Homicide-Suicide (Dyadic Death) -.:University of Limpopo

CASE REPORT

Homicide-Suicide (Dyadic Death) A Case Study of Double Hanging

Marna du Plessis, MBChB and Keven Khazamula Hlaise, MBChB, Dip for Med, FC for Path(SA)

AUTOPSY FINDINGS Abstract: Murder-suicide, homicide-suicide, and dyadic death all refer Autopsy of the female showed a petite, adult female with to an incident where a homicide is committed followed by the perpetra- a body mass of 50.8 kg and a height of 1.7 m. Her mouth was tor’s suicide almost immediately or soon after the homicide. Homicide- covered by a transparent plastic ligature tied behind her neck. suicides are relatively uncommon and vary from region to region. In the Her wrists tied together behind her back with a similar ligature. selected literature that we reviewed, shooting was the common method An orange nylon ligature, with a sliding knot, was tied around of killing and suicide, and only 3 cases of homicidal hanging involving her neck. There was a friction abrasion/contusion measuring child victims were identified. We present a case of dyadic death where the 2 cm wide, circumferentially around the upper third of her method of killing and suicide was hanging, and the victim was a young neck, in an inclining direction toward an apex, which was located woman. on the left side of the occiput. Key Words: dyadic death, murder-suicide, hanging, homicidal hanging Autopsy of the male showed an adult male with a body (Am J Forensic Med Pathol 2012;33: 262Y264) mass of 78.8 kg and a height of 1.8 m. His face and hands were free of any covering or tying ligature. There was a friction abrasion/contusion, measuring 1.7 cm wide, circumferentially urder-suicide, homicide-suicide, and dyadic death all refer around the upper third of his neck in an inclining direction Mto an incident where a homicide is committed, followed toward an apex, which was located on the left mastoid area of by the suicide of the perpetrator almost immediately or soon the scalp. Y after the homicide.1 4 Suicide pacts are also a form of dyadic In both cases, the internal organs were congested. A blood- death, as seen in the case by Avis and Hutton,5 where a couple less dissection of the neck had no remarkable findings; the hyoid committed suicide by hanging, and the weight of 1 partner was bone and thyroid cartilage were intact, and there were no inti- necessary in executing the hanging. The second most common mal tears of the internal carotid arteries. Petechiae of the pleurae form of homicide-suicide is filicide-suicide.6,7 and epicardium were identified, but the conjunctivae were unre- Rare forms are familicide-suicide, extrafamilial homicide- markable. Blood was taken for alcohol estimation. The cause of suicide, and homicides involving parents and siblings.7 Extra- death was consistent with hanging. familial homicide-suicide does not include only mass murders but also cases where the perpetrator is in a moral or emotion- al relationship with the victim such as a neighbor, landlord, or DISCUSSION employee.2,7Y9 The perpetrators in extrafamilial homicides- Homicide-suicide cases are relatively uncommon and vary suicides can either be adults or adolescents, but adolescents among different regions.2 Coid (in Milroy10) described laws are less likely to commit suicide following the homicide.7 We pertaining to homicide-suicide, with the first law pertaining to present a rare form of dyadic death where both the suicide and low homicide-suicide rates in countries with high homicide homicide were committed by hanging, and we also reviewed rates.10 According to Milroy,10 the homicide-suicide rates in- selected literature on the subject. ternationally are as follows: Miami, Fla (1977Y1985): 0.55 per 100,000; Australia (1989Y1991): 0.16 per 100,000; New Zeal- and (1976Y1989): 0.05 per 100,000; Scotland (1986Y1990): CASE HISTORY 0.05 per 100,000; and England/Wales (1980Y1990): 0.07 per Two bodies of young adults, a male and a female, who were 100,000. In Miami, Fla, the homicide-suicide rate is the highest, known to be in a consortial relationship, were found hanging in and the lowest rates are in Scotland and New Zealand.2,10 an informal house. Both were suspended on a rafter next to each Marzuk et al11 first classified homicide-suicide based on the type other by an orange nylon ligature. The female had her mouth of relationship between the victim and perpetrator and on the covered with a transparent plastic ligature, which was tied behind motivation of the perpetrator (jealousy, mercy killing, etc). This her neck, and a similar ligature tied her wrists together behind classification has later been modified by Hanzlick and Kopo- her back; the male’s face and limbs were not covered or tied by nen,12 although the basis of the classification remains the same. anything (Figs. 1Y4). A suicide attempt by the male was reported Jena et al3 found that the average annual incident for homicide- 3 months before this fatal attempt. suicides in South Africa, Pretoria region, was 1 per 100,000 over a period of 5 years. The victims involved in dyadic deaths and homicidal hang- Manuscript received October 14, 2010; accepted December 21, 2010. ings are usually females, children, mentally disabled individuals, or From the Department of Forensic Medicine, Medunsa Campus of University individuals incapacitated by drugs, disease, or alcohol.1,4,8,10,13Y15 of Limpopo, Medunsa, South Africa. 2Y4,8,9,16,17 The authors report no conflicts of interest. The perpetrator in these cases is usually male. Where Reprints: Marna du Plessis, MBChB, Department of Forensic Medicine, females are the perpetrators, the victims are their children, and Medunsa Campus of University of Limpopo, Medunsa 0204, this is known as filicide-suicide.2,4,6,9,17,18 According to Polson South Africa. E-mail: [email protected]. 1 Copyright * 2012 by Lippincott Williams & Wilkins (quoted by Lew ) there needs to be a disproportion between the ISSN: 0195-7910/12/3303Y0262 victim and perpetrator to make the crime possible; the victim should DOI: 10.1097/PAF.0b013e3182186f67 be a child or an adult incapacitated by drugs, alcohol, or disease.1

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FIGURE 1. Female victim suspended by ligature with plastic ligature in situ. FIGURE 3. Female victim’s hands tied with plastic ligature behind her back.

In the study done by Jena et al,3 the results showed that the majority homicide and suicide, but in some cases, this can differ.2,3,8 Sui- of victims were females, in keeping with our case. The victims in cidal hanging in homicides-suicides is seen in numerous stud- homicide-suicides are either related to or in a close relationship with ies.2,3,8,16,17 A study done by Travis et al16 shows hanging to be the perpetrator; victims who are unknown to the perpetrator are the leading cause of suicide in England and Wales. Hanging rare.1,2 Spousal killings (commonly associated with discord in was the second leading cause of suicide in a study done by Jena the spousal relationship) and children killed by their parents are et al3 in the Pretoria region as well as in New Hampshire as the commonest form of homicide-suicide.1,2,10 In the case pre- reported by Campanelli and Gilson.17 In the literature review sented here, the victim was in a consortial relationship and had a of Sauvageau,13 two retrospective studies describing homicidal child with the perpetrator. The presence of mental illness, such as hanging involving child victims in homicide-suicide cases are depression and schizophrenia, in perpetrators is a very common described. Lew1 described a case of a double hanging, where the ﬁnding in cases of homicide-suicide.1,2,8,9 father had schizophrenia, stabbed his wife, and hanged their son We have found from the literature review that the com- and then himself in the attic of their house. mon method of killing and of suicide in dyadic deaths is shooting; the reason, whether it is due to the male predominance or availability of ﬁrearms, is not clear.2Y4,8,17 Female perpetrators use less violent means of homicide such as poisoning, either by medication or carbon monoxide poisoning.2 It is seen that the perpetrator will use the same weapon or method to commit the

FIGURE 2. Transparent plastic ligature covering victim’s mouth. FIGURE 4. Two bodies of a male and female found hanging.

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Y Homicidal hanging in homicide-suicides is rare.1,13 15,19 7. Liem M. Homicide followed by suicide: a review. Numerous cases of homicidal hangings involving children in Aggress Violent Beh. 2010;15:153Y161. homicide-suicides are described in the literature, but whether 8. Santoro JP, Dawood AW, Ayral G. The murder-suicide. 14 there are any adult cases is unclear. Double hanging involv- A study of the postagressional suicide. Am J Forensic Med Pathol. ing only adults in homicide-suicides was not found in the 1985;6(3):222Y225. selected literature that we reviewed. The case that we have pre- 9. Chan CY, Beh SL, Broadhurst RG. Homicide-suicide in Hong Kong, sented here has 2 interesting aspects: both victim’s and perpe- 1989-1998. Forensic Sci Int. 2004;140:261Y267. trator’s method of death was hanging, and second the pictures 10. Milroy CM. The epidemiology of homicide-suicide (dyadic death). demonstrate clearly that the female is the victim because she Y is tied and gagged in keeping with a homicidal hanging, but Forensic Sci Int. 1995;71:117 122. this similar picture can be found in suicidal and autoerotic 11. Marzuk PM, Tardiff K, Hirsch CS. The epidemiology of hangings.20Y22 In our case, no paraphernalia indicating an auto- murder-suicide. J Am Med Assoc. 1992;267(23):3179Y3183. erotic nature was found, and the female had no record of suicidal 12. Hanzlick R, Koponen M. Murder-suicide in Fulton County, Georgia, attempts. 1988-1991. Am J Forensic Med Pathol. 1994;15(2):168Y173. 13. Sauvageau A. True and simulated homicidal hangings: a six year ACKNOWLEDGMENT retrospective study. Med Sci Law. 2009;49(4):283Y290. The authors thank Dr M. M. Sefanyetso, Department of 14. Vieira DN, Pinto AE, Sa´ FO. Homicidal Hanging. Am J Forensic Forensic Pathology, Medunsa, who performed the autopsy of Med Pathol. 1988;9(4):287Y289. the male in the case presented in this article. 15. Leth P, Vesterby A. Homicidal hanging masquerading as suicide. Forensic Sci Int. 1997;85:65Y71. REFERENCES 16. Travis AR, Johnson LJ, Milroy MM. Homicide-suicide (dyadic deaths), homicide, and firearms use in England and Wales. 1. Lew EO. Homicidal hanging in a dyadic death. Am J Forensic Med Am J Forensic Med Pathol. 2007;28(4):314Y318. Pathol. 1988;9(4):283Y286. 17. Campanelli C, Gilson T. Murder-suicide in New Hampshire, 2. Byard RW, Knight D, James RA, et al. Murder-suicides involving 1995Y2000. Am J Forensic Med Pathol. 2002;23(3):248Y251. children. A 29-year study. Am J Forensic Med Pathol. 1999;20(4):323Y327. 18. Yip PSF, Wong WC, Cheung YT, et al. An empirical study of characteristics and types of homicide-suicides in Hong Kong, 3. Jena S, Mountany L, Muller A. A demographic study of 1989Y2005. J Affect Disorders. 2009;112:184Y192. homicide-suicide in the Pretoria region over a 5 year period. J Forensic Legal Med. 2009;16:261Y265. 19. Cooke CT, Cadden GA, Hilton JMN. Unusual hanging deaths. Am J Forensic Med Pathol. 1988;9(4):277Y282. 4. Shiferaw K, Burkhardt S, Lardi C, et al. A half century retrospective study of homicide-suicide in Geneva, Switzerland: 1956Y2005. 20. Goonetilleke UKDA. Two unusual cases of suicide by hanging. J Forensic Legal Med. 2010;17:62Y66. Forensic Sci Int. 1984;26:247Y253. 5. Avis SP, Hutton CJ. Dyadic suicide. A case study. Am J Forensic 21. Gorniak JM, Sudimack JR, Stanforth JR, et al. Hanging deaths with Med Pathol. 1994;15(1):18Y20. bound hands what is the manner? Am J Forensic Med Pathol. Y 6. Saint-Martin P, Bouyssy M, O’Byrne P. Homicide-suicide in Tours, 2007;28(3):232 234. France (2000Y2005)Vdescription of 10 cases and a review of the 22. Elfawal MA, Higazi MHM. Examination and significance of ‘tied up’ literature. J Forensic Legal Med. 2008;15:104Y109. dead bodies. J Clin Forensic Med. 1998;5:27Y31.

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