Of the few relevant studies identified (n=15), some attempted to categorize female serial killing according to patterns of and motives for the homicides. The most common motive was material gain or similar acquisitive gratification; killing for some type of physical and/or emotional sadistic pleasure/release was apparently rare in female serial killers. No consistent theory of serial killing by women has emerged, but psychopathic personality traits and abusive childhood experiences have been consistently found in studies of female serial killers. In contrast to men, women serial killers tend to know their victims, often partners or helpless individuals in their care. They usually use covert methods of killing. Their offenses are commonly committed with a man or men. The female patient described in this article did not fit these general characteristics of female serial killers. She committed her crimes against strangers at sites geographically distant from her home, acting alone and using violent methods. The literature search used EMBASE (1980-2004), MEDLINE (1966-2004), and PsycINFO (1967-2004), using the search terms "female," "serial," "multiple," "killing," "killer," "murder," "homicide," and "manslaughter." 1 table and 31 references