QUESTION:
Dear Dr. Heller,
How frequently does the self-inflicted violence turn outward to violence against others? There is a student on a local high school campus who has been demonstrating increasingly horrific self-mutilation behavior. Should he be considered a threat to other students and removed from campus? Clearly, whatever steps the school has taken to help this child have only made the situation worse as his behavior is escalating rapidly. Parents and students are becoming frightened.
DR. HELLER'S ANSWER:
Nobody knows the exact statistics, but I know many, many individuals who self-mutilated and hurt others. The shooter at the LA Jewish Center described this.
Self-mutilation is not usually a "violent" act towards the self, but rather an (unfortunately) effective technique to relieve the emotional pain of dysphoria (anxiety, rage, depression and despair). The problem is that the dysphoria pain can be so bad that the individual misinterprets reality. This is called "psychosis." While psychotic, an individual can misinterpret anything - and can believe being violent towards another is a reasonable act.
Additionally, while moderately angry (and especially if raging) an individual's sense of survival can overcome their rational thinking abilities ("shoot first, ask questions later"). That's why they refer to someone who has lost control and their understanding of reality as "mad."
It's likely appropriate to consider the individual a "threat" - particularly after all the school shootings that have been seen. This is particularly true if the school's attempts to make things better have made things worse. This may be due to the techniques employed by the school, the student's problems, or both. Regardless, violence must be stopped and if at all possible prevented. If he has paranoid schizophrenia, this should be obvious to the treating mental health professionals.
I'd highly recommend reviewing the information on bipolar mania and BPD dysphoria (anxiety, rage, depression and despair) to educate yourself and as many individuals involved with this scenario as soon as possible.
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