This study analyzed characteristics of 164 perpetrators of spousal homicide in Sweden between 1990-1999. Key findings include: 1) There was a four times higher suicide rate among spousal homicide perpetrators (24%) compared to other homicide perpetrators (6%). 2) 79% of spousal homicide perpetrators underwent forensic psychiatric examinations and all except 5% were diagnosed with at least one psychiatric diagnosis. 3) Only 7 (4%) of the spousal homicide perpetrators met the diagnostic criteria for psychopathy, suggesting psychopathic traits were comparatively uncommon in this group.

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Criminal Behaviour and Mental Health, 14, 121–133 2004 © Whurr Publishers Ltd 121
Characteristics of spousal
homicide perpetrators: a study of all
cases of spousal homicide in Sweden
1990–1999
HENRIK BELFRAGE 1 AND MIKAEL RYING 2 , 1 Sundsvall Forensic
Psychiatric Centre and Mid Sweden University; 2National Swedish Police
and Stockholm University, Sweden
ABSTRACT
Background In Sweden 20 000 cases of assault against women are reported to the
police every year.
Method All data on the perpetrators of spousal homicide in Sweden between 1990 and
1999 were investigated (n = 164). A control group of all other perpetrators of
homicide in Sweden during the same period, i.e. cases of homicide not committed in the
context of spouse violence (n = 690) was used. All verdicts, as well as all material in
the police investigations, including interviews with all of the police investigators, were
analysed. Copies of police examinations of the suspects, and forensic reports from the
autopsies, were also examined. Data on all registered criminality were collected from
the National Police Register, and in cases where the perpetrators had been subject to
forensic psychiatric examinations, those reports were obtained from the Swedish
National Board of Forensic Medicine. In addition, the Psychopathy Checklist:
Screening Version scores were rated from the forensic psychiatric examinations.
Results There was a four times higher suicide rate among the spousal homicide perpe-
trators (24%, n = 40) compared with the perpetrators in the control-group (6%,
n = 39, chi-squared = 55,42 df = 1, p < 0.001). Consequently, suicidal ideation
must be considered as an important risk factor for spousal homicide. In 79% of the
cases the spousal homicide perpetrators were subject to forensic psychiatric examina-
tions. All except 5% were diagnosed with at least one psychiatric diagnosis, and 34%
were sentenced to forensic psychiatric treatment. If it is assumed that the psychiatric
morbidity was high in the 24% of the perpetrators who committed suicide, then 80% of
all perpetrators of spouse homicide during the study period can be characterized as
mentally disordered. ‘Psychopathic’ perpetrators, who generally are over-represented in
most violent criminality, were comparatively uncommon. Only seven (4%) in the
study group met the diagnostic criteria for psychopathy as measured with the PCL:SV.
Discussion The group of spouse killers studied here fits the dysphoric/borderline group
of spouse assaulters. This is a group that may benefit from treatment. Perhaps police
officers could help identify this kind of spouse assaulter before a fatality occurs.

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122 Belfrage, Rying
Introduction
More attention than previously has been directed to spouse violence in recent
years. It has been identified as a huge problem in our society; estimates indicate
that between 3% and 14% of women in North America report assaults by their
male partners every year (Johnson and Sacco, 1995). In the United States, the
1992 National Crime Victimization Survey indicated that more than a million
women were victimized by their intimates (Healey and Smith, 1998). In
Canada, spouse violence account for approximately 80% of all violence reported
to the police, and 20–40% of all adult male offenders have a documented
history of spousal assault (Kropp and Hart, 2000). In Sweden, where this study
was conducted, approximately 20 000 cases of assault against women are
reported to the police every year (Sweden has approximately 9 million inhabi-
tants). Close to 80% of all violence against women in Sweden is performed by a
perpetrator known to the victim (Rying, 2001). The dark figures in this area are
expected to be high, and thus the cost of this violence to society is immense.
Physical and psychological damage to the victims, deaths, increased healthcare
costs, prenatal injury to infants, physical and psychological damage to children
exposed to violence in their homes are just some of the effects leading to an
increase in demand for social, medical and criminal justice services.
New legislation, a batterer intervention programme and a victim protection
programme are some of the strategies that society is working with in this area.
One of the essential tasks in this field must be to identify women at high risk,
and to develop strategies to reduce that risk. This implies a focus on the
(potential) perpetrators. Who are they? What characteristics do they have?
What risk factors are of particular importance when assessing risk for spouse
violence? Can we identify certain batterer typologies, or are all men at equal
risk? These are some questions that are essential to deal with. Important work
has undoubtedly already been done in this area. The Spousal Assault Risk
Assessment (SARA) Guide (Kropp et al., 1995), for example, is a validated and
commonly used risk assessment guide in this field, and important work has been
done by Campbell and co-workers on the specific issue of spouse homicide (e.g.
Campbell, 1995).
Despite the high prevalence of spouse assault the number of women who are
actually killed by their batterers is comparatively small. Campbell (1995)
reminds us that homicide occurs at a base rate of 9 in 100 000 in North
America, while domestic violence is estimated to occur at a base rate of approx-
imately 16 000 in 100 000. The corresponding figures for Sweden are a base rate
of 0.36 homicides in 100 000 and 356 reported cases of spouse assault in 100 000
(Rying, 2001). Even though the prevalence of spouse violence is lower in
Sweden compared with the US, the development during recent years is quite
similar in the two countries: the number of spouse homicides is decreasing over
time (US Department of Justice, 2000; Rying, 2001). It is speculated that an

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Characteristics of spousal homicide perpetrators 123
increased awareness of this problem in society, and consequently more compre-
hensive protective actions taken against spousal assault, might be an important
explanation for this decrease (Browne et al., 1999).
The statistical consequence of the comparably small number of women being
victims of spousal homicide is that prediction of spousal homicide based solely
on a history of spouse violence is no better than chance. Not even as a group are
battered women more likely to be killed than non-battered women, since
approximately half of all women who are murdered by their partners were never
physically abused prior to the homicide (see Walker and Meloy, 1998). This will
be somewhat discouraging to professionals working with risk assessments and
risk management in the field of spouse violence.
In this study we have investigated all cases of spouse homicide in Sweden
between 1990 and 1999 (n = 164), using all other cases of homicide in Sweden
during the same period as the control group (n = 690). The aim has been to
learn more about perpetrator characteristics in cases of severe spouse violence,
and thus add to the research on risk assessment and risk management in spousal
violence.
Material and method
The material consists of all material in police investigations, including inter-
views with all of the police investigators; this included copies of police
examinations of the suspects and forensic reports from the autopsies. All
verdicts were also studied. The relation between the victims and the perpe-
trators is given in Table 1.
The 164 perpetrators who had been intimate partners with their victims (see
Table 1), were selected as our study group. As a control group we used all other
perpetrators of homicide in Sweden during the same period, i.e. cases of
homicide not committed in the context of spouse violence (n = 690). The term
‘intimate partner’ is here defined as current or former married, cohabitants, or
boyfriend-girlfriend.
Table 1: Relation between female victims and their perpetrators in all cases of homicide in
Sweden 1990-99 (numbers and percentages)
Category n %
Children age < 15 40 12
Unsolved cases 26 8
Stranger 20 6
Known but not family 40 12
Family excluding (ex)spouse 36 11
(Ex)spouse 164 51
Total 326 100

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124 Belfrage, Rying
Having identified the perpetrators in the study group, data on all registered
criminality regarding these perpetrators, except for those who committed
suicide in connection with the crime, were collected from the National Police
Register. The reason for leaving out the suicide group is that all data concerning
dead people are deleted from the Swedish Police Register (see Belfrage, 1998).
In this study, 40 (24%) perpetrators were deceased, and thus data on their crimi-
nality are not available. All of these perpetrators, except one, committed suicide
in connection with the homicide, which is in line with previous studies
(Easteal, 1994; Gillespie et al., 1998).
In cases where the perpetrators in the study group had been subject to
forensic psychiatric examinations, data on principal psychiatric diagnoses in
those reports were brought in from the Swedish National Board of Forensic
Medicine (n = 96, 58%). Forensic psychiatric examinations were performed on
79% of the perpetrators in the study group who did not commit suicide in
connection with the homicide.
The proportion of personality disorders among the perpetrators in the study
group was high (44%, n = 35), and subject to a closer analysis by us. We
considered it unsatisfactory that nearly half of the cases where personality
disorder was the main diagnosis were labelled ‘personality disorder UNS’ (not
specified). We therefore looked at all the full forensic psychiatric reports of all
perpetrators labelled ‘personality-disordered’ in the study group. The aim was to
identify psychopathic and borderline personality traits, which are the person-
ality traits often linked to spousal violence according to the literature (e.g.
Kropp et al., 1995).
The diagnoses were made according to the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association,
1994). Additionally, psychopathy was measured using the Psychopathy Checklist-
Revised: Screening Version (PCL:SV, Hart et al., 1995). The PCL:SV is a 12-item
rating scale of psychopathic personality traits (Figure 1). Items are scored on a
three-point scale, based on the extent to which they are applicable to the
individual (0 = does not apply, 1 = partially applies, 2 = definitely applies). A
total score, ranging from 0 to 24, reflects the extent to which the examinee
matches the description of a prototypical psychopath. A cut-off of 18 and above
is typically used to delineate ‘psychopathy’. Items also are scored to yield two
subscale scores. Part 1 represents interpersonal and affective characteristics of
psychopathy such as lack of remorse and empathy, egocentricity and manipula-
tiveness, whereas part 2 addresses behavioural and lifestyle factors such as
impulsivity and antisocial behaviours. The psychometric properties of the
PCL:SV are well established (Hart et al., 1995), and it has been used as a
measure in other studies, e.g. in the MacArthur Study (Monahan et al., 2001).
The PCL:SV ratings were performed by author HB, and discussed with an
experienced forensic psychiatrist (Dr Göran Fransson). Drs Belfrage and
Fransson have together performed more than 300 real-life psychopathy assess-

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Characteristics of spousal homicide perpetrators 125
Part 1 Part 2
1. Superficial 7. Impulsive
2. Grandiose 8. Poor behavioural controls
3. Deceitful 9. Lacks goals
4. Lacks remorse 10. Irresponsible
5. Lacks empathy 11. Adolescent antisocial behaviour
6. Doesn’t accept responsibility 12. Adult antisocial behaviour
Figure 1: The PCL:SV items.
Source: After Hart et al. (1995).
ments in the Swedish correctional system, and their inter-rater reliability has
been checked in previous studies (e.g. Strand et al., 1999; Belfrage et al., 2003).
We are usually sceptical about diagnosing and/or performing ratings of psycho-
pathic traits using files alone. However, in this study 11 of the 36 personality-
disordered perpetrators had been subject to previous real-life assessments by Drs
Belfrage and Fransson, so we considered our ratings to be more accurate than is
usual in file ratings alone. It has also been shown that file-only ratings of
psychopathy might be at least somewhat adequate (Grann et al., 1998). The
statistical method used was an ordinary chi-squared test.
Results
Motives
In more than 40% (n = 60) of the cases in the control group, where the motive
was known (n = 150), the crime was committed in relation to a separation
between the victim and the perpetrator. This is probably a minimum figure,
since sometimes there was a lack of information about this in the police files. In
20% (n = 30) of cases, ‘jealousy’ was noted as the motive. This corresponds to
previous research where the perpetrators’ need for control is found to be a main
motive (Gelles, 1972; Daly and Wilson, 1988; Dobash and Dobash, 1992;
Dawson and Gartner, 1998).
Past threats and violence
The police investigations also showed that in 42% of the cases in the study group
the victims had been threatened, and in 36% they had been physically assaulted,
by the perpetrators before the actual crime. In approximately half of these cases,
the victims themselves had reported this to the police. Again, these are probably
minimum figures owing to the lack of information. We had, for example, no

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126 Belfrage, Rying
access to any information from social services or hospital files. This might
explain why other studies, from the US, report comparatively higher numbers
than found in this investigation (e.g. Moracco et al., 1998; Smith et al., 1998).
Substance abuse
In the study group, a total of 44% (n = 72) of the perpetrators and 37% (n = 61)
of the victims were influenced by alcohol at the time of the crime. Even though
these figures in themselves can be considered as high, since they represent almost
half of the cases, they are lower than those found overall in cases of homicide in
Sweden, where 61% (n = 543) of the perpetrators and 51% (n = 477) of the
victims were influenced by alcohol at the time of the crime (perpetrators: chi-
squared = 79.59, df = 1, p < 0.001, victims: chi-squared = 57.97,
df = 1, p < 0.001) These figures are also lower than is usually reported in studies
of spouse assault in general (e.g. Gondolf, 1988; Walker, 1989; Saunders, 1993).
We have to keep in mind, however, that this study concerns cases of spousal
homicide, where other risk factors might be more prominent, e.g. mental disorder.
Crime scenes
A majority of the spousal homicides occurred in the homes of either the victim
or the perpetrator, or in their joint home (85%). This high figure may be due to
the fact that a high proportion of the homicides occurred in connection with a
separation. When the separation process is over, the probability of the violence
occurring outdoors increases (Dawson and Gartner, 1998).
Modus operandi
The method of spousal homicides was much the same as in all cases of homicide
in Sweden, except for strangulation. This was twice as common in the study
group (21%), compared with all cases (11%, chi-squared = 11.15, df = 1,
p < 0.001). Use of firearms was relatively uncommon (20% in the study group),
while stabbing was the commonest method (40%). There was a strong corre-
lation between use of firearms and suicide (in two-thirds of the cases).
Immigrant background
Nearly 40% of the perpetrators and 30% of the victims in the study group were
born in a country other than Sweden. This is about four times the expected rate
(Rying, 2001). However, as found in other studies (e.g. Goetting, 1995; Smith
et al., 1998), the victims and the perpetrators commonly came from the same
ethnic background (83%).
The immigrants represented two main groups: those who originated from
other Nordic countries (Finland represents 10% of all immigrants), and those

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Characteristics of spousal homicide perpetrators 127
who originated from the Middle East and former Yugoslavia. The latter group
are, to a great extent, refugees with traumatizing war experiences and/or
somewhat different cultural values.
Previous criminality
In total, 61% (n = 75) of the perpetrators in the study group had a criminal
record, which was a somewhat lower proportion than in the control group (72%,
n = 497, chi-squared = 41.43 df = 1, p < 0.001). The commonest previous crimes
were illegal threat, various acts of violence, property crimes and traffic crimes.
There was in the study group no clear correlation between criminality and
substance abuse. Those perpetrators who were substance abusers were more likely
to have a criminal record (75%, n = 123 vs 54%, n = 373, chi-squared = 23.87 df
= 1, p < 0.001) and they had more commonly been sentenced for violent crimi-
nality (45%, n = 74 vs 33%, n = 228, chi-squared = 8.35, df = 1, p < 0.01).
Suicide
In 24% (n = 39) of the cases in the study group the perpetrators committed
suicide soon after the homicide. This is four times higher than in the control
group (6%, n = 39, chi-squared = 50.14, df = 1, p < 0.001). If attempted suicides
are included, nearly one third (n = 50) of the study group is represented. These
results correspond well with previous research, where it has found that suicide in
connection with homicide is particularly common when the homicide victims
are women or children (Wolfgang, 1958; Easteal, 1994; Gillespie et al., 1998).
Those perpetrators who committed suicide (n = 39) differed from the others
(n = 125) in the study group. They were older (10 years, M), they were more
commonly born in Sweden (90%, n = 35 compared with 13%, n = 16, chi-
squared = 19.74, df = 1, p < 0.001), they were more commonly employed (80%,
n = 31 vs 51%, n = 64, chi-squared = 10.26 df = 1, p < 0.01), they were more
rarely under the influence of alcohol or drugs at the time of the homicide/suicide
(26%, n = 10 vs 44%, n = 55, chi-squared = 4.02, df = 1, p < 0.05), and they were
less known to have previously threatened or used violence towards their victims
(10% ,n = 4 vs 42%, n = 53, chi-squared = 13.49, df = 1, p < 0.001). Thus, those
perpetrators who committed suicide soon after the crime can be said to have
been less socially marginalized compared with the other perpetrators.
Psychiatric morbidity
In 79% (n = 130) of the cases in the study group the perpetrators were subject to
forensic psychiatric examinations, compared with 60% (n = 366) 366/690 =
53% in the control group (chi-squared= 36,78 df = 1, p < 0.001).
Swedish forensic psychiatric examinations are comprehensive, and carried
out during a period of approximately 4–6 weeks at forensic psychiatric clinics

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128 Belfrage, Rying
(see Belfrage and Fransson, 2000; Grann and Holmberg, 1999). All but five
(5%) in the study group were given at least one psychiatric diagnosis, whereas
41 (34%) were sentenced to forensic psychiatric treatment. Thus, there was a
substantial amount of psychiatric morbidity in this group. Additionally, it could
be hypothesized that the psychiatric morbidity was substantial among those 39
perpetrators (24%) who committed suicide in relation to the homicide. There is
a well-known link between dangerousness to self and dangerousness to others
(e.g. Menzies et al., 1985). Consequently, suicidal ideation is considered as an
important risk factor for spousal violence (Kropp et al., 1995). If those who
committed suicide are added to the group considered as mentally disordered,
80% (130) of all perpetrators of spousal homicide during the study period can be
characterized as such. In Table 2 the distribution of principal diagnoses
according to the forensic psychiatric examinations is given.
From Table 2 it can be seen that the study group displayed a substantial
psychiatric morbidity. More than one-third (36%) were thought to be psychotic
and 21% received other serious diagnoses (dementia, mental retardation, post-
traumatic stress syndrome, etc.).
Psychopathy
The PCL:SV ratings had a mean of 11.27, which is less than usually found in
criminal populations (Hart et al., 1995). Only seven perpetrators in the study
group met the diagnostic criteria for psychopathy, i.e. received a score above 17.
This is seven out of those 35 personality-disordered perpetrators who were
subject to a closer analysis by us, i.e. 20%. However, in comparison with all the
other perpetrators in the study group who were subject to forensic examinations
and received principal psychiatric diagnoses other than personality disorders,
the proportion is seven out of 96, i.e. 7%. Additionally, if we hypothesize that
none of those who committed suicide fulfilled the diagnostic criteria for
psychopathy (suicide is regarded as unusual among psychopaths, e.g. Hare,
1993), the proportion goes down to seven out of 136, i.e. 5%. Thus, Hare
psychopathy in this study group was rare, while other psychiatric disorders were
common.
Our findings in this respect might at a first glance be seen as somewhat
surprising, since psychopathy is said to be over-represented among men who
commit spousal violence (e.g. Hart et al., 1993; Kropp et al., 1995). However,
the commonest personality trait displayed in this group was a trait very much
considered as ‘non-psychopathic’, namely depressiveness. In all cases, except for
the seven psychopathic perpetrators, the forensic psychiatric reports displayed a
history of depressive episodes throughout their lives that had resulted in
contacts with psychiatrists or psychologists. Thus, spousal homicide may be one
area of crime where psychopathic perpetrators are not over-represented.

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Characteristics of spousal homicide perpetrators 129
Table 2: Distribution of principal diagnoses in forensic psychiatric examinations (FPE) on
perpetrators of spousal homicide in Sweden 1990–99 (numbers and percentages)
Category Total
n %
Paranoid schizophrenia 3 3
Schizophrenia syndrome 2 2
Schizo-affective syndrome 1 1
Delusional syndrome 10 11
Depression 10 11
Bipolar syndrome 1 1
Alcohol-induced psychotic syndrome 1 1
Psychotic syndrome unspecified 7 7
Psychoses total 35 36
Paranoid personality disorder 1 1
Antisocial personality disorder 5 5
Borderline personality disorder 4 4
Histrionic personality disorder 1 1
Narcissistic personality disorder 6 6
Personality disorder unspecified 14 15
Dissociative syndrome 1 1
Dystymia 3 3
Sexual sadism 1 1
Personality disorders total 36 38
Dementia 2 2
Mental retardation 2 2
Post traumatic stress syndrome 2 2
Maladaptive stress reaction 6 5
Substance abuse 6 5
Other diagnoses 2 2
Other diagnoses total 20 21
No diagnosis 5 5
Total 96 100
Note: Twenty-six perpetrators (21%) were not subject to forensic psychiatric examinations; 39
perpetrators (24%) committed suicide in connection with the homicide; one perpetrator died
as a result of a fire that he caused in connection with the crime. Two cases were missing (1%).
Discussion
Studies from several countries show that violence towards women is a frequent
phenomenon and committed by men with different personalities from different
social classes, e.g. Canada (Statistics Canada, 1993), Finland (Heiskanen and
Piispa, 1998) and Sweden (Lundgren et al., 2001). Among spouse assaulters
generally, it is found that many men are personality disordered (Hamberger and
Hastings, 1988; Hart et al., 1993), and that they often display psychopathic
personality traits (Huss and Langhinrichsen-Rohling, 2000). When it comes to

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130 Belfrage, Rying
homicidal violence, however, this study clearly indicates that the perpetrators, to
a great extent, have comparatively severe psychiatric disturbances but rarely
psychopathic personality traits. This finding is supported by the results from a
previous study of a Swedish sample of psychiatrically examined spousal
assaulters, containing a sub-group of spousal homicide offenders, where it was
found that Hare psychopathy and a general antisocial lifestyle were highly
predictive of spouse assault recidivism (Grann and Wedin, 2001) but, among
those who were sentenced for spouse homicide, only one reoffended (the case was
described as an upper-end outlier). Thus, very few, if any, were probably
diagnosed as psychopaths. Furthermore, published lists of risk factors to be
considered when assessing risk for lethal spouse violence commonly contain
factors not usually related to the psychopathic personality. Hart (1988), for
example, lists suicide ideation, obsessiveness and depression as important such
factors.
Our results do not indicate that the psychopathic batterer is at low risk of
committing spouse violence. On the contrary, his violence is well known to be
strongly repetitive, but it rarely seems to be homicidal in the context of spouse
violence.
There have been several recent attempts to construct typologies of spouse
assaulters. One commonly used typology is the one proposed by Holtzworth-
Munroe and Stuart (1994), which includes three major groups: family only
batterer, dysphoric/borderline batterer and generally violent/antisocial batterer.
The study group described here corresponds, to a great extent, to the dysphoric/
borderline group. As described by Holtzworth-Munroe and Stuart, these men
show high levels of anger, aggression and severe violence. They express low to
moderate extrafamiliar and general violence and their alcohol/drug abuse
can be seen as moderate. As previously described, the commonest personality
trait displayed in our study group was a trait very much considered as ‘non-
psychopathic’, namely depressiveness.
It is of importance that this group, the dysphoric/borderline group, is
generally regarded as benefiting from treatment (e.g. Bateman and Fonagy,
2000), unlike the psychopathic batterer (e.g. Harris et al., 1991). This means
that risk assessment procedures have to consider different risk-management
strategies, depending on what type of batterer is dealt with. Improvement may
prevent future spousal homicides.
The very high prevalence of mental disorders among perpetrators who
commit spouse homicide makes it important for professionals who are engaged
in risk assessment and risk management in this context to incorporate this
knowledge in their decision-making. This must be regarded as essential also for
the police, who often comprise the first player in the chain. It is sometimes
argued that the police should do purely police work and not try to function as
street-corner psychiatrists. However, studies in Sweden indicate that not only
can the police have a reasonable conception of whether a suspect has mental

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Characteristics of spousal homicide perpetrators 131
problems or not but they are also comparatively successful in initiating adequate
protective actions (Belfrage, 2001; Kropp and Belfrage, 2002; Belfrage, 2003).
Thus, it is essential that checklists for risk assessment and risk management in
the area of spousal assault incorporate clinical, dynamic risk factors as well, and
not just statistical, static risk factors. This is regardless of who is performing the
risk assessment, since mental disorder seems to be a too strong risk factor to
leave out of an assessment in this context. Consequently, the police version of
the SARA, named the B-SAFER (Kropp et al., 2003), incorporates such a
clinical item – ‘mental disorder’ – that the police have to consider provisionally.
Finally, we would like to stress that this study is based on all cases of spouse
homicide in Sweden during a 10-year period. The generalizability of our
findings in a Swedish context is thus great. We believe that there might be a
decreased generalizability in North America, not at least concerning use of
firearms, immigrant background and modus operandi. However, we cannot see
why there should be any differences with regard to the prevalence of mental
disorders, and the proportion of psychopathic perpetrators, among spouse
homicide offenders.
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Address correspondence to: Professor Henrik Belfrage, PhD, Sundsvall Forensic
Psychiatric Centre, Box 880, 851 24 Sundsvall, Sweden. Fax: +46 60 18 39 10,
email: Henrik.Belfrage@lvn.se