Murder-Suicide may be defined as extreme pattern of domestic violence. Research is hampered by the fact that with the death of the perpetrator the files are usually closed and an analysis of the cases is hardly possible. Knowledge about the circumstances of murder-suicide, however, is of special interest for the forensic-psychiatric expert when the perpetrator survives and the need for forensic assessment arises. Since forensic-psychiatric assessment is always based on comparison with similar cases we compared the files of surviving perpetrators of murder-suicide with those of lethal domestic violence.

All forensic-psychiatric expertises about surviving perpetrators of homicide-suicide which occurred in the region of Basle, Switzerland, between 1987 and 2006 (n = 6) were compared with those of perpetrators of homicide in a domestic environment (n = 20) in the same period.

There were comparatively more women but less foreigners among the perpetrators of homicide -suicide, their socioeconomic level was much higher and there were more children among the victims. The most frequent psychiatric diagnosis in both groups was personality disorder, but the range in the domestic murder group, however, went from no diagnosis at all to psychosis, i. e. assumed full criminal responsibility to assumed not guilty by reason of insanity. There was no case of not guilty by reason of insanity among the homicide-suicide group.

The disparities of these two patterns of domestic violence are much greater than we expected, which underpins the need for specific forensic assessment as well as preventive actions.