The first piece of suspense created, was from the very beginning where we see him changing his identity and leaving the house as if everything was normal. The suspense was created through the initial first shot inside the house of which the camera panes across the screen showing his tools. Then there are a number of close ups on various parts of his body; mainly hands and face. For example, when he cuts himself with a razor and there is a sudden close up of the blood, this starts to build the atmosphere for the audience. Especially as he is casually changing his identity but we don't know why as of yet. Once he gets downstairs and turns the music on, Silent Night plays, which indicates a sense of calmness about the scene. Suddenly, we see a distortion of reality as the camera tilts to the side and we see a dead boy which then leads us to seeing three other dead bodies. This instantly sets us up for whats to come in the rest of the movie.
The second element of suspense that I found effective was when he kills the cat lady, as a false plateau is used at the beginning of the scene when the cat appears out of nowhere. This throws us off guard a little which builds suspense perfectly. Furthermore, there were many point of view shots as if he was watching her which sets us up for his attack. When she pulls back the door and his reflection is in the mirror we immediately jump as we know whats to come.
The third piece of suspense was when he kills his girlfriend's sister. I found the most crucial indication that built suspense was the use of pathetic fallacy. The weather was windy and rainy which helped to set the atmosphere as the sounds were quite loud and vivid. Moreover, when the umbrella fell into the pool it was another false plateau used to heighten our nerves. Then when he comes up behind her the weather gets more vicious as he strangles her. A close up shot of her face is used to show her strain of dying. In doing so, we instantly know that he will try and kill off the rest of the family next which leaves us anticipating more.