Children Who Witness Parental Murder: Posttraumatic Aspects

CARL P. MALMQUIST, M.D.

In this paper the traumatic situation of children witnessing a parent being murdered is
examined. The purposes are to (1) evaluate the psychiatric consequences of such a trauma,
in terms of meeting diagnostic criteria, and (2) assess the impact on the affective and
cognitive functioning of the child. Methodological complications are present in such rare
events. When a parent is seriously wounded in an attempted murder but survives, the
situation is dissimilar from a parental death; when a child is directly involved, such as being
shot at, a key variable has changed; the response to the child may change the outcome;
differences in family structure, and the clinical status of the perpetrator (e.g., was the
person psychotic and for how long?) are all relevant. This study investigated 16 children
between the ages of [j and 10 who had witnessed a parental murder. The children were
assessed clinically as well as by utilizing the Impact of Event Scale. Complex legal situations
often arise when children are exposed to a parental homicide. The situations may involve
participation in a criminal trial as well as civil issues involving mental distress. Both may
demand the child's participation as a witness, beyond the initial traumatic event of
witnessing a parent murdered.
Journal of the American Academy of Child Psychiatry, 25, : ~ : 3 2 0 : ~ 2 5 1986.
Increasing attention is being paid to the effect of
trauma on people. This is especially so in the areas of
clinical treatment and research with adults, and it has
been extended into a concern for children exposed to
such situations. Diagnostically, under the generic
heading of Anxiety Disorders, there is now a specific
entity of "posttraumatic stress disorder" in the DSM-
III. The disorder can be either acute, chronic or de-
layed. Although this diagnostic category was not offi-
cially recognized earlier, clinicians had been aware of
the impact of traumatic events on personality func-
tioning and had made such diagnoses in a nonsys-
tematic manner. The events recognized as stressors
have often been the expected concomitants of major
trauma, such as that associated with rape; physical
assault; military combat; natural disasters (floods,
earthquakes, tornadoes); terrorism; accidents (cars,
airplanes); or fires. Sometimes the trauma is a by-
product of political programs (torture, death camps,
forced marches under deprivation, bombing). The dis-
order is more severe and longer-lasting when the stres-
sor is of human design rather than seen as a misfor-
tune in nature.
The area examined in this paper deals with a spe-
cific type of traumatic situation-that of children
witnessing the murder of their parent, conceptualized
Receu-ed Sept. I. 191'2; revised Ike. to. 191'2; accepted Jan. 5.
191':1.
Dr. Malmquist is Professor of Social Psychiatry. Department of
Sociology, Unioersitv of Minnesota, Minneapolis, MN 55455, uherc
reprints may I", requested.
0002-71 :IH/H6/2GO:l-0:120 $02.00/0 II' 19H()by the American Acad-
emy of Child Psvchiatry.
as an extreme situation giving rise to a posttraumatic
stress disorder. Investigation of the impact of trauma
on children requires clarification in comparison to
adults. However, few would argue that a child wit-
nessing a parental murder would not suffer some type
of psychological trauma. A separate article has dealt
with the legal issues when the child, as a third party,
observes the event and claims to have suffered com-
pensable emotional injury (Malmquist, 1985).
Efforts have been made to detail clinical psychopa-
thology and intervention steps with survivors of dif-
ferent kinds of trauma. Most of these have not in-
volved children, and those that have often dealt with
the effects of hospitalization. Investigation of the ef-
fects of other traumatic events on children has been
slow to evolve. One study dealt with children whose
school had been destroyed by a coal mining disaster
(Lacey, 1972). Another discussed the responses of
children to terrorism in Ireland in terms of their
proximity to the areas of actual attack (Fraser, 1973).
Yet another dealt with the consequences on child
survivors of a dam breaking (Newman, 1976). The
effects on 23 children kidnapped together on a bus
has been discussed (Terr, 1979). The impact of a dog
bite on personality development of 3 children under
36 months has been examined (Gislason and Call,
1982). Children already enrolled in a Head Start pro-
gram were surveyed for their reaction to a severe
winter storm (Burke et aI., 1982). Most articles deal
with adult survivors of well-publicized disasters. The
Monticello tornado, the Managua earthquake, the
Wilkes-Barre flood, the Beverly Hills Supper Club fire
:120
CHILDREN WHO WITNESS PARENTAL MURDER 321
in Kentucky, and the Buffalo Creek Dam (Cohen,
1976; Gieser et aI., 1981; Hartsough et aI., 1976; Hef-
fron , 1977; Lindy et aI., 1981) are examples.
Several consequences follow from explicit psychi-
atric recognition of posttraumatic disorders. It can be
predicted that there will be an increase in published
reports. This will provide added data to rework some
of our ambiguous concepts. Second, there will be an
impact outside the strict area of clinical impressions.
The impact will influence sociological thinking and
research which also has a keen interest in the impact
of trauma and disasters. These kinds of situations can
also be anticipated to give rise to an array of lawsuits
and utilization of clinical material in courts. Finally,
the entire field requires a clarification in our thinking
regarding the impact of severe trauma on children.
The same symptomatic picture is not necessarily elab-
orated in children exposed to the same trauma. There
is the added element of an underdeveloped psycholog-
ical state in which the traumatic events may elicit
different responses than in adults. Different develop-
mental levels are a significant variable. There is also
the surprising lack of early aftereffects in some chil-
dren (Lebovici, 1974). Closeness to the event may also
playa critical role in determining response. The anal-
ogy has been used of the response of a pond full of
frogs in which a stone is thrown into the middle; the
frogs in the middle experience fear and those at the
rim experience the ripple as anxiety (Black, 1982).
Witnessing a parental death can occur in different
ways. The child my be present and actually view the
event, or be in the immediate vicinity and within a
short period of time be a primary reactor to it. It is
significant how few of these children receive psychi-
atric attention subsequent to such a trauma. Attention
is often first directed to the children at the time legal
issues arise, and there may then be a realization that
an expert witness is needed. Whether this represents
another example of the need to deny some of the
aftereffects of traumatic events on children by the
participants, until forced to do so by those not directly
involved with the children, is not clear. What can be
stated affirmatively is that most of the cases seem to
have had minimal or no psychiatric intervention prior
to the raising of legal issues. Perhaps this requires a
backhanded extension of appreciation to the legal
profession who force our attention to these cases even
though their interests are not clinical.
Research Issues
Witnessing a parental murder is categorized as a
rare event. Hence, generalizations supported by sta-
tistical measures to draw conclusions about signifi-
cance are difficult to attain. In any type of rare event,
subtle differences exist between seemingly similar and
traumatic events. Consider some of the following fac-
tors which complicate any research conclusions:
1. If the parent who has been assaulted in an at-
tempted murder survives, does this make a significant
difference in terms of the psychological impact on the
child? We would be ignoring a crucial variable if we
did not maintain that a live parent alters the group of
survivor children from those where a parent has been
killed . Perhaps such differences in themselves would
be minimal, and if we could accumulate sufficient
cases with a rigorous methodology over an extended
period of time, we might be able to draw conclusions
about differences between the two outcomes following
a murderous assault.
2. The problem of family violence has been exposed
to increasing discussion. Diverse methodological dif-
ficulties exist in these studies. Some studies of violence
within family units have defined violence as including
incidents of slapping while others have extended the
definition to maiming. The whole array of episodes
varying from slappings to homicide may then be
lumped together and conclusions offered about "family
violence." We must be wary of extending conclusions
from these sources to the traumatic impact on a child
being privy to a parental death by violence. The cau-
tion is not because these diverse sit uat ions may not
give rise to an assortment of psychopathological re-
actions; some indicate up to one-third of children who
witness interparental violence have behavioral or emo-
tional problems (Hilberman and Munson, 1978; Lev-
ine, 1975). However the types of reaction and problems
ensuing in such situations may be quite different from
when a parent is murdered.
3. There is an overlap with problems of abused
children. Yet, the reaction of a child who has been
physically abused by a parental figure (not even in-
cluding the controversial question of emotional ne-
glect), is not analogous to the child who witnesses the
murderous assault on a parent.
Method
In this study, six young children between the ages
of 5 to 10 separately witnessed a parental murder.
There were four boys and two girls. In addition a
series of 10 children were present during an act of
familicide in which a family member attempted to kill
all the members of the family (Malmquist, 1980). The
details of the situations were often horrifying to the
adults exposed to them. The situations will be briefly
summarized.
Case 1. A boy of 10 years, an only child, heard
unusual noises in the kitchen of his home. On going
into the kitchen to check things, he found his father
beating his mother on the head with a frying pan. The
mother was on the floor screaming. After a few sec-
322 C. P. MALMQUIST
onds, the boy ran from the house, returning in 20 to
25 minutes. He then saw a crowd gathered outside and
a police car. The actual incident involved the mother's
head being smashed in, and she died shortly after
arrival in the emergency room from a subdural he-
matoma. The solution provided by relatives was to
send the boy immediately a thousand miles away to
live with relatives. The father was diagnosed as having
a major depressive episode with psychotic delusions
about his sinfulness and guilt over some minor
transgressions from years earlier.
Cases 2 and 3. Two brothers, 6 and 9 years, returned
from a weekend custody visitation with their divorced
father. On entering their mother's home through an
open front door, they stumbled onto the scene of their
dead mother, lying in a pool of blood with multiple
stab wounds ("holes all over her body"). Smelling gas,
they ran to the garage and found the motor of her car
still running, with the mother's boyfriend slumped
over the steering wheel. He was later pronounced dead.
Case 4. A lO-year-old girl, arriving home from school
in midafternoon, found her mother and father both
shot. A note revealed the father had acceded to killing
his wife who had been diagnosed as having a malig-
nancy, and then turned the gun on himself.
Case 5. An 8-year-old girl heard her mother engaged
in an argument with her separated father. The father
had been released from a psychiatric hospital a short
time earlier. Upon hearing shots, she ran to the scene
from her bedroom and saw her father with a gun in
his hand and the mother lying on the floor bleeding.
The father at that point turned toward the girl, shot
at her but missed, and ran from the house.
Case 6. A boy of 5 years was sitting on his mother's
lap in a chair when her former boyfriend barged into
the home. The boyfriend fired several shots at the
mother which killed her. One shot grazed the boy.
Although emergency room reports noted his wound
was not serious, it stated he bled quite vigorously.
Cases 7-16. A series of cases of familicide had 10
children exposed to the homicidal scene. Some of these
children were shot at, and others survived by hiding
or running.
A number of points can be noted from these cases
of children being exposed to the trauma of witnessing
a parental murder. They illustrate how diverse the
situations can be: (1) Some families are intact and
some not. (2) Some of the perpetrators were acutely
psychotic in a psychiatric diagnostic sense at the time
of the act. If so, a different set of antecedents had
been present which presumably operated before the
homicide in comparison to the situation of a child
with a nonpsychotic parent. (3) A suicide by the
perpetrator following a killing changes the variable of
a surviving parent. (4) The presence of ongoing mental
illness, in one or both parents, such as paranoid de-
lusions, needs consideration. (5) Different handling of
the children following the event may change the clin-
ical picture in the child subsequent to the event. (6)
The length of time elapsed between the event and
some type of professional intervention may alter the
natural history. (7) Whether the child was wounded
or shot at in any way during the episode may be a
significant variable. These variables can all effect the
reaction to such an event. They are signposts to make
the evaluations of conclusions all tentative even if a
larger group was available.
In terms of meeting DSM-III diagnostic criteria for
a posttraumatic stress disorder, all of these children
easily did so. They had recurrent thoughts about the
episode which came back, sometimes at unpredictable
and unwanted moments. Hence, some of their intru-
sive thoughts occurred when they were sitting in a
classroom or even in the middle of recitation in class.
Not only did all of the children dream about the event,
but 14 of 16 had nightmares. The nightmares were
part of a larger picture of having fears which were
present before going to sleep, or of going into rooms
alone, particularly after dark. Two of the boys were
frightened about going into a bathroom alone unless
someone first went in and checked it out. Although
none of these children reported feeling as if another
murder was about to occur, they did report associa-
tions about the murder. In this connection, one of the
children reported going by a certain neighborhood and
feeling sad. Another connected a persistent depressive
mood with respect to a television program which had
a theme of homicide occurring within a family. For
some of the children the inescapable presence of pic-
tures of the deceased induced sad moods. Although
adults might have removed pictures or belongings of
the deceased from the children, they could not effec-
tively remove every picture or article.
In terms of a numbing response to their environ-
ment, these children were at the opposite end of the
continuum compared to adults. Their anxiety, rest-
lessness, hyperalertness, vigilance, and difficulty con-
centrating were prominent. Varying degrees of school
difficulties appeared and their trouble concentrating
and memory impairment were noted in school records.
The possibility of diverse outcomes was seen in school
performance. In the year following the event all but
one had a significant decline in their school perform-
ance. However, one of the children went in the oppo-
site direction and took on a new-found studiousness
following the parental death. While this might not
surprise us clinically in terms of the possibilities of
diametrically opposed outcomes being possible, it is
CHILDREN WHO WITNESS PARENTAL MURDER 323
the type of possibility that often gets obscured in group
data.
Impact of Event Scale
The Impact of Event Scale was developed by Ho-
rowitz et al. (1980) to assess a person's recognition of
states of stress in the 7 days since an event occurred.
Although the instrument was developed for adults, the
items seem applicable to children who have been ex-
posed to a stressful event as well (see Table 1). Pangs
of emotion about the event, preoccupation with it, and
intrusive ideas related to it were the most commonly
reported signs and symptoms with these children. For
children, the questions were asked to them and about
them. A clinical judgment was then made about their
interactions on a 4-point scale from 0 to 5, with 15
items as Horowitz did with adults.
General Symptom Picture
Apart from the descriptive criteria meeting DSM-
III standards for a diagnosis of stress disorders, pres-
ent in all of the children, there was a need to under-
stand the diverse factors that were operating. The
descriptive symptoms will be elaborated upon from
that perspective. Anxiety and/or nightmares were
present in all of the children. They were described as
exhibiting marked anxiety compared to their pretrau-
matic selves. Descriptions from school personnel and
the surviving parent when available were consistent
in this respect. The picture was of generalized rest-
lessness and jumpiness. For one boy, going back to the
house where the incident occurred 2 months earlier to
get belongings, led to periods of restless sleep, periodic
awakening, and nightmares for 10 straight nights.
Nightmares were replays of the scene of discovery but
with seemingly minor changes which gave a different
outcome. Some of the dreams were more diffuse and
less structured. Shapes and hulks chased them, faces
were without features, or other scary features were
prominent in content. A 9-year-old boy, who had
shown no interest in comic books before the death of
his mother, became obsessed with them and began
spending hours a day reading them. Collecting comic
books had become his hobby. An 8-year-old girl who
had expressed minimal interest in drawing before the
episode thereafter became immersed in drawing; the
content varied from extremes of blandness and hap-
piness, such as a sun with a shining face, to scenes of
darkness and roads leading nowhere without people.
Signs and symptoms of major affective disorder
were present, with the children exhibiting persistent
disturbances in mood. Denial of painful affect worked
only up to a point. One boy, who had dreamed he
thought he saw his deceased mother, stated a year
after the event that he had accidentally come across a
picture of her which was inside a book. He told no one
of this but when alone, he began to get the book to
take out the picture, look at it, and cry. He described
this in the course of his treatment with deep sobbing
TABLE 1
S.D. Group Mean" Scale
Impact of Event Scale: Response and Clinical Assessment in Subjects Who Witnessed a Parental Homicide (N = 16)
._. __ - _0 .__ _ _
Percent Positive
Endorsed
Intrusion Items
I had waves of strong feelings about it 100 4.60 0.87
Things I saw or heard suddenly reminded me of it 100 4.00 1.17
I thought about it when I didn't mean to 88 3.86 U8
Images related to it popped into my mind 88 4.71 0.71
Any reminder brought back emotions related to it
[)6 2.89 1.61
I have difficulty falling asleep because of images or 88 4.87 1.69
thoughts related to the event
I had bad dreams related to the event 81 ::l.OO 1.7[)
Avoidance Items
I knew that a lot of unresolved feelings were still 6:1 3.20 1.08
there, but I kept them under wraps
I avoided let t ing myself gel emot iorial when I f,O 4.00 1.00
thought about it or was reminded of it
I wished to banish it from my store of memories [)O 4.60 0.80
I made an effort to avoid talking about it. 98 3.86 1.38
I felt unrealistic about it, as if it hadn't happened 6:1 3.20 1.66
or as if it wasn't real
I stayed away from things or situations that might 69 4.46 0.89
remind me of it
My emotions related to it were kind of numb
[)O 1.1:1 2.35
I didn't let myself have thoughts related to it 7[) 4.[)0 0.87
-- ----------------
a Scale: ;; is severe; :1 is moderate; I is mild; 0 not at all.
324 C. P. MALMQUIST
and commenting how young his deceased mother
looked in the picture.
While these children often appear restless and anx-
ious, they also exhibit a blandness in their facial
expressions. They did not like to speak about what
had happened, which was usually possible since, ex-
cept for their psychiatric treatment, they reported no
one asked them about what happened. They appeared
to the adults around them as "difficult to please."
What this meant was that in their daily life, nothing
seemed to please them or go right. Enthusiasm for
most things seemed lacking on any consistent level.
Although there has not been an explicit demand or
threat to remain silent, the child may interpret the
silence of adults as a demand for forced silence, and
talking about the event as similar to violating a prom-
ise (Lister, 1982).
Psychophysiological complaints emerged for the
first time in 10 of 16 children. Although some of these
somatizing processes could have been included with
affective manifestations, for clarity they were listed
separately. The most frequent pattern was related to
anxiety in which reassurance for minor problems, such
as scratches or bumps, was sought. Headaches, com-
plaints of dizziness, and abdominal pains were most
frequent. In one boy, :1 months after the death, a
prolonged diarrhea lasting 2 months commenced
which gave rise to an exhaustive medical workup
without a finding of organic pathology. In another boy
who had been toilet trained for years, regressive, noc-
turnal enuresis occurred about once a week for the
next year.
While these children did not express overt guilt,
they showed open anger. Puzzling questions were ex-
pressed such as, "Why did it have to happen?" or
"Why to my mother of all people?" Rather than the
type of anger in adults who ponder their personal
disaster, the children reminisced about things their
deceased parents had done which angered them at the
time. One boy brought up how his mother's boyfriend,
after her divorce, had forced him to eat food he did
not like. A girl angrily recalled when her mother had
been unhappy and would tell her about it. She had
not known what to do about it , but was left feeling
that she was supposed to do something. While some
children had accidents, such as cutting a hand while
whittling, or lying on a raft which drifted out onto the
middle of a lake so the child required rescuing, it is
difficult to say whether these were more frequent than
could have happened in the course of childhood ex-
periences or whether they had more specific meaning.
Recollection of vivid memories of the event were
present in all 16 of the children. The recall of the
homicidal scene persisted and recurred at unpredict-
able moments. These "flashbacks" were a source of
annoyance since they might occur while reciting in
school, as noted earlier, or in the middle of talking
with someone. A result was that they might be criti-
cized for not paying attention or be teased by other
children for such lapses. Since they never told anyone
why they had seemed distracted, the situation was
interpreted by others on a surface level and never
understood.
The intrusive details might pertain to acts con-
nected with the killing (such as visualizing the moth-
er 's head having been disfigured with blood), or images
of knife wounds in the body of a parent. In one child
a scene from the mother's funeral kept recurring where
a relative turned to the boy and stated, "Take your
last look at your mother since you will never see her
again." The image of the casket door being closed over
his mother's face frequently intruded itself in diverse
contexts. The result of these persistent thoughts and
images gave an impression that the child was confused
and bewildered, particularly since the intrusive
thoughts occurred in neutral situations. While these
reactions are similar to experiences of mourning a
parent who dies by whatever means, the vividness of
the violent scene being a firsthand experience makes
a difference in persistence and difficulty in ridding
oneself of thoughts. Another result of these lapses was
to be on the receiving end for sadistic taunting by
others who perceived the preoccupied child as being
different, odd, too serious, or intense.
Given a sample of 16 children who had been part of
a direct situation of a parent being killed, it would be
difficult to draw major generalizations about their
subsequent acting-out behaviors. In an effort to detail
sequelae of witnessing a parental homicide, we can
only give some of the descriptive aspects and raise
dynamic hypotheses as to what meaning it has. In 8
of these children acting-out behaviors became appar-
ent after the homicidal event that had not been pres-
ent before. In one case the behavior went to an ex-
treme of persistent vandalistic acts with a friend which
involved hundreds of dollars of damage to property.
In the case of a l O-year -old girl, petty pilfering oc-
curred as she took small items from her teacher or at
an aunt's house. A 9-year-old boy frequently asked
relatives for gifts, but upon receiving them, expressed
disappointment that they were not what he wanted or
not good enough, conveying a disappointment in them.
He would often later trade these gifts with other
children at his school or neighborhood. For the
younger children the type of "forbidden games" as
described by Terr (1981) became difficult to distin-
guish from repetitive, compulsive reenacting of the
traumatic event. These themes would come out in a
CHILDREN WHO WITNESS PARENTAL MURDER 325
therapeutic context as well. Bergin (1958) described
such details in a 4-year-old girl who had witnessed her
father murder her mother.
Discussion
Throughout the evaluation of these 16 cases, the
question of systematic themes in the children has been
in the background. It is exceedingly complex to eval-
uate the impact of a specific traumatic event on a
child even when it is so striking as witnessing a parent
murdered. The reactions do not easily lend themselves
to generalizations that can withstand critical evalua-
tion. Even with severe trauma, difficulties arise from
unsystematized impressions which lead to hypotheses
that are difficult to test and refute.
An effort has been made in this article to assess
empirically the consequences of one discrete example
of extreme stress. It would be most difficult to concep-
tualize an event that raises the possibility of having
more potential adverse consequences than being privy
to a parent being murdered. The need to be cognizant
of diverse factors which may be operating anteced-
ently, causing the individual child to be left vulnerable,
is important in addition to the presence of the provoc-
ative event itself.
With these caveats, what might be offered about
children exposed to such a situation? Based on this
sample, there appears to be a great diversity in their
responses. Although they all fit the minimal empirical
criteria as found in a posttraumatic stress disorder, a
good deal of resilience is witnessed in their adapta-
tions. Despite the presence of diverse symptom pic-
tures, indicating distressing signs of anxiety, they did
not collapse into psychotic states. Perhaps the key lies
in the strength of their antecedent object relations
and self-esteem which allows them to handle such a
traumatic event and loss without a massive abandon-
ment of ego functionings and defenses beyond the
clinical picture with which they presented.
All of the variables connected with a child dealing
with any type of major object loss are present in this
group of children. The situation is also complicated
by the presence of the traumatic aspects connected
with the loss to begin with, as well as perhaps the
need to participate as a witness subsequently in crim-
inal and civil proceedings. My impression is that the
capacity to continue to function, and eventually over-
come the stress disorder, resides in the strength and
comforting role of internalized objects. Either these
have been present and available prior to the incident,
or in their absence the child is left quite vulnerable.
Only if the child has comforting internal agents, and
has been exposed earlier to minor traumas (with which
he has been able to cope), can he deal with the possi-
bility of a major trauma. The linchpin appears to be
the suffering of earlier object losses in graduated doses,
and the self-esteem system that evolved therefrom.
The children who appear able to cope with such a
horror and disappointment in their lives are those who
can still affirm their own value and worth. Alterna-
tively, the child who is exposed to such a situation in
the absence of such bulwarks, is likely to remain prone
to episodes of anxiety and depression long after the
traumatic episode. Confirmation of this hypothesis
will need testing in the diverse types of traumatic
situations to which children may be exposed.
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