The case study featured in the article involved a sexually aggressive murder. Although the case was complex, the offender shared many common characteristics with violent offenders in previous studies especially regarding social, psychological, psychiatric, and neuropsychological disturbances. The offender came from a poor family who lived in a rural area. The family was influenced by a subculture of violence. Although members of the offender's nuclear family apparently had no patterns of violent behavior, at least two cousins had been convicted of murder. The offender often experienced violent behavioral patterns, anti-social misconduct, drug and alcohol addiction, and bizarre behavior after his return from Vietnam. He also suffered symptoms of post-traumatic stress disorder, somatic disorders, dissociative states, and visual hallucinations. He had attempted suicide, frequently displayed suicidal ideation, and had performed serious self-mutilations. This case illustrates the need to examine the synergetic and interactive effects of multiple factors when considering behavioral and structural etiology, especially among sexual murderers with histories of violent crime. It is likely that this murder could have been prevented had appropriate intervention and treatment been rendered. The offender had been arrested on numerous occasions, often for bizarre and irrational behavior. 5 notes and 12 references