Major commonalities among sexual homicide models include the presence of deviant sexual interests and low self-esteem. Using a sample of violent sexual offenders who have either physically injured or killed their victim (n = 229), the current study investigates the impact of persistent deviant sexual interest(s) and persistent low self-esteem on sexual homicide. Findings suggest that both persistent deviant sexual interests and persistent low self-esteem are important predictors of sexual homicide. These findings suggest that there is a group of sexual murderers with low self-esteem who are driven by deviant sexual interests and may kill to satisfy their deviant sexual interests.