Homicide-suicide and other forms of co-occurring aggression against self and against others

Assessing the risk of harm to self and the risk of harm to others usually are distinct clinical processes. Yet these forms of aggression frequently coexist, occasionally with lethal outcomes. The author summarizes the literature on co-occurring aggression against self and others. Studies of homicide-suicide are reviewed first. Studies investigating the risk of co-occurring aggression against self and against others are reviewed next. The studies show a strong link between the 2 forms of aggression, etiologically implicating depression and other factors. Both types of risk assessment should occur jointly. Guidelines for combined risk assessment, prevention, and treatment are offered.