Murder-suicide accounts for !000 to !500 deaths in the United States (and less than 50 in England and Wales) each year. Affective disorder is by no means the only possible psychopathology; in an epidemiological review Marzuk et al.(89) identify five principal types of offences.

• Spousal: the result of pathological jealousy.

• Spousal: elderly men with poor health and with ailing spouses (sometimes both) who feel either or both cannot cope with declining health, adversity, or loneliness.

• Filicide-suicide: a depressed mother kills her child(ren) and herself to save them all from a painful world (see above).

• Familicide-suicide: a depressed, paranoid, or intoxicated senior male in the household kills the family and himself in the setting of financial, marital, or other social stresses.

• Extra-familial murder-suicide: disgruntled, paranoid, or narcissistic individuals who believe they have been slighted in some way, or perceive themselves as humiliated, take revenge on single or multiple victims, the latter either as specific targets or as bystanders.

Personality disorder

The relationship between personality disorder and offending is controversial, principally because an uncertain clinical category has been, and continues to be, drawn into legislative efforts designed to protect the public. In the United Kingdom there is currently a renewed government initiative to introduce legislation aimed at preventive detention of personality-disordered people before they offend. Underlying the controversy are some important issues.

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