Some serial lust killers suffer from erectile dysfunction in the context of a consensual relationship with a living human. In one sample of them, 44 per cent indicated erectile difficulties. It appears that some killers can only secure and maintain an erection, if at all, in the presence of a dead body, as with John Christie, or blood, as with Andrei Chikatilo. More speculatively, Robert Lee Yates Jr. also fits this description. It appears that John Christie was mocked for erectile difficulties. He viewed the body of his grandfather, which possibly had a role in the tragedy. It is possible that being gassed in World War I contributed to his pathological sexuality. Andrei Chikatilo is the most famous serial killer from the USSR. His early life in the Ukraine was associated with a multitude of different stressors. His erectile difficulties might have stemmed in part from bullying and taunting.

Even some entirely peaceful gay males feel so-called internalized homophobia towards gay males, including themselves. This is particularly so if their social context is anti-gay and they have not ‘come out’ publicly. For a tiny minority, feelings of shame and guilt might sometimes be assuaged by acting aggressively towards other gay males, which appears to be an example of what Freud termed ‘reaction formation’. Such combined lust-anger emotion appears to be at the basis of the killings by several men (described here), who exhibit sexual sadism. Some serial lust killers were rejected and taunted for being gay. This triggered mixed emotions towards their orientation and combined attraction and hatred towards other gays. The chapter describes several homosexual serial killers, all of whom targeted gay males or young men offering sexual services, often torturing them before killing. Most famous is John Wayne Gacy and most recently convicted is Bruce McArthur.

The chapter looks at two heterosexual killers who made extensive confessions of their crimes: Gerald Stano and Gary Ridgway. It looks at their similarities and differences. Both had unhappy childhoods with sibling rivalry and the experience of bullying and taunting, and both felt inferior and failures in life. Each killer revealed a fusion of sex and violence, and showed evidence of stress exacerbating their toxic behaviour, both chronically and acutely (e.g. mocking remarks by a sex worker). As a difference, Stano but not Ridgway was adopted. Stano’s physical condition was very poor at the time of adoption, which might have been associated with brain damage. Ridgeway but not Stano was married and had secure employment. Stano displayed considerable sexual envy towards courting couples. The two killers either exclusively (Ridgway) or commonly (Stano) targeted sex workers. Each showed non-lethal choking of a regular partner.