Journal of Forensic and Legal Medicine 46 (2017) 1e10

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Journal of Forensic and Legal Medicine

j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / j fl m

Sexual homicide: Brief review of the literature and case report

involving rape, genital mutilation and human arson
Maria-Valeria Karakasi a, Epameinondas Vasilikos a, Polichronis Voultsos b,
Aikaterini Vlachaki a, Pavlos Pavlidis c, *
a
Psychiatric Department, G. Papanikolaou General Hospital of Thessaloniki, GR 57010, Exohi, Asvestoxori, Thessaloniki, Greece
b
Department of Forensic Medicine & Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
c
Laboratory of Forensic Sciences, School of Medicine, Democritus University of Thrace, GR 68100, Alexandroupolis, Greece

a r t i c l e i n f o a b s t r a c t

Article history: The objective of the current paper is to report a new case of sexual murder involving human arson and
Received 6 June 2016 summarize the literature on the phenomenon of sexual homicide. The present case study is unprece-
Received in revised form dented in Greece and a rarity in international literature due to the fact that the victim suffered genital
13 October 2016
mutilation and incineration while still alive. The evaluation consisted of 176 articles; 53 were reviewed
Accepted 18 December 2016
Available online 20 December 2016
by the authors. The results revealed sparse, but significant, research findings. The authors discuss the
limitations regarding research, incidence of the phenomenon, crime-scene patterns, offender charac-
teristics (killing methods, motive inferences, sociodemographic data, classifications, psychopathology,
Keywords:
Forensic pathology
modus operandi), and victim selection. The incidence of the phenomenon is unclear (1e4%) due to non-
Forensic psychiatry standardized criteria. It is an expression of displaced anger or sexual sadism and/or a way to elude
Sexual detection (ancillary benefit). Most offenders (in their first kill) and victims were in their late 20s to early
Murder 30s and belong to Caucasian populations. Personal weapons were commonly used against women,
Erotophonophilia strangulation is the prevalent killing method against children, and firearms against men. Most of the
Lust murder sexual homicide perpetrators are non-psychotic at the time of the attack, but experience personality
Aggression pathology, primitive defenses, pathological object relations, and withdrawal into fantasy in order to deal
Criminality
with social isolation.
Behavior
© 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
Classification
Sexual assault
Homicide
Catathymia
Compulsive
Paraphilia
Antisocial
Narcissistic
Incineration
Immolation
Arson
Firesetting
Criminology

1. Introduction intercourse, triggered by the victim's rebuff and/or the perpetra-

Sexual homicides consist of two key components: the homicide
of a person and the sexual behavior of the perpetrator. The homi-
cide may be an impulsive, wrathful killing during sexual
* Corresponding author. Forensic Medicine, School of Medicine, Democritus
University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
E-mail address: pavlidi@med.duth.gr (P. Pavlidis).
tor's intoxication (by alcohol and/or drugs) or an act meticulously
planned for days or even weeks before the attack. The first is usually
charged as a degree of manslaughter, whereas the latter is charged
as first-degree or aggravated murder.1,2
Sexual behavior may occur prior to, during and/or after the
homicide. It is comprised of sexual fantasies, sexual arousal,
masturbation, actual penetration, and may even be symbolically
expressed through genital mutilation of the victim.1,3

http://dx.doi.org/10.1016/j.jflm.2016.12.005
1752-928X/© 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
2 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
2. Methodology
This paper briefly updates the relevant literature on sexual ho-
micide and reports a new case of sexual murder involving rape,
genital mutilation and human arson. An exhaustive systematic re-
view was carried out on sexual murder incidents by searching the
electronic data bases of PubMed, Google search, Google Scholar,
Heal Link, EMBASE, Scopus and Cochrane Library. The search terms
were: “sexual homicide,” “sexual murder,” “erotophonophilia,”
“lust murder,” “sexual offenders,” “catathymia,” “rape murder,”
“sexual assault,” “homicide,” “violent offenders,” “molest,” “rape,”
“paraphilia,” “sex crime,” “sexual violence,” “sadistic violence,”
“lust killing,” “necrophilia,” “lethal sexual assault,” “violent crime.”
No language restriction was applied.
Overall one hundred seventy-six (176) articles and books
deriving from various scientific areas concerning sexual homicide
dating from 1886 to January 2016 were thoroughly studied. All 176
articles were reviewed and evaluated by the authors. Sparse, but
significant, findings were revealed from virtually all empirical
studies concerning sexual homicide that had already been
conducted.
Regarding the issue of sexual homicide, many limitations arise.
The scope of sexual homicide poses many difficulties in the
methodology of the research studies conducted, as there are
numerous parameters to investigate, such as the scene of the crime
(modus operandi, crime-scene patterns), the characteristics of the
offender (motive inferences, psychiatric diagnoses, sociodemo-
graphic data, history, phallometric features classifications), the
victim selection (demographic characteristics, offender-victim in-
teractions) as well as the weapon and method of killing (forensic
aspects). Therefore, empirical studies of sexual homicide incidents
vary in several parameters regarding both methodology and
examined material.
The major issue encountered in the literature is the lack of ho-
mogeneity in study samples. Many factors contribute negatively to
this matter. The definition of the term “sexual homicide” has been
evolving over the years. The occasionally different definitions that
have been employed have, in turn, led to diversified criteria for
selection of the participants. Subsequently, the vague quality of the
different samples examined in empirical research studies is largely
attributable to the non-standardized definition describing this
phenomenon. Furthermore, the available material for evaluation is
very scarce, which requires long-term studies.
In addition, many studies use mixed samples, which do not
specify the demographics of the perpetrators and victims, such as
the offenders' age and gender as well as the type of victims (e.g.,
adult males, adult females, minors and the elderly). This lack of
specification leads to intensified ambiguity and heterogeneity
among samples, which, in turn, complicate their retrospective
comparison.
Furthermore, the sources from which information is extracted
also vary among different studies (e.g., self-reports, interviews,
clinical examination, institutional records, psychiatric court re-
ports, police data, public media reports, crime-scene investigation
reports or pictures), which lead to the investigation of different
aspects of the crime.
An additional obstacle for a proper comparison of samples from
different studies is the selection of similarly deviant control groups,
which consist of sexual offenders, psychopaths, and non-sexual
homicide perpetrators instead of healthy non-offending pop-
ulations. Consequently, the comparison is made between varying
samples and, thus, the results that are obtained may be neither
comparable nor representative of specific offender groups.
For the reasons outlined above, research studies of high validity
and robust methodology as well as the most recent articles were
selected for the synthesis of the present brief review, while one
hundred twenty-three (123) articles were not included. All the
articles have been evaluated and supplemented by searches of the
bibliographies of key papers. The studies were reviewed in order to
investigate the incidence of sexual homicide, characteristics of of-
fenders and victims, crime-scene patterns as well as methods of
killing and modus operandi. As explained above, all the following
statistics and typologies are derived from empirical studies exam-
ining small and heterogeneous samples. Most empirical and sta-
tistical studies converge and approximate on these percentages.
Nevertheless, over the years, as the understanding of this phe-
nomenon increasingly deepens through better-structured and
more-standardized research studies, statistically significant vari-
ables are likely to evolve and lead to more concrete, valid, and
reliable statistical results, definitions, and classifications.
In addition, the following case study is written in compliance
with the Helsinki Declaration of 1975, as revised in 1983. The
complete anonymity of the victim and the offender has been
assured.
3. Literature synthesis
3.1. Incidence
The prevalence of sexual homicide is unclear. Crimes involving
sexual homicide are frequently registered as homicides of “un-
known motive,” due to non-standardized criteria and underlying
dynamics that are difficult to interpret. In addition, most official
crime databases do not disclose the specific manner of a committed
homicide. It is estimated, however, that sexual homicides consti-
tute from one percent of the total homicides reported by the police
in the USA every year to approximately four percent in Canada.1,4e9
3.2. Offender characteristics e sociodemographic variables
3.2.1. Race and gender
The majority of sexual murderers are white males (72.3% Cau-
casians), while females represent only five percent in the FBI
database cases. (N ¼ 3977 from 1976 to 2007).5e10
3.2.2. Mean age
Mean age of sexual murderers is 26.9. (N ¼ 3977) One out of
nine (11.4%) were young persons (under 18) at the time of the first
murder. (N ¼ 166).1,4e10
3.2.3. Marital status
27.1% lived in a relationship, and 25.3% had children. (N ¼ 166).
3.2.4. Level of education
Although sexual murderers have an average cognitive ability,
they are also of a low educational and occupational status. The
incidence of those unemployed was 29.5%, and only 0.6% had a
university degree at the time of the crime (N ¼ 166).
3.2.5. Autonomy
Forty percent were still living with their parents at the time of
the homicide, while 50% lived independently. (N ¼ 166).1,4,7,9
3.3. Victimology
In general, the majority of the victims are female (80.2%), adults
(70%) and their mean age is 28.3 (N ¼ 86).1,4,6e13 Regarding the
subcategories of the perpetrator-victim relationships, strangers
comprise 60.5,percent, acquaintances 23%, spouses/ex-spouses
2.6%, and male strangers 2.6% (N ¼ 38). Sexual partners of the
 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
sexual murderers, seldom become their victims.1 Furthermore,
adult women who are under the influence of alcohol and/or drugs
are more often targeted as victims, probably due to greater
vulnerability.9 Caucasian sexual killers tend to kill intra-racially,
while non-Caucasian sexual killers kill both intra- and inter-
racially. Therefore, most of the victims belong to Caucasian
populations.1,4,6,7,9,14,15
Unlike adult women as sexual homicide victims, adult men,
elderly women and children victimized by sexual killers are mostly
strangers.7,9,16 In cases of adult men, assaults involving consensual
sexual activity usually precedes the killing. Elderly women are
more frequently attacked inside their household environment
(94%), while their attackers are men younger than their victims by
20e35 years.9,17,18 With respect to children, school-aged females as
well as primary and secondary school males are most often tar-
geted by sexual killers.7,19
3.4. Motivation
The key motivations of sexual homicide as identified by most
empirical studies are: (a) deviant sexual gratification, (b) resent-
ment towards women, and (c) avoidance of being detected. Adult
women are often victimized due to all three of the aforementioned
motives, but some variations have been noted in other victim
groups. In cases of adult men as victims, the crime is primarily
aimed at financial gain (80%), while sex is commonly used as a way
to create confidentiality.7,9,16 Sexual satisfaction among homosex-
ual men, however, is a motivation in 20% of cases. In cases of elderly
women victimization, sexual homicide occurs mainly in continuity
with another offense, usually burglary.17,18 In such cases, the orig-
inal intention of the perpetrator is financial gain, while sexual as-
sault is a secondary incentive. In regard to minors as victims, the
main motivation is sexual gratification coupled with the victims'
vulnerability.9,19
3.5. Killing methods
3.5.1. Against adult women
In cases of sexual murders against adult women, no definite
method of killing has been identified as statistically prevalent.
Personal weapons, however, such as stabbing and strangulation are
most commonly used.7,9,10 A notable feature in the killing process
regarding this victim type (adult women) is genital mutilation
(13.3%, N ¼ 158), which usually takes place post mortem and is
associated with curiosity and deviant or sadistic sexual
fantasies.7,9e11
3.5.2. Against adult men
Firearms are prevalent wounding agents among sexual homi-
cide incidents against adult men, while postmortem mutilation is a
rarity in this category.16
3.5.3. Against elderly women
In cases of sexual murders against elderly female, no statistically
prevalent method of killing has been identified. Two research
studies were conducted in order to investigate the primary killing
method of elderly women as sexual murder victims in 1991 and
2002 respectively, but reached different conclusions. Fox and Levin
(1991) were led to the statistical prevalence of strangulation,
whereas Safarik and his colleagues (2002) concluded that firearms
were the primary killing method against female elderly victims.17,18
3.5.4. Against children
Postmortem dismemberment and mutilation have been docu-
mented as a frequently-practiced ritualistic behavior against
3
children, while strangulation has been recorded as the leading
cause of death in this category.19
3.6. Female-perpetrated sexual homicides
Only a single systematic study has been conducted to study the
phenomenon of female-perpetrated sexual homicide (by Chan and
Frei).8 Despite its reliable methodology and important results,
however, several limitations arise.
There are no valid criteria in the characterization of a female-
perpetrated homicide as “sexual,” and, thus, the actual number of
female-perpetrated sexual killings may not be effectively depicted
by the number of recorded incidents. Furthermore, there is lack of
research studies involving the psychopathology, diagnostics, his-
tory, modus operandi, and motivational drives of female sexual
homicide offenders.8
3.6.1. Incidence
Chan and Frei investigated a sample of 3977 cases of sexual
homicide, which occurred over a period of 32 years (1976e2007)
throughout the FBI's Supplemental Homicide Report (SHR) data
and estimated that the recorded cases of female sexual murderers
represent only five percent of sexual homicide cases (204 cases).8
3.6.2. Age
Among the aforementioned female sexual homicide offenders
(N ¼ 204), 177 were female adult offenders (86.8%) and 27 (13.2%)
were juveniles.
3.6.3. Race
The statistics indicated that female sexual homicide offenders
tend to kill mostly intra-racially and yielded relatively equal
offender-victim racial distributions between White (53%) and Black
(47%) female offenders.
3.6.4. Victimology
Victims of female sexual homicide are individuals of the oppo-
site gender; 75% of the victims are males and mostly adults (77.7%).
It has also been noted that female sexual killers frequently target
individuals with whom they have shared a relationship (80.7%)
(N ¼ 192). The analytical rates for victim-offender interactions in
female-perpetrated sexual homicides have been identified as fol-
lows: (a) in 50.5% of the cases, the victims were friends and ac-
quaintances; (b) 13.5% intimate partners; (c) 16.7% family
members; and (d) 19.3% complete strangers.8
3.6.5. Killing methods
Furthermore, in regard to weapon selection, female sexual
killers tend to use firearms (54.0%) primarily against their victims
(N ¼ 200), while contact weapons (such as blunt objects) are the
least preferable (6.5%). The weapon selection is probably based on
the differential of perpetrator-victim physical strength. Adult vic-
tims (N ¼ 155) were more likely to be killed by the use of firearms
(62%), adolescents (N ¼ 7) had equal possibility to be murdered
either by firearms (43%) or personal weapons (43%), and children
(N ¼ 16) were mostly (87.5%) murdered with personal weapons (for
example, strangulation, asphyxiation) as the most vulnerable
victim type. Edged-weapons were most frequently used against
elderly victims (40%, N ¼ 20).8
3.7. Sexual homicide compared with other crimes
3.7.1. Non-sexual and sexual homicide
Significant differences can be observed between the phenom-
ena of non-sexual and sexual homicide. Among the non-sexually
4 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
violent crimes, including homicide, most potential victims are men,
while in sexually violent crimes the targeting of women is far more
frequent. Interestingly, from a relational perspective, there is a
similarity between sexual homicide and other paraphilias, whereas
a differentiation is noted in regard to other violent crimes. For
example, some sexually deviant people deliberately target
strangers (such as perpetrators involved in voyeurism, exhibi-
tionism, or frottage), while most non-sexually violent offenders
choose victims who are in some way involved with them
(familiar).1,12
3.7.2. Sexual homicide and other sexual crimes
Compared with other sexual crimes, scientific research has not
determined whether sexual homicide is the endpoint of a contin-
uum of sexual violence or a distinct phenomenon.12 The main dif-
ference between sexual offenders and sexual killers seems to be the
theme of isolation that prevails among the latter. The majority of
sexual homicide perpetrators exhibit very limited socialization
even from a young age. This may be a result of personality pa-
thology (higher prevalence of maladaptive personality traits) and/
or a possible indication of abnormal affect resulting in impaired or
reduced ability to interact and normally empathize with others.7,9,12
3.8. Crime scene typology
The Behavioral Science Unit of the FBI divided crime scenes into
two types, organized and disorganized.
In organized crime-scenes, the attack is planned and directed
towards a targeted stranger (an element that personalizes the
victim), there is use of restraints, the perpetrator demands sub-
mission, while the conversation is controlled by him. These ele-
ments together with the carefully organized crime scene reflect the
attacker's need for control. Sexual aggression is enacted ante-
mortem, while the body and weapon are transported away from
the crime scene. Postmortem mutilations are not observed
eexcluding any attempts to conceal the body and the crime.
Organized crime scenes are more common among serial sexual
murderers. On the other hand, in disorganized crime scenes, the
offense is spontaneous (a burst of violence), while the scene itself is
sloppy. The crime often takes place in a location known to the
perpetrator, and the victim is usually an acquaintance. There is
almost no conversation between the offender and the victim, while
the identity of the victim seems to be insignificant (depersonal-
ization of the victim). Minimal restraints are used and postmortem
sexual acts are usually committed. The body and weapon are often
present at the crime-scene.1,7,9,12,20
3.9. Classification of sexual murderers
Various typologies have been structured since 1986 through
different scientific approaches, which are distinguished in prag-
matic, theoretical, statistical, and clinical classifications. Due to the
small samples or weaknesses of the methodology, however, no
typology is currently prevalent with respect to others. Therefore, a
major issue arises, as sexual homicide taxonomy is currently non-
standardized, while all different classifications are potentially
equally valid (or invalid). Roughly, the distinctions in virtually all
classifications, however, seem to revolve around the offender's
expression of either rage or sexual sadism. The typologies that
follow involve sexual homicide offenders who target adult women,
adult men, and mixed types of victims. Typologies of sexual ho-
micides involving men as victims will not be presented below as
they are outside the scope of this paper, while no typology
currently exists on sexual murderers who victimize children.7,9,16
3.10. Taxonomy of sexual homicide offenders of mixed victim types
Four typologies of sexual homicide offenders have been devel-
oped according to research studies which did not distinguish be-
tween victim types.
The first typology, which was theorized by Ressler et al., be-
tween 1986 and 1988, divided the perpetrators into (a) organized
and (b) disorganized sexual murderers, by using the modus oper-
andi and personality traits of the perpetrators as examined vari-
ables.5 This research study is based on the aforementioned
pragmatic taxonomy of the FBI. The research sample consisted of 36
different mixed single-victim and serial sexual killers. The limita-
tions of the research were the use of the offenders' behavior only in
the crime scene as the single classification “tool,” as well as the
heterogeneity of the examined sample consisting mainly of serial
sexual killers, while the victims of non-serial offenders derived
from various gender/age groups (e.g., adult women, adult men, and
children). Accordingly, the organized sexual homicide perpetrator
is found to be an intelligent, skilled, often employed person. His
actions are characterized by a high level of premeditation, as he
engages in stalking, uses restraints to subjugate his victim, and
leaves neat, organized crime scenes with very little evidence that
would possibly incriminate him. He is also likely to follow media
reports of the police investigation of his crime.5,7,9
In contrast, the disorganized sexual killer often has a history of
an underlying childhood trauma (abuse or neglect), and isolation is
a more prevalent feature. Low levels of planning and premeditation
are employed for the realization of his crime, as the victim in most
cases is a casual acquaintance. The identity of the victim does not
seem to play a central role. The perpetrator engages in postmortem
sexual acts, such as genital mutilation, while the weapon is dis-
carded at the crime scene.5,7,9
Another categorization of sexual homicide offenders was
structured by Keppel and Walter in 1999, and was based on a
psychodynamic typology of rapists by Groth, Burgess and Holm-
strom, in 1977, which was revised by Hazelwood and Burgess in
1987.21e23 This typology focuses on the assessment of behavioral
features and modus operandi aiming to classify sexual killers of
mixed victim types. However, certain limitations arise in the
methodology that influence the validity of this typology: the
composition of the sample is a weak point (consisting of sexual
killers of mixed victim types), which is too general and therefore
may not lead to accurate conclusions. Furthermore, no empirical
research was subsequently conducted, and, thus, the estimation
method of the prevalence for each category is vague. The perpe-
trators in this typology are divided into (a) power-assertive, (b)
power-reassurance, (c) anger-retaliatory, and (d) anger-excitation
profiles.21e23
Power-assertive sexual murderers are described as individuals
who are slightly over the age of 20 and experience antisocial per-
sonality traits, which are reflected in poor school performance and
propensity for delinquency. The driving motivation for the reali-
zation of the crime is to satisfy their needs for power and domi-
nance. During sexual homicide, the rape is premeditated, while the
killing is unplanned and results from increased aggression in order
to ensure control over the victim.7,9,21e23
Power-reassurance sexual murderers are approximately 25
years old on average and usually victimize individuals who are
10e15 years older or younger. Social isolation, deficiency in
achieving personal goals and intimate relationships as well as
extensive rape fantasies are prevalent in this type of perpetrators.
Their incentive is to act out fantasies and seek reassurance of sexual
adequacy. Regarding sexual homicide, the rape is premeditated,
while the killing is unplanned and results from the offenders' sense
of failure and panic when the victims refuse to yield to the
 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
perpetrators' sexual fantasies. Personal weapons are the most
prevalent methods of killing, such as pummeling and manual
strangulation. Exploratory postmortem mutilation and/or necro-
philia are frequently enacted, while disorganized crime scenes are
the commonest.7,9,21e23
Anger-retaliatory sexual homicide offenders are individuals
aged in their mid-to-late 20s. They tend to create superficial
interpersonal relationships, are characterized by outbursts of anger
and usually have a history of violent criminal history. In regard to
the realization of sexual homicide, both the rape and homicide
involve a high level of premeditation, as the sexual offense is
committed with the intent of killing the victim during or after the
sexual activity. The homicide is an anger-venting act, which in-
volves “over-kill,” expressing grievance towards women (symbolic
rage regarding a female victim usually precipitated by criticism
from a dominating female figure). Furthermore, they often target
older victims and take trophies.7,9,21e23
Anger-excitation sexual killers are approximately in their mid-
30s. They seem like ordinary people, often in a marital relation-
ship, and of average intelligence. Sexual sadism is their key motive
for the commission of the crime, while both rape and homicide are
well-planned and precipitated by highly specialized fantasies. The
act of torturing and killing the victim is pleasurable as an “an
indulgent luxury” that offers sexual gratification, rather than the
end goal of a dead body, and, therefore, the offense is characterized
by a prolonged, bizarre, ritualistic assault on the victim. Further-
more, they often take trophies from the victims in order to prolong
the pleasure through fantasy and masturbation.7,9,21e23
Another typology theorized by Beech and his colleagues in 2006
divides the perpetrators into (a) prototypical sex killers (or calcu-
lated pain infliction murderers), (b) grievance driven killers, and (c)
rape plus murder offenders.24 The classification is based on the
assessment of the motivational drives of the perpetrators. The
study material derived from the post-treatment interviews of 28
convicted sexual killers (of mixed types of victims). The limitations
of this typology arise from the fact that no subsequent replication of
this research study was conducted on larger samples (thus affecting
the validity of results). Furthermore, as mentioned above, the use of
offenders of combined victim types in the sample is a
drawback.7,9,24
Regarding “prototypical sex killers” or “calculated pain infliction
murderers,” deviant sexual fantasies (which may escalate to sexual
sadism) are prevalent. The offense is intentional and driven by the
perpetrators' desire to enact their sexual fantasies. Therefore, sex-
ual arousal and pleasure are gained through the crime. Perpetrators
frequently engage in postmortem sexual activity and
mutilation.7,9,24
“Grievance driven murderers” are motivated by their rage to-
wards their victims (mostly females). Poor self-control and anger
outbursts are prevalent, while the sexual murder often involves
“over-kill.”7,9,24
The incentive of “rape-plus-murder” offenders is the sexual in-
tercourse itself, and strangers are most frequently targeted. The
perpetrators have limited history of non-sexually violent crimes,
but have already committed previous sexual offenses. The of-
fenders do not aim at the homicide itself, which is nevertheless
enacted, either to control the victim or to avoid detection.7,9,24
A fourth typology theorized by Meloy and Schlesinger distin-
guishes between (a) catathymic and (b) compulsive sexual homi-
cide offenders. (1,25) Clinical judgment was the examined
parameter in a research sample that consisted of case studies. Two
limitations again arise in this classification: the fact that (a) it ex-
amines mixed victim types as well as that (b) a replication of this
research study is required in larger samples, which would add to its
credibility level.9
5
The term of “catathymia” was first used by Wertham in 1937 to
describe a motivational pattern that involves episodes of erupting
violence in individuals who had never previously demonstrated
similar behavior.7,9,12,25 An underlying sexual conflict with strong
feelings of sexual inadequacy is experienced by the catathymic
sexual murderer also combined with intense levels of negative
affect. Catathymic sexual homicide offenders are further distin-
guished into (a) acute and (b) chronic.7,9,12,25
Acute catathymic sexual killers often experience pathological
attachment. Either physical or sexual childhood trauma often exists
in their history. Sexual murder is committed amid negative affects
and emotional tension deriving from the underlying sexual conflict
that they experience (such as jealousy and fear). Strangulation,
dissection and mutilation frequently occur during and/or after the
homicide. The offenders usually target strangers and leave behind
disorganized crime scenes. On the contrary, chronic catathymic
sexual murderers are often diagnosed with borderline personality
disorder, as they experience poor attachment, and impairment in
their way of associating with others. Obsessional thoughts,
depression, suicidal ideation, and stalking are also usual. The
feeling of anger (catathymic tension) escalates and erupts both
aggressively and self-destructively. The crime is realized when
homicidal obsessional thoughts become uncontrollable, while self-
harm may follow unless the tension is released.7,9,12,25
Unlike the aforementioned catathymic offenders, compulsive
sexual murderers are sexually motivated. They experience sexual
arousal and gratification through violence, while an obsessive-
compulsive behavioral pattern is observed, as they leave orga-
nized crime scenes. The compulsive sexual murderers can in turn
be divided into (a) planned and (b) unplanned.7,9,12,25
Planned, compulsive sexual murderers put high levels of pre-
meditation and meticulousness into the committed crime in order
to avoid detection and arrest. Their underlying dynamics involve
sexual sadism, deviant sexual fantasies and a compulsion to kill.
These offenders have a propensity for recurrence, and, thus, serial
sexual killers fall into this category. Unplanned compulsive sexual
murderers are characterized, instead, by lower levels of premedi-
tation and target their victims in an opportunistic manner due to an
internal impulse. These offenders are socially immature in-
dividuals, with sexual incompetence and poor employment history.
The underlying psychopathology of this category includes disor-
ganized personalities, borderline, schizotypal, schizoid personality
disorder or personality traits, schizophrenia or psychotic
disorder.7,9,12,25
3.11. Typology of sexual homicide offenders of adult women
Only one typology currently exists in regard to sexual homicide
offenders that target solely adult women, which was theorized by
Beauregard and Proulx in 2002.26 Pre-crime, crime, and post-crime
phases as well as offender characteristics and modus operandi were
the parameters that were examined throughout the research
sample, which comprises 36 non-serial sexual murderers of adult
women. The distinction was made between sadistic and anger
profiles of sexual murderers. The categories used in the study were,
however, very generalized, which requires more research studies
for the designation of sub-categories.7,9,26
According to Beauregard and Proulx, sadistic sexual murderers
have high levels of premeditation and victimize both targeted
victims and strangers. They seem to be very similar to compulsive/
organized sexual killers. The duration of the crime tends to exceed
30 min. The use of physical restraints and verbal humiliation are
employed to achieve dominance and control over the victim. Body
mutilation is very frequently observed, while the victim's body is
disposed at a different location to delay detection. On the contrary,
6 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
sexual murderers falling into the anger profile execute a rather
opportunistic enactment of the offense without extensive planning.
Several similarities can be noticed in this category with the disor-
ganized and catathymic sexual killers. The use of physical restraints
and postmortem mutilation are prevalent features in the crime,
while its duration is shorter than 30 min. The victim's body is
usually left at the crime scene.7,9,26
3.12. Psychopathology
Most sexual murderers are neither psychotic at the time of their
offence, nor do they have any psychotic disorders that can be
diagnosed through clinical examination.1,5,12,27e31 They may have
other diagnoses, however, such as mood disorders (especially
depression), drug and/or alcohol abuse disorders. Ressler et al.
(1998) examined 118 cases in half (49%) of which sexual homicide
offenders had consumed alcohol before the attack, while one-third
(35%) reported drug abuse. In addition, two-thirds (68%) of sexual
homicide perpetrators had a history of depression (N ¼ 118).1,5
Among sexual-homicide perpetrators who left behind orga-
nized crime scenes, sexual sadism was prevalent ranging from 37 to
89% in various research studies.1,4,32e37 Sexual sadists fantasize
committing acts involving the infliction of psychological or physical
suffering to their victim, a practice which is sexually arousing to
them.5e12,38 Sexual sadism correlates with antisocial personality
disorder and the sexual homicide offenders tend to repeat the at-
tacks serially.1,10,11 In addition, sadism, fetishism, exhibitionism and
voyeurism may be encountered.7,38e41
Research has indicated that almost every perpetrator of sexual
homicide presents with narcissistic and antisocial personality traits
whether or not a full personality disorder is present. Pathological
narcissism can be observed in the perpetrator's sense of entitle-
ment, delusions of grandeur and emotional detachment. Predation,
lack of empathy, cruelty, deceptiveness and manipulation, on the
other hand, are characteristics of psychopathy. In these individuals,
lack of empathy is combined with predatory object
relationships.1,6,12,42e46
The pathology of sexual homicide perpetrators is less adaptive
and more dysfunctional than the average antisocial and narcissistic
individuals, as the former presents greater obsessional thinking,
dysphoric rumination, craving for affection, and a borderline per-
sonality organization. In general, most of the diagnoses among
sexual murderers are personality disorders that belong to Cluster
B.1,4,6,12,29,43e46
3.13. Serial sexual homicide offenders
Even though 60.0% of serial homicide offenders are sexual
killers, only 2.0% of sexual homicide perpetrators are serial mur-
derers.47 Serial sexual homicide perpetrators are not only sexually
motivated, but sexual sadism and antisocial personality disorder
are also prevalent in their psychopathology.1,6,12,48 Serial offenders
have a higher prevalence of narcissistic, schizoid and/or obsessive-
compulsive traits.1,4
Research carried out by Harbot and Mokros (2001) detected a
significantly higher degree of at least one personality disorder
prevalent among serial sexual homicide offenders in comparison to
single-victim sexual murderers (89% vs 18%), while Hill (2007) has
found only a slight difference (89% vs 76%) between the two
groups.4,34,49
Psychosexual disorders (serial: 77.3%, non-serial: 2.1%) and
gender identity disorder (serial: 69.0%, non-serial: 10.2%) were
detected in a higher prevalence among serial sexual homicide of-
fenders by James and Proulx (2014) (N ¼ 1836; 176 serial and 1660
non-serial). (47) Data were extracted from 45 empirical, descriptive
studies previously conducted. It was also noticed that serial sexual
killers are raised in more problematic family environments than
those of non-serial killers in regard to parental alcoholism (serial:
69.0%, non-serial: 45.1%), drug abuse (serial: 33.3%, non-serial:
10.8%), psychiatric history (serial: 53.3%, non-serial: 21.1%), and
criminality (serial: 50.0%, non-serial: 18.3%) (N ¼ 1836; 176 serial
and 1660 non-serial). Higher rates of promiscuous sexual behaviors
were found to be engaged within the family environments of serial
sexual homicide offenders (46.2%), compared to non-serial of-
fenders (7.2%). Furthermore, a higher level of experienced physical
neglect (serial: 74.0%, non-serial: 16.3%) and psychological abuse
(serial: 74.0%, non-serial: 57.8%) during childhood was observed
among serial sexual killers, while the incidence of experiencing
sexual abuse was found almost equally between the groups (serial:
31.4%, non-serial: 29.5%) (N ¼ 1836; 176 serial and 1660 non-
serial).47
The majority of serial sexual murderers (72%) had also been
diagnosed with at least one paraphilia compared to single-victim
offenders (46%). Furthermore, sexual sadism is the most common
paraphilia among serial sexual homicide offenders (2.78-fold
higher), rather that single-victim killers. Additionally, other com-
mon paraphilias noted are fetishism, voyeurism and
exhibitionism.1,4,34,36
Serial sexual homicide offenders are more likely to premeditate
the offense structurally: they victimize strangers, chose a victim
with distinctive characteristics, leave organized crime scenes and
experience social isolation (71.0%), daydreaming (82.0%) and
deviant sexual fantasies at a higher prevalence (N ¼ 176).1,4,47,49,50
3.14. Fantasy
Hazelwood and Warren (1995) have described five components
of sexual fantasies: relational (the relationship the perpetrator
fantasizes with the victim), paraphilic (the sexual acts and/or
paraphilias), situational (the preferred surroundings for the fantasy
to unfold), self-perceptual (the feelings the offender wishes to
experience), and demographic (important criteria for the victim to
“fit” well into the fantasy).1,7,12,48,51
Prior to the attack, sexual murderers often experience stressful
situations, such as marital, economic, legal and employment
problems, conflict, injuries, and bereavement. Negative affect
(anger, loneliness, humiliation) has also been found to associate
with deviant fantasies and masturbation among sexual homicide
offenders (especially serial offenders).47 Planning also precedes the
attack: choosing the victim, time and place that the sexual homi-
cide will occur.1,5,12,40,52 Therefore, fantasy seems to play a crucial
role in the lives of sexual homicide offenders. It is a putative pre-
cursor to sadism and a primary drive, especially in serial-, and
generally in organized-compulsive offenders.1,4,27,31,44,47 Fantasies
provide sexual homicide offenders with a “primary drive mecha-
nism,” as they provide them with pleasure e when combined with
masturbation, release of sexual tension, mood regulation, stimu-
lation of grandiosity and omnipotence (by controlling the victim),
and compensation for (felt as self-perceived) sexual inadequacies,
childhood trauma and stressful situations.1,12,52
Ressler et al. (1988) theorized that sexual murderers are
obsessed by their fantasies, and any failure to enact them exactly as
imagined will make them repeat the act.5,7,12 They tend to engage in
“tryout attacks,” which are precursors to their criminal behavior.
Fantasy offers sexual homicide perpetrators the opportunity to
practice their paraphilia, so that through repetition (fantasies and
“tryouts”) the crime fits the fantasy.4,7,12,52 Therefore, most sexual
homicides are not impulsive, but opportunistic, as the act is
partially premeditated.1,5
 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
4. Case presentation
4.1. Background
In the present case study, an incident of sexual homicide is
described, during which a 34-year-old woman was brutally raped
and murdered by a 27-year-old man in a city in northern Greece
during the Christmas season of 2012. The criminal offense took
place in the early morning hours in the courtyard just outside the
apartment block where the victim's parents lived.
In the middle of that night, the neighbors of the apartment
building suddenly heard female screaming. There was fire and
smoke below their balconies, and, thus, they thought that a car had
caught on fire. The victim's father was the first who rushed to help.
He found a woman dead and burning in the courtyard. A motor-
cycle that was in the vicinity of the victim was also on fire. Her face
was disfigured due to the thermal burns, and, therefore, he did not
initially recognize the victim. He immediately called the police and
the National Center for Emergency Assistance. Only when he had
identified her keys in the lock of the front door of the building, did
he realize that the victim was his daughter.
4.2. Crime scene investigation
The crime scene was disorganized and rather compatible with a
catathymic type of sexual murder. The victim was found outdoors,
behind apartment buildings, in a supine position. The cadaver was
left in view and was depersonalized due to human arson. The facial
characteristics were hardly recognizable. Second- and third-degree
thermal burns were observed on the anterior surface of the thoracic
region, upper extremities and head. The area where the victim was
found contained a large amount of blood and residue from burnt
clothes. The sexual parts of the victim's body were exposed, as the
trousers and underwear were lowered to the height of the
gastrocnemius. Furthermore, there was evidence of sexual inter-
course as well as sadistic fantasy, due to the victim's genitalia
mutilation. Injuries extended throughout the genital, perigenital
and anal area, and there was absence of the tone of the anal
sphincter. No mechanical use of restraints was noticed.
At approximately six meters' distance, blood as well as burnt
clothing residue were also observed. In the same place, there were
two motorcycles which bore evidence of fire damage. Among the
motorcycles and the victim's body, bloodstains were detected as
well as burnt buttons from the coat of the deceased. This scene
indicated the victim's course between the motorcycles, where the
fire started, to the location where she passed away.
4.3. Postmortem examination e autopsy findings
As the forensic examination concluded, the deceased suffered
blows due to blunt force to the head (frontal and right temporal
areas). The victim also suffered vaginal and anal sexual abuse with
great violence, causing extensive laceration of the soft tissues be-
tween the genital and anal area, which resulted in massive bleeding
as well as extensive ecchymoses and lacerations of the genitals.
Subsequently, burns were induced in the anterior thoracic area,
upper extremities and head through incineration. Following the fire
outbreak, the victim, burning and bleeding, attempted to remove
her flaming coat and ultimately reached the point where she was
found, approximately six meters away from the location of the
sexual abuse. The presence of bloodstains and burnt buttons from
her coat were indicative of the route that was followed. The victim's
death resulted from multiple severe head injuries, profuse bleeding
due to the genital and anal area mutilation as well as second- and
third-degree thermal burns.
7
The perpetrator was arrested after the examination of visual
material that was retrieved from the security camera of a nearby
pharmacy. In addition, the identification of the perpetrator was
facilitated by fingerprints and palmar prints detected on a car that
was parked at the crime scene. The genetic material samples ob-
tained from the decedent's vaginal smear matched the perpetra-
tor's DNA samples. Subsequently, the suspect's DNA samples were
also cross-checked with DNA samples collected from the crime
scene. The victim's purse was detected inside a garbage bin in the
same area by police authorities, while the investigations conducted
in the offender's house revealed the victim's mobile phone in the
perpetrator's loft. The mobile phone bore traces of blood, a sample
of which was also sent for DNA examination, and this sample also
matched the victim's genetic material.
4.4. The crime description according to police investigation data
The victim was residing permanently in a nearby city and was in
her hometown during that time period in order to spend the
Christmas holidays with her parents. On the evening of the murder,
the victim and a friend of hers had been in a pub until 4:20 a.m.,
after which they shared a taxi to return home. The taxi transported
the victim first to her parents' home and continued on its way in
order to accommodate the other woman.
Sexually motivated, the perpetrator approached the victim. She
refused so he moved closer to her in order to obtain physical con-
tact with her without her consent. She became defensive and tried
to hit him. The victim rushed to unlock the outer door of the
apartment building, but did not manage to enter, when the
perpetrator attacked her; the victim's key was found in the lock of
the outer door of the apartment building in the crime scene.
The perpetrator immobilized the victim and dragged her to the
parking area in the rear of the block of flats; fingerprints and palmar
prints were detected on parked cars. This was the place where the
victim suffered physical violence (multiple blows) to her face and
body. Furthermore, the enraged offender beat her head against the
wall in an attempt to immobilize and control her.
Afterwards, as the victim was semi-conscious from these
physical injuries, the offender lowered her trousers approximately
to knee height, positioned her on the seat of a motorbike parked
nearby, and raped her vaginally and anally. Subsequently, while the
victim was in the same position, the sexual homicide offender
engaged in genital mutilation with his fingers by putting both his
hands in the victim's vaginal cavity and ripping the soft tissues from
the vagina to the anal area, thus, causing injuries and profuse
bleeding.
Probably due to intense pain, the victim regained consciousness.
She suffered more blows, however, and lost consciousness again.
After that, the perpetrator cut the fuel-tank hoses from the
motorcycle, doused the victim with gasoline and lit a fire. Due to
pain reflexes activated by arson, the victim regained consciousness
again and started running in the courtyard area, while screaming.
She was being burnt (hair and coat) throughout her whole route to
the spot where her cadaver was found, which was within approx-
imately six meters from the point where she was raped.
4.5. The sexual homicide perpetrator
After the consummation of the crime, the perpetrator stole the
victim's purse, which he then disposed of in a rubbish bin in the
area of the crime scene, probably to mislead the police and make it
seem like a theft. He kept the deceased's phone, however, as a
trophy.
As discovered by the authorities, the victim was the perpetra-
tor's neighbor and had been a previous casual acquaintance. During
8 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
the preceding year, the perpetrator had lived three blocks away
from the victim's house with his fiance e. Furthermore, he kept a
grocery store on the same street where the victim lived. In fact, the
name of the store was an anagram of the word “grocer” in Greek,
which meant “you fire me up.” At 6:00 a.m., he returned to the area
of the crime, opened his grocery store pretending to be ignorant of
the event and even showed interest in the progression of the case
by attending the police investigation from the street.
As documented by the toxicological examination, the sexual
homicide perpetrator was not under the influence of alcohol or
drugs. He justified the present incident of sexual homicide by
saying that sexual urge had been his primary motivation. In his
confession, the offender remained emotionally detached, and his
phrases reflected an impoverished sense of conscience or empathy.
“I liked her, I came up with it, and I did it,” he said. He claimed that
the victim had not initially reacted to his actions, and, therefore, he
was certain that she liked him. Shortly afterwards, however, he
claimed that she had begun shouting threateningly that he would
go to prison, a possibility which had panicked him.
According to his testimony, plea, and the data verified by the
relevant authorities, the offender set the fire in order to burn the
victim and eliminate all incriminating evidence. As he was leaving,
he could hear the victim screaming. He returned to his flat, washed
his clothes and slept until it was time to open his store.
In the past, the offender had been investigated by the author-
ities for drug trafficking, theft and aggression. In addition, nine
months previous to this attack, he had been convicted of attempted
rape of a 21-year-old female student, imprisoned for six months
and then released on bail. The perpetrator had also followed a
similar pattern at that time: the victim was a stranger; he grabbed
the victim's neck, dragged her to the rear of a building, and
attempted to rape her in public; the victim fell to the ground, hit her
head on the cement, and remained unconscious. She recognized
the perpetrator because he was still wearing the same jacket when
he was arrested. At the trial, however, the fact that the victim was
unconscious and perhaps could not remember well was taken into
account, as well as the fact that the offender eventually chose not to
rape her. Therefore, the validity of the victim's testimony was
doubted, and the perpetrator was released on bail being charged
only with dangerous bodily harm. He had also claimed a compen-
sation for “wrongful” imprisonment.
His brother had escorted him to visit a private psychiatrist
because his behavior had deteriorated after the six-month
imprisonment. A few days prior to the sexual homicide, however,
the perpetrator had become verbally and physically aggressive in
the city hospital without any known cause.
Furthermore, the sexual homicide offender had a social
networking profile page which was full of sexual insults and
paraphilic comments. As noted by the police, a few hours before
committing the crime, he wrote sarcastically that he wondered
with whom he would copulate that day. Immediately after the
crime, when the offender returned to his apartment, he deleted the
text from his page.
4.6. Early life
The offender was described by people who had known him
since his childhood as irritable, violent, aggressive, uncontrollable,
and quarrelsome. His performance in school was very poor and his
education stopped in primary school, although he did not suffer
from intellectual disability. As a minor, he exhibited strongly de-
linquent behavior, as he was accused of motorcycle theft, and, as a
result, he had concerned the juvenile probation service on several
occasions.
All his acquaintances avoided him because of his great outbursts
of anger, constant brawls and quarrels over minor issues, and
frequent antagonism towards local residents. Most interestingly, he
had an obsession with motorcycles, which he often stole for joy-
rides and then abandoned in deserted locations. Furthermore, he
used to ride them along rural roads at high speed doing “wheelies.”
He also seemed to experience delusional grandeur and had very
little control over his anger.
The offender's parents did not make any visits during his cus-
tody. They had not spoken to him for years. Both parents had been
accused of illicit antiquity excavations and had been under police
investigation for illegal acts. His mother evidenced a borderline
personality structure and was a very dominant, aggressive female
figure; whenever neighbors would ask her to admonish her son,
she forced them off her property with a shotgun. As a mother, she
was emotionally detached and unaffectionate and did not provide
nurture and discipline.
4.7. Sentence
The offender's request to postpone the hearing until psychiatric
assessment was rejected, and his sole defense witness did not
attend the trial. He was found guilty of first-degree murder, rape
and arson in complete soundness of mind. He was sentenced to life
and would be eligible for parole in 25 years. Throughout the
hearing, he sat silent and expressionless, seeming to be not fully
aware of the situation at the time.
4.8. Case study
This sexual homicide incident involves remarkable violence and
rage, as reflected in the hideous sexual torture that the victim
suffered while still alive and the fact that she was also burned to
death. The perpetrator exhibited signs of personality pathology,
impulse control disorder, abnormal bonding, decreased socializ-
ation, deficient conscience, entitlement, grandiosity and negative
affect (mostly anger) even from a young age. His rage against
women had increased even more due to his previous six-month
imprisonment, which functioned as a narcissistic injury rather
than a disciplinary reformation. During his incarceration, he un-
derwent a psychiatric evaluation and was assessed with the Min-
nesota Multiphasic Personality Inventory and Rorschach test. He
was diagnosed with an antisocial personality disorder including
histrionic and narcissistic features. It is not known whether he
evidenced any chromosomal or brain abnormalities. No PET scan
was conducted.
The offender had an impaired ability to empathize with others
normally. He exhibited a propensity for social withdrawal into
fantasy, alternating with aggression. Furthermore, he evidenced
impaired reality testing at a borderline level as he confused the
origin and meaning of perceptual stimuli. For example, he mis-
interpreted the anxious reaction of the victim, who had not reacted
aggressively at first, as sexual consent, while her screams and
rejection were perceived as intentional sexual humiliation and
menace. In addition, he projectively identified his own rage to-
wards women onto the victim, as a putative threat towards him,
and he believed that she had to be controlled and dominated.1
The perpetrator's sense of grandiosity and omnipotence was
also combined with his obsessive thoughts and pervasive fantasies,
which interestingly had always revolved around motorcycles. The
fact that he raped, tortured and burned the victim on the motor-
cycle was not a random event but the situational component of his
sexual fantasy.1
The scene of the crime is classified in the disorganized category;
the body was left in view at the death scene, there was a minimal
use of restraints and minimal conversation, the attack was not
 M.-V. Karakasi et al. / Journal of Forensic and Legal Medicine 46 (2017) 1e10
personalized, the victim seemed to be a random casual acquain-
tance and the location was known. Moreover, major rage was
expressed in the perpetrator's acts, which is compatible with the
catathymic sexual murderer.1,7,12,23,27
As it afterwards turned out, however, the attack was moderately
premeditated; the perpetrator had targeted the specific woman for
days, which personalizes the victim. He was sexually aroused by
torture: all of the aggressive acts were practiced antemortem,
behavior which is highly suggestive of sexual sadism and has
greater propensity for repetition. The trend for recurrence (the
tendency to potentially become a serial sexual murder) was also
reflected by the fact that the previously attempted rape was used as
a “tryout.” In addition, there are two more facts that match the
compulsive sexual murderer: the victim was raped anally, and
following the murder, the offender behaved as normal, slept, and
opened his store as usual. In addition, a trophy was collected from
the victim (the mobile phone). No postmortem genital mutilation
took place.1,7,12,23,27
This is a mixed case of sexual homicide that meets the criteria
for the sexually motivated, disorganized, anger profile, single-
victim, sexual homicide perpetrator. More specifically, the
offender most closely matches the profiles of the “disorganized
sexual-homicide perpetrator,” according to Ressler and his col-
leagues; “anger-retaliatory sexual murderer” in regard to Keppel
and Walter's typology; “rape-plus-murder” type according to Beech
and his colleagues; “acute catathymic sexual murderer” according
to Meloy and Schlesinger; and “anger profile” according to Beau-
regard and Proulx. (see Classification of sexual murderers in the
Discussion section, 1,5,21e26) The findings of this case-study are
consistent with the findings of the formerly conducted research
studies which are summarized in the literature review.
Throughout relevant forensic literature, human incineration is
often observed as a result of accident. Most of the remaining few
cases that have been reported were suicidal, while criminal human
burning is a rarity. Firesetting in a murder is usually practiced
postmortem and commonly aims at covering up evidence in the
crime scene, making the deceased unrecognizable or disposing of
the body. In every case, the perpetrator uses it with the intention to
avoid detection, while it has not been associated with a particular
psychopathology. 53e55 Criminal immolation is a very rare phe-
nomenon recorded in the international forensic literature, but to
the authors' knowledge this is the only recorded incident that in-
volves human arson in the context of sexual homicide.53
5. Conclusion
Sexual homicide offenders share common characteristics and
are roughly divided into various taxonomies. The distinctions in all
classifications, however, are based on the offender's expression of
either displaced anger or sexual sadism. The main incentives to
sexual homicide are deviant sexual arousal, rage towards women,
and avoidance of incarceration. The offenders experience an
inability to associate with others, deviant fantasy, felt or self-
perceived inadequacies, suppressed temper with underlying ten-
sion, primitive defenses, and pathological object relations. The
majority of sexual homicide perpetrators are narcissistic and psy-
chopathic individuals, but other mental disorders may also be
present (depressive disorder, drug and/or alcohol abuse disorder,
sexual sadism). The above described case is unprecedented in
Greek criminality, and, through comparison with the findings of the
relevant literature, it can be concluded that this case incorporates
many of the aforementioned characteristics.
9
Declaration of interest
There are no potential conflicts of interest regarding this review.
Acknowledgements
I would like to express my deep gratitude to the Cambridge
Academic Editors Ms Kathleen Malone Hart (M.A., Anglo-Irish
literature, University College, Dublin, Ireland, 1974) and Mr Robert
Chatel (A.M., philosophy, University of Chicago, 1972) who helped
us edit our manuscript with their collaboration and combined
experience. I would also like to extend my thanks to the anonymous
reviewers who have greatly contributed to our improvement as
authors with their helpful and constructive comments.
This work has not been funded by any corporation.
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