"You're beautiful, Sarah."
In August 1991, Joseph's mother Harriet was involved in a car accident that completely disfigured her face. Harriet was bedridden at the Long Term Acute Care ward for the hospital until she passed away from her injuries in September 1994. The entire ordeal imprinted on Joseph's mind, as he was still developing his love map, and he developed an attraction for women with disfigured faces. Afterwards, Joseph was put in a group home called New Dawn owned by Ted and Cheryl Banks, but it was shut down due to a series of child abuse scandals after Joseph was found with bruises on his face and wearing a torn T-shirt. On November 14, 2012, Joseph started working for a catering service called Delivery Dining, and he met a reclusive, introverted woman named Sarah Sherwood, who suffered from neurofibromatosis type II, in which a tumor formed in the right side of Sarah's face, disfiguring it. Despite her deformed face, Joseph fell in love with her and became her boyfriend. Three weeks prior to "Inner Beauty", Joseph encouraged Sarah to go outside for a picnic at a local park. When Joseph left her alone to get the wine, Sarah's fears manifested into an anxiety attack, in which she was imagining that everyone was staring at her and laughing at her. Two days after that, Sarah committed suicide by shutting herself inside a swimming pool with a retractable cover at her parents' home, and drowning herself. Joseph found her body; as a result, he snapped, suffering a psychotic break, and started abducting women and trying to make them look exactly like Sarah.
After killing three women in his botched attempts to remold them into Sarah's image, Joseph, in the process of disposing the body of his third victim, abducts Danielle Steinhardt. He takes her to a house he shared with Sarah and performs surgery on her, successfully disfiguring her face and swelling up her right cheek. Once Danielle regains consciousness, Joseph shows her his handiwork, calls her Sarah, and tells her she looks beautiful, though she is horrified. He then takes her to Sarah's bedroom, which he and Sarah personally renovated, and shows Danielle Sarah's old dolls, trying to put her into the role of Sarah. Danielle briefly plays along with Joseph's fantasy, and when he lets his guard down, she incapacitates him with a hand mirror, flees outside the home, and comes across a jogger, but is too disoriented from the surgery to say anything. Joseph catches up to her, tells the jogger that Danielle is his wife who just came out of surgery, and drags her back inside the house without arousing suspicion. Moments later, she starts experiencing intense pain from the surgery, and Joseph finds that he has run out of painkillers. He slips further into his psychosis just as Rossi and JJ burst into the room and hold him at gunpoint. Joseph holds Danielle hostage and refuses to let her go, but Rossi tells him to accept the fact that Sarah is gone and that he will never be able to rewrite the past. Joseph hallucinates Sarah calling out for him, peacefully surrenders, and is arrested.
Joseph initially targeted random high-risk Caucasian women living in the Oak Park Community, but he later switched his focus to women with blonde hair like Sarah. He would charm them into getting a ride on his work van, after which he would knock them out with a chloroform-soaked rag. He would then take them to the house he shared with Sarah, and perform facial surgeries on them to alter their appearance so they could resemble Sarah. He accomplished this by installing implants into their right cheeks, which would cause them to swell up. While performing the surgeries on them, he would drug them with morphine and meperidine he stole from rehab centers that he delivered food to so they would not feel any pain from the surgeries. He would also put each victim (with the exception of the second) in a duplicate of the dress that Sarah was wearing when she killed herself. In the case of Belinda Cameron, he dyed her hair so that its color would match that of Sarah's.
Because of his lack of medical knowledge, the victims died from a variety of causes due to the surgeries. Once they died, he would try to remove the sutures, only to wind up cutting them in the process. As a result, Joseph would cut the victims' faces with a scalpel to mask his handiwork. He would also removed the implants from their cheek except in the case of his third victim. His signature was dumping the bodies in enclosed spaces occupied with bodies of water, as a reference to the location where he found Sarah's body following her suicide.
The unsub is a white male aged in his late 20s to early 30s. He is specifically targeting and operating on women found in and around the recovery community of Oak Park, Sacramento. The fact that he is able to earn the trust of his victims suggests that he may be a member of the recovery community. Death is not the goal for the unsub, but pain is: he cuts his victims for the purpose of inflicting physical and psychological scars that are permanent and will never heal.
It was originally believed the unsub was a surgical sadist and his victims were surrogates for the woman he believes wronged him, possibly a first victim that was not found at the time. Due to the fact that his anger towards her was not satiated after hurting her, it was believed that this woman may have a personal connection to the unsub and finding her will be the key to stopping him.
- September 1: Debbie Leitelt (unintentionally exsanguinated)
- September 13: Belinda Cameron (died from sepsis)
- September 20:
- Leslie Schellin (died from unknown causes; dumped her body in a different location)
- Danielle Steinhardt (abducted and disfigured the right side of her face via botched surgery; briefly escaped; was rescued two days later)
- Joseph is similar to Rhett Walden, a.k.a. "The Hill Ripper", a psychotic budding serial killer who appeared in Season Six. Both were delusional killers whose mothers died prior to their killings, targeted women, and incapacitated their victims with rags soaked with chloroform before abducting them. Both were also noted to hold their victims captive in their homes and made them wear outfits to make them look like the women they lost, and also mutilated the faces of the victims they killed post-mortem.