N Am 12(293–317):ix. https://doi.org/10.1016/s10564993(03)00003-8
Vellut N, Cook JM, Tursz A (2012) Analysis of the relationship between neonaticide and denial of pregnancy using data from judicial files. Child Abuse Negl 36:553–563. https://doi.org/10.1016/j.chiabu.2012.05.003
Wessel J, Buscher U (2002) Denial of pregnancy: population based study. BMJ 324:458
Wessel J, Endrikat J, Büscher U (2003a) Elevated risk for neonatal outcome following denial of pregnancy: results of a one-year prospective study compared with control groups. J Perinat Med 31.https://doi.org/10.1515/JPM.2003.004
Wessel J, Endrikat J, Kästner R (2003b) Projective identification and denial of pregnancy - considerations of the reasons and background of unrecognized pregnancy also undiagnosed by a physician. Z Geburtshilfe Neonatol 207:48–53. https://doi.org/10.1055/s-2003-39147
Wessel J, Gauruder-Burmester A, Gerlinger C (2007) Denial of pregnancy-characteristics of women at risk. Acta Obstet Gynecol Scand 86:542–546. https://doi.org/10.1080/00016340601159199
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Barnes, D.L. Towards a new understanding of pregnancy denial: the misunderstood dissociative disorder. Arch Womens Ment Health 25, 51–59 (2022). https://doi.org/10.1007/s00737-021-01176-7
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DOI: https://doi.org/10.1007/s00737-021-01176-7