Introduction
Violence is one of the twenty leading causes of disability-adjusted life years worldwide, and its contribution to disability is expected to increase in the next two decades1.
Little research was done on female criminal offenders for a long time, and the data on crime by women were assumed to be associated with data on crime by men; women were thus not analyzed separately. In fact, social development was accompanied by an exceptional increase in the burden of violence in all areas with human presence. To overlook women’s presence in this scenario is thus a sign of prejudgment.
According to McKeown2, the development of criminal behavior in women differs from that in men. The personal history of female offenders nearly always includes physical and sexual abuse, financial difficulties, mental health problems, and substance abuse. Meanwhile, intimate partner murder by women frequently follows previous victimization from domestic violence. Another finding is that women are less likely to use firearms to commit murder.
Violence perpetrated by community-living women is not well understood, due to a shortage of studies in this area. This is due partly to the fact that women are considered more victims than perpetrators of violence3. A study of psychiatric comorbidity in the United Kingdom from 2000 to 20074 found that the principal victims of women with aggressive behavior were intimate partners and friends. Prevalence of aggressive behavior in women was 5.5% in 2000 and 5.1% in 2007. Compared to the non-violent group, violent women displayed significantly more psychiatric morbidity (depression, anxiety disorders, alcohol and psychoactive substance use disorders, and antisocial personality disorder).
Fazel and Grann5 analyzed this issue by examining data from hospitals and crime records in Sweden from 1998 to 2000. The definition of violent crime included homicide, attempted homicide and aggravated physical assault, threatening behavior, and sexual crime. During this period, 1.4% of the overall population had been discharged from psychiatric hospitals (55.8% of whom were women). Of all the patients with mental disorders, 6.6% had a history of incarceration for violent crime, compared to 1.8% of the overall population with history of imprisonment for such crimes. Among patients with mental disorders, women committed nine times more violent crimes than men. However, compared to men, violent crimes committed by women were more likely to be attributed to severe mental disorders.
Another study on this theme found that 50% of the violent crimes committed by women were associated with a diagnosis of mental disorder6. Studying this issue, Teplin et al. 7 found that one-fifth of the incarcerated female population have a diagnosis of severe mental disorder and that this figure is double the rate of mental disorders in women in the overall population. The most common psychiatric disorders in incarcerated women are mood, anxiety, psychotic, substance use, and personality disorders (especially antisocial and borderline)7-9 , besides histrionic and narcissistic disorders10.
One of the most consistent findings in the literature on violence is that aggressive behavior rates are lower in women than in men. Various studies have found that since adolescence, women display significantly less aggressive behavior and arrests for violent crimes. In the overall population, men are more physically aggressive than women according to various indicators, including incarceration for homicide and other violent crimes11. However, studies have suggested that mental disorders reduce or even eliminate the gender differences. Studies in large unselected samples in which individuals are followed since birth have shown that the risk of aggressive behavior increases in the presence of mental disorders in both men and women, but relatively more in women12.
Research furnishing data that assist the identification of individuals with mental disorders involving risk of aggressive behavior, and adequate treatment for these individuals, can help prevent this behavior and its expression in society. Such studies can also allow to better characterize risk groups or situations and elucidate the specific motivations related to manifestation of aggressive behavior in individuals with mental disorders.
The current study thus aimed to evaluate, from the forensic psychiatric perspective, a population of women admitted to a forensic psychiatric security facility in Rio de Janeiro, Brazil, for crimes involving violent behavior. We previously published a preliminary article13 reporting 14 cases of patients who had committed homicide.