Motor

Extended Suicide

Extended suicide is the rare and tragic pattern in which a person with severe depressive illness kills a loved one, most often their own child, before taking their own life. It is driven by a delusional belief system, typically the conviction that the person has passed on an incurable, inherited illness or doom to their children, and that killing them is, within the twisted logic of the delusion, an act of protection rather than harm, sparing them from a life the parent believes will be one of certain suffering.

This has traditionally been understood as arising from severe, delusional depressive illness rather than from any wish to harm; the parent is not acting out of hostility toward the child, but out of a profound, delusionally distorted sense that death is preferable to the suffering they believe the child is destined for.

Recognition features

• The killing of a loved one, most often a child, by a person with severe depressive illness, followed by (or intended to be followed by) the person's own suicide
• Driven by a delusional belief, typically that the person has passed on an incurable illness, doom, or hereditary curse to the victim
• Understood by the person, within their delusional framework, as an act of mercy or protection rather than an act of hostility or harm
• Occurs in the context of severe, established depressive illness with prominent delusional content, rather than as an impulsive or purely reactive act

Eliciting it at interview

• In any severely depressed patient with delusional beliefs involving guilt, hereditary illness, or doom affecting their children, directly and explicitly assess for thoughts of harming their children as well as themselves
• Explore the specific content and logic of any delusional belief about passing on illness or doom, since this reveals the underlying reasoning that could motivate this pattern
• Treat any such presentation as a psychiatric emergency requiring urgent assessment and appropriate safeguarding action for any children or other loved ones involved

Distinguishing features

• Differs from impulsive behaviour in being driven by a sustained, specific delusional belief system rather than arising without any identifiable motive
• Differs from ordinary child homicide in its specific motivational structure: a delusionally distorted belief that death is a form of protection or mercy, rather than hostility, rage, or an unrelated motive
• The underlying depressive delusion, most often concerning guilt or hereditary illness, is the key feature distinguishing this from other patterns of violence associated with mental illness

Common misconceptions

• That extended suicide reflects hostility or resentment toward the children involved; the parent's own account and the underlying delusional logic instead typically reflect a distorted sense of protecting them from a worse fate
• That this pattern is common; the book is explicit that this is a very rare presentation, and the rarity should not lead to complacency about the risk when the specific warning delusional content is present

Related phenomena

Depressive Illness · Morbid Disorder of Emotion

Diagnostically relevant to

Major Depressive Disorder (links open the DSM-5 Learning Lab)

Practice this

A mother with severe, delusional depressive illness, believing she has passed an incurable inherited curse on to her children that guarantees them a life of suffering, kills both her children and then attempts to take her own life, describing this afterward, within her belief system, as an act of protecting them. What is this pattern called? · A father with severe, delusional depressive illness, believing his family faces certain financial ruin and that this is entirely his fault, expresses a plan to end his own life alone, with no mention of harming his children. Before revealing the answer: does this meet the pattern of extended suicide? · A patient suddenly carries out a violent act. Before revealing the answer, decide what distinguishes impulsive behaviour from extended suicide. · You are assessing a parent with severe, delusional depressive illness and are concerned about risk to their children. Which single question is most essential to ask directly? · A parent who commits extended suicide typically describes the act, within their own delusional framework, as protective rather than hostile. Why is understanding this delusional logic clinically important?

Illustration

A 44-year-old mother with severe, untreated depressive illness becomes convinced that a rare inherited condition running in her family will inevitably cause her two young children immense suffering, and tragically acts on this delusional belief before her own planned suicide is interrupted by a family member's unexpected visit, at which point the full extent of her delusional thinking becomes clear to those around her.

References

• Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 8, 'Motor Disorders'.