Violence has been a major issue of concern to social and public policies since the dawn of humanity, and the reportedly increased prevalence during some periods of time might have been biased due to a diversity of reasons. In fact, nowadays, increased reporting due to over coverage of events from an exuberant mass media, not necessarily means that the prevalence per se is higher.

In spite of all controversies related to the prevalence of family violence, otherwise of violent acts in general, the felonies and illtreatments have been a major subject of forensic science, psychiatry, psychology and sociology in general.

Families under stress are clearly under a higher risk for abuse and violence. Aggression has been studied under several aspects of its phenomenology, but the fact that its appearance is a positive spiralling, produces even more concern [1]. The amount of the violence will be more manifest and worrying when families are frustrated, since aggression is abnormally pointed as a normal response to frustration [2]. An increase in the amount of verbal aggression would unmistakably lead to an increase in the amount of physical aggression, whose pattern on the other hand, seems cyclical [3,4].

Mariticide is the extreme form of family violence, and interestingly but logically enough, a continuum in the personality profile of filicide, mariticide and homicide perpetrators has been suggested [5]. Holistically speaking, mariticide as a crime might be subdivided in uxoricide (largely considered as an epiphenomenon of femicide) and husbandicide, which respectively mean the killing of one’s wife, or one’s husband, from the respective spouse [6,7]. Among risk factors leading to violent acts inside families, and eventually to murder, authors have count alcoholism, low economic and social status, insufficient education, multiple children families and other circumstantial features. If alcohol has an undisputable and largely confirmed role, other drugs of abuse with cannabis at the top of the list, seem to contribute to aggressive and violent behavior, including intimate partner violence [8]. The belief that male are more aggressive than females might have only a cultural and sociological explanation. In fact, biology in itself does not support such a conjecture [9].

Family violence might culminate in homicidal acts, with mariticide being a form of the latter. Perpetrating spouses will use different means to commit homicide, depending on the availability. Knifes and stabbing instruments are freely available and easily accessible, thus differing from firearms that need at least some training to get purposefully used.

Stabbing injuries are potentially associated with use of any piercing instrument, with the external wound giving few, if any data, regarding the depth and the severity of the injury. Massive internal haemorrhage can be undetectable, and the majority of cases are homicidal in their nature. We present the case of a mariticide, with the wife of a middleage Albanian man stabbing her husband to death with a single edged blade knife.

Full external examination and autopsy of a corpse was performed in a forensic facility. Pictures and biological material were retrieved for further preservation and anatomo-pathological study. Details of the murder were made available through the investigative procedures, and duly presented to the state attorney following the case.

A left parasternal sharp-edged incisive wound was seen; a particular myocardial incisive-lacerative rupture was photographed in autopsy (Figure 1).

Figure 1: Myocardial laceration following stabbing with a kitchen knife (autoptic view).

The characteristics of the rupture suggested the usage of a single edged blade knife, and the suspicion that the perpetrator was a lefthanded person was formulated. Obvious compatibility with the surface wound (Figure 2) and internal, myocardial laceration is clear.

Figure 2: Surface wound; a left parasternal incision mark (arrow).

Heart tamponade following the traumatic right ventricle rupture is the mechanism of death in this case. The importance of meticulous and detailed autoptic study is unavoidable in the setting of homicidal crimes, especially in view of an increased prevalence of severe domestic violence, attempted or completed murder that we’re witnessing nowadays.

The crime of murder and homicide remains still a challenge in Albania. Internationally collected statistics will confirm that this country has had an ominous increase of prevalence of murder, from 2.7 homicides per 100.000 inhabitants in 2009; to 4 homicides per 100.000 inhabitants during 2010. The last figure (related to the year 2010) unfortunately is among the highest in the geographical region of Balkans.

We have found presence of alcohol in 10.6% of the fatal assault cases. This might quite well prove the reinforcing effect of alcohol toward verbal and physical violence that to some degree might be related with the perpetration of the murder itself.

When studying the event circumstances, means and mechanisms through which the injuries were perpetrated, we have found a distribution that is graphically depicted in the Figure 3, which handles the overall figures of murder, not strictly the mariticide. The highest number of murders for the period 2008-2013 was related with firearm injuries (260 cases), which when summoned with explosions (13 cases) makes a total of 273 casualties (71.3%). Injuries from stabbing instruments follow with 60 cases (15.7%); blunt traumatic injuries were responsible for 45 cases (11.8%). At the last we had asphyxia as a mechanism of death with 5 cases (1.2%), and no homicide or murder was perpetrated via intoxications.

Figure 3: Means of murder perpetration in the autoptic study sample 2008-2013.

Homicidal mortality according to autoptic data retrieved from cases of our Institute (2008-2013) suggests that 16.9% from all autopsies were violent death cases. This figure when compared relatively with the overall population of Albania places the latter in the first position among other European countries.

Mariticide is registered under the homicide section when officially reported. However, some characterization of mariticidal activity might be done.

As we have illustrated with our case report, stabbing injuries albeit non predominant, are responsible for approx. 15% of all violent deaths during a five-year period. There is a gender difference in the killing methods, proven from casuistics many larger than ours. In fact, men tend to kill partners using proximity methods, such as beating, strangling or chokeholding [10]. Due to obvious disparity in physical force, women on the other hand use much more often weapons when conflicting with partners [11].

Environmental characteristics have been scrutinized with regard to mariticide in general as well. Married partners seem to be at a lower risk, when compared with cohabiting or common-law partners [12,13]. Estrangement or an irreversibly broken relationship is a very important risk factor, comporting an increased risk of uxoricide, but probably not of husbandicide [14].

During consideration of a mariticidal act, two major perspective need to be addressed: the situational, and the evolutionary one. There are obvious sex differences in aggressive behavior, pertaining prevalence, means of perpetrating violence, and other derivates of the issue. Stabbing injuries should not be considered from a merely forensic iconography standpoint, since the weapon used will reflect the motivations for the killing [15]. Motivational drives of mariticidal acts are collected from perpetrators’ interviews and hearings, and therefore can be object to different biases, mainly from insincerity that generally characterizes the perpetrators’ confessions, but for other reasons as well [16]. The more often use of weapons from women during husbandicide has been given different reasons, such as the premeditation of a self-defence in the setting of a chronic physical abuse from the spouse, but as well as an attempt to offset the strength difference between men and women [17].

The large-scale preventive interventions aiming at stopping domestic or family violence have produced, at least, a larger awareness and a greater public sensitivity. Higher disclosure rates have become a normality, and with the implementation of local and ad hoc programmes, a fall in the prevalence of domestic felonies might be expectable, even if some previous and preliminary reports might be gloomy [18,19].