Homicide followed by suicide is an extremely rare event, requiring an integrated theoretical understanding that goes beyond explaining it as either homicide or suicide. Police reports, newspaper articles, and interviews with families, friends, and neighbors connected with 42 homicide–suicide cases that occurred in greater metropolitan New Orleans between 1989 and 2001 form the empirical base of this study. A homicide followed by suicide typology predicated on thematic context, including victim–perpetrator relationship, age, sex, race, ethnicity, and occupation in addition to precipitating factors, motivation, type of fatal injury, and location of event, is discussed. An integrated theoretical model using structural conflict intensity factors; elements of the social stress–strain perspective focusing on frustration, failure and anomie; and power dominance issues is presented. Although additional research is certainly called for, these sociological autopsies raise important methodological and theoretical questions for future exploration.