Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). The perpetrator pathology-based classification grouped homicide-suicide into six types of disorders: depression, sociopathy, psychosis, alcohol abuse and intoxication, jealousy, and paranoia. The study used data on all homicide-suicide events that occurred in Galveston County, TX, over a continuous 18-year period (n = 20). The study attempted to determine how closely these cases would correspond to the descriptive categories and the utility of the classification system. It also sought data concerning the motivation, psychological stressors, and psychopathology of individuals who commit combined homicide-suicide. The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of those were of the consortial type, possessive sub-type. Tables, figure, references