Hypercortisolism has been associated with aggressive and psychotic behavior. It has been linked to violent behavior including homocide. It has even been used as a defense in homicide cases, and successfully in the attempted filicide by Jozetta Rannay Byrd after she attempted to kill her own children. I have personal knowledge of another instance of a mother who was a trained mental health professional that was treated with Prednisone, becoming increasingly less attached, more controlling within her family dynamic and more abusive towards her husband and son. Child Protective Services, the court, the police and all of the medical & mental health professionals all failed to recognize the risk factors for her filicidal behavior, to recognize what a precipitating event was, the psychology behind it, and what to do about it. They instead chose to see the husband as the cause for concern.
I have created a single graphic that identifies all of the risk factors for filicidal behavior and the progression of steps leading to filicidal-suicidal behavior. It is important to recognize the etiology that ties hypercortisolism to filicide.
A cortisol imbalance in the family is associated with increased levels of violence and divorce within the literature. It would not be incorrect to look at this to include both natural and synthetic forms of glucocorticoid imbalance as producing the same effects. This is key because they both cause volumetric reduction of the hippocampus. The hippocampus is a region of the brain associated with emotional control and executive function. A volumetrically reduced hippocampus is also associated with psychopathic behavior. It is interesting to note that a 1996 study at the University of Pittsburgh recognized a prevalence of psychopathic behavior over 17 times greater than the general population in 33 Cushing's Disease patients before surgery. The same study also recognized a correlation between normalization of cortisol levels, hippocampus growth, and a reduction of psychopathic behavior. Anosognosia is the inability of someone to be able to recognize their own mental deficits, while denial, a characteristic narcissistic defense mechanism of psychopaths, can include the refusal to acknowledge their own mental deficits. One of the symptoms of hypercortisolism can be delusions, a shifted perception of reality that can be the narcissistic support for the mask of normalcy which can include paranoid or encapsulated delusions where patients appear to be functioning normally in other aspects of their lives. As the inability to connect emotionally, the need to protect the mask of normalcy of the false self grows, and the need to control those closest to them also grows, it is not unexpected that divorce follows. It will be a high conflict divorce if children are involved. The patient who exhibits a hypercortisolism induced psychopathic behavior more succinctly described as tertiary psychopathy, will be lacking in theory of mind processes as a result of damage to the hippocampus, and they will necessarily view their children as extensions of themselves. In their delusional psychosis, they will effectively practice gas lighting techniques with their children therefore creating a folio a deux with their children. Trauma bonding and attachment based parental alienation of the non custodial parent will follow if the courts allow it, and in their ignorance, they generally do until it gets so obvious that it can no longer be overlooked. Unfortunately, when the courts finally understand the situation for what it is, and not how the psychopathic parent might like others to view reality it becomes a precipitating event. The tertiary psychopath will do literally anything to avoid the feeling of narcissistic mortification. They do not fear like normal people and have just two fears which are being exposed and losing control of their targets which give them emotional supply. Death, suicide and murder are not on that list. Upon narcissistic mortification, they become angry at themselves for having lost control, which becomes depression. Suicide among those with hypercortisolism is seven times higher than the general population. Suicide for a tertiary psychopath with children is different. Since they see their children as extensions of themselves, if they are truly to commit suicide, they must kill their children first. They may rationalize it as protecting them, or they may do it to further harm their ex significant other.
Having the risk factors does not mean that they will be acted upon. There is no data that quantifies the conditional probability of the risk of this behavior, nor is there any data the could quantify what an acceptable risk might be. It is unlikely that filicidal-suicidal behavior would occur without a precipitating event that is either real or imagined.
It becomes quite easy to see that if hypercortisolism can drive a formerly loving parent to being capable of killing their own child, that exposure such as might occur in the workplace could also precipitate catastrophic results.