RAMLE, Israel – The man accused of going on a three-state stabbing rampage in the United States was also a suspect in a stabbing near his hometown in Israel.

But what drove Elias Abuelazam remains a mystery: Relatives describe a shy man from a respected family who had recently become despondent.

Profilers say the case is baffling because, despite five deaths, murder did not appear to be the goal.

Abuelazam is suspected of attacking people in Michigan, Ohio and Virginia, leaving 13 people wounded in addition to the dead. He was arrested Wednesday in Atlanta as he prepared to board a flight to Israel, where relatives said he lived until his family sent him to the U.S. when he was 18.

The 33-year-old man appeared briefly Friday in an Atlanta courtroom and agreed to return to Michigan to face an attempted murder charge in one of the attacks — a July 27 stabbing in Flint, Mich., that put the victim in the hospital for a week.

Authorities said more charges were expected.

A relative in this poverty-stricken city said Abuelazam had become unhappy about his personal life. Others in the Arab neighborhood where he grew up expressed shock that he could be a suspect in the attacks.

“I wouldn’t believe it even if I saw it with my own eyes,” said Abuelazam’s 49-year-old cousin, also named Elias Abuelazam.

He said news of the arrest had devastated Abuelazam’s mother. “She was hysterical,” he said.

The family’s modest two-story stone home in Israel, in a Christian section of Ramle’s historic old city, remained dark Friday, and Abuelazam’s mother, Hiam, was holed up inside.

In a radio interview, she called her son a “religious, God-fearing man” and said she refused to believe he was a killer.

However, Israeli police said he was a suspect in a stabbing attack early this year, although charges were never pressed.

A senior police commander said Abuelazam was believed to have stabbed an acquaintance in the face with a screwdriver about six months ago. The commander said police dropped the case because the victim refused to cooperate with investigators.

He said Israeli police would request samples of Abuelazam’s DNA to investigate unsolved stabbings in the Ramle area.

The commander spoke on condition of anonymity because he was barred by police rules from speaking to the media.

The alleged victim in the attack, Ziad Shahin, denied being assaulted by Abuelazam but had a large scar from his right ear to his throat. Shahin said he was born with the mark.

Acquaintances in Ramle said Abuelazam’s father died of illness when Abuelazam was a baby, and that he was raised by his mother and four sisters. The family owned a grocery store and two other shops in town, and the mother was well regarded.

Abuelazam’s most recent visit came earlier this year, and he returned to the U.S. in the spring, shortly before the stabbing spree began in Flint.

All but four of the 18 attacks occurred in the Flint area. The others were in Leesburg, Va., and Toledo, Ohio. In one case, the attacker used a hammer.

Robert Keppel, a retired Washington state homicide detective who profiles serial killers, said it’s rare for someone to attack males exclusively.

Whoever is responsible for the 18 attacks, “he’s just getting off on stabbing people. He’s not guaranteeing that they die,” said Keppel.

Also Friday, police in Leesburg said they were investigating whether Abuelazam is responsible for the March 2009 stabbing death of a 44-year-old man who lived across from Abuelazam in a townhome community.

If authorities connect Abuelazam to that slaying, he could face the death penalty. Michigan, where the other deadly attacks occurred, does not have capital punishment.