Several key patterns appear when examining the phenomenon of murder-suicide. Perpetrators are almost always male. Firearms are nearly always used to first kill another person and then self, and the murder-suicide is usually planned rather than being impulsive. Because such a suicidal individual has so little stake in living, once he has decided to die, he plans to take someone else down with him in a desperate and dramatic act. Most often the victim is a person or persons known to the killer, or it may be any member of an organization or group that is resented. Anger, revenge, jealousy, obsession or possessiveness, and hopelessness in the wake of a profound loss are among the dominant motivations for murder-suicide. These motives may be grouped under the concepts of either or both alienation and him-her-based murder-suicide (failed relationship with a particular person of the opposite sex). There are several common elements that may forecast the possibility of murder-suicide in a school setting. A student perpetrator of murder-suicide who targets a school often is a socially isolated individual with a limited network of friends. Typically, such an individual has few positive attachments to his parents or other family members. In many instances of murder-suicide, the perpetrator has recurring fantasies about "getting even." As a first step toward reducing the risk of school shootings, all students should understand that any threat by a peer to kill another or to commit suicide should be taken seriously and reported immediately. There should be a serious and sustained effort to end any harassment of students perceived to be at risk of violence; this means mounting efforts to counter bullying, public ostracism, and humiliation of the student who might be suicidal. Further, a reduction in harassment throughout the school would have significant benefits in reducing one of the reasons for school shootings. Resources and training for school-based counseling and support services, as well as the training of teachers to address the concerns of students with conduct disorders are among the most needed areas of school reform. There should be appropriate assessment practices for all students, with the goal of early identification of problem behaviors and academic skill deficits. 6 references