Murders and suicides involving caregivers across the U.S. serve as distressing examples of individuals snapping under the stress.

In 2011 and so far this year, these and other horrific cases demonstrate how caregiver burnout can escalate to fatal incidents.

  • An Ohio man, Paul Gilkey, 63, shot and killed his two sisters-in-law, adult son and then himself – in front of his terminally ill wife – in January, police said. The Associated Press reported that the shootings happened as "family tension about the cancer-stricken woman's care apparently boiled over." The dispute was reportedly over whether Gilkey's wife should have been fed toast and tea or the orange he had peeled for her, the AP reported. His sister-in-law, Peggy Gilkey, told media that "he was really trying to take care of her, but he felt like people weren't letting him." Wife Darlene Gilkey, 59, and a stepson survived in the incident near rural Logan, Ohio.
  • Thomas Moak Jr., 58, is accused of murdering his parents, Isabelle Moak, 82, and Thomas Sr., 80, and sister, Renee O'Connor, 60, in Sarasota, Fla., in February. According to the Sarasota Herald-Tribune, "Several neighbors who knew Moak said he was under a great deal of stress caused by caring for his elderly parents and by being out of work."
  • David Winter was accused of murdering his elderly father, who had Alzheimer's, in March 2011 by bashing him in the head 40 times with a flashlight and stabbing him in the chest 13 times with a letter opener. Police testified that Winter "snapped." Winter, who is serving 18 years in prison after pleading guilty and who has a developmental disability, told the court, according to the Bismarck Tribune: "I'm not an evil person. I just had more than I could handle."

An reader recently shared the strain of caring for her aging mother, writing: "I truly feel that the only thing that keeps me from taking my own life is that there will be no one to take care of my mother."

She's not alone. Research cited by the National Center for Elder Abuse shows that 20 percent of caregivers "live in fear that they will become violent."

Sometimes, caregivers' actions aren't deadly, but harmful on a daily basis. Multiple studies have found that an estimated one-third of caregivers have verbally abused a family member. Other behaviors include physical and sexual abuse, as well as neglect, confinement, and deprivation of food, medical care, medication and shelter.

Dr. Diana Denholm, a board-certified psychotherapist and author of "The Caregiving Wife's Handbook: Caring for Your Seriously Ill Husband, Caring for Yourself," shares this example: If a distressed caregiver feels as the person they are caring for isn't happy with the food they're providing, they may think, "He isn't eating the food I prepare for him, so I'm not going to give him anything. So they start starving the patient."'

If you're feeling that you're being pushed to the edge, there are ways to keep from losing control.

1. Establish expectations

Talk to your spouse or parent and decide what you do for them and what they want to do for themselves. If you stop enabling a co-dependent relationship, your anger level is likely to drop because you won't be taking on every role, Denholm says.

For example, your spouse or parent may want to dress themselves. "Then you don't have that job anymore," she says. "If he dresses himself and puts on a polka dot shirt and plaid pants, you leave it alone."

If you have a micro-managing personality, letting go of roles can be a challenge, and the expectations may have to change as a condition worsens.

2. Ease family tensions

When another family member not involved in daily care thinks they have all the answers, that angers the caregiver, Denholm says. Even a visiting family simple questions such as "Why is dad wearing that?" "Shouldn't he have a more comfortable bed?" and "Why are you going to that doctor?" can spark arguments and violence.

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The Mayo Clinic recommends holding a family meeting to discuss roles and responsibilities as well as feelings of resentment and disagreements about financial decisions, which can create tension. Invite a counselor or clergy member to join you. You also may need to have periodic meetings or conference calls with your family to keep everyone involved and to discuss changes in responsibilities.

3. Seek peace at home

If your parent wants to eat a certain food or handle their condition in a particular way, don't push the point to get your way. There will be times where you agree to disagree, Denholm says. Dropping these battles will allow you to focus on why you love the person and want to care for them.

4. Avoid giving into guilt

Realize that you're doing the best you can and that no caregiver is "perfect," according to the Mayo Clinic. Give yourself credit and focus on the positive ways you are providing care for your family member.