- Suicidal Behavior
- Parasuicidal Behavior and Self-Mutilation
- Eating Disorders: Anorexia Nervosa, Binge Eating Disorder, and Bulimia
- Violence and the Verbally Aggressive Student
- Alcohol and Other Drug Abuse
- Poor Contact with Reality
OBSERVER RESPONSIBILITY AND INTERVENTION
It is important that everyone in the Park University community, students, faculty and staff, share a sense of responsibility for observing, identifying and reporting any type of behavior that could potentially harm members of the Park University community.
Reasons for BIT Referral
- Self-injurious behavior including but not limited to cutting, disordered eating, alcohol/drug abuse
- Suicidal thoughts or actions
- Erratic behavior (including online activities) that disrupts the mission and/or normal proceedings of University students, faculty, staff, or community. Behaviors include but are not limited to: weapons on campus, significant inappropriate disruption to community, potential for safety being compromised.
- Involuntary transportation to the hospital for alcohol and drug use/abuse.
Depression and the variety of ways in which it manifests itself is part of a natural emotional and physical response to life’s ups and downs. With the busy and demanding life of a college student, it is safe to assume that most students will experience periods of reactive (or situational) depression in their college careers.
Major depression, however, is a “whole-body” concern, involving the body, mood, thoughts, and behavior. It affects the way a person eats and sleeps, the way a person feels about him or herself, and the way a person thinks about things.
Major depression is not a passing blue mood. It is not a sign of personal weakness or a condition that can be wished or willed away. People with depression cannot merely “pull themselves together.” Without treatment, symptoms can last for weeks, months or years. Appropriate treatment, however, can help over 80% of those who suffer from depression.
- Persistent sad, anxious or “empty” mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex and school
- Insomnia, early morning awakening or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Decreased energy, fatigue, being “slowed down”
- Thoughts of death or suicide attempts
- Restlessness, irritability
- Difficulty in concentrating, remembering, making decisions—may effect completion of assignments
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
- Inconsistent class attendance
- Decline in personal hygiene
These students are characterized by having persistently lofty or irritable moods. Different from the normal ups and downs that everyone goes through, these symptoms are severe. They can result in damaged relationships, poor job or school performance, and even suicide.
- They often see themselves in a grand light, sometimes believing that they are famous or that the work they are doing is awe-inspiring.
- They often are overly talkative, with rushed speech and racing thoughts.
- Typically, their high energy interferes with their sleep.
- They can be very irritable and overly involved in pleasurable activities, such as sex or spending money.
Generally, these students are not dangerous, but caution should be taken, especially if alcohol or if other drugs are involved. If they try to put their rapid thoughts and words into action, they may place themselves in unsafe situations.
Signs and symptoms of mania (or a manic episode) include:
- Increased energy, activity, and restlessness
- Excessively “high,” overly good, euphoric mood
- Extreme irritability
- Racing thoughts, talking fast, jumping from one idea to another
- Distractibility, can’t concentrate well
- Little sleep needed
- Unrealistic beliefs in one’s abilities and powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that is different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
- Provocative, intrusive, or aggressive behavior
- Denial that anything is wrong
THE SUICIDAL STUDENT
Take It Seriously
- 75% of all suicides give some warning of their intentions to a friend or family member.
- All suicide threats and attempts must be taken seriously.
If you have been contacted directly by a student who is threatening suicide, it is important to act as quickly as possible by making sure they get immediate intervention. This might involve calling 911 if you are with them or the police if you not with them and concerned about their safety and well-being. The incident needs to be reported to the Behavioral Intervention Team for appropriate follow-up.
Warning Signs of Suicide
Suicide can be prevented. While some suicides occur without any outward warning, most people who are suicidal do give warnings. Prevent the suicide of loved ones by learning to recognize the signs of someone at risk, taking those signs seriously and knowing how to respond to them.
- Observable signs of serious depression
- Unrelenting low mood
- Anxiety, psychic pain and inner tension
- Sleep problems
- Increased alcohol and/or other drug use
- Recent impulsiveness and taking unnecessary risks
- Threatening suicide or expressing a strong wish to die
- Making a plan
- Giving away prized possessions
- Sudden or impulsive purchase of a firearm
- Obtaining other means of killing oneself such as poisons or medications
- Unexpected rage or anger
The emotional crises that usually precede suicide are often recognizable and treatable. Although most depressed people are not suicidal, most suicidal people are depressed. Serious depression can be manifested in obvious sadness, but often it is rather expressed as a loss of pleasure or withdrawal from activities that had been enjoyable. One can help prevent suicide through early recognition and treatment of depression and other psychiatric illnesses.
There are behaviors that are somewhat less serious in nature but still need to be addressed by a referral to the Behavioral Intervention Team. These behaviors include self-mutilation such as cutting behavior and risk-taking behavior. While these behaviors may not be immediately life-threatening, these behaviors have the potential to escalate into more serious life-threatening situations. These behaviors are reflective of underlying psychological issues that need to be addressed.
Parasuicide: An apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death. A sub-lethal drug overdose or wrist cutting are examples. Previous parasuicide is a predictor of suicide. The increased risk of subsequent suicide persists without decline for at least two decades.
Self-mutilation is defined here as intentional and acute physical self-injury without intent to die, which includes various methods such as cutting and burning. In contrast, only a minority of individuals attempt suicide (i.e., intend to die) by cutting or burning (e.g., Wexler, Weissman, & Kasl, 1978), and suicide attempts are much more likely to be medically severe (Brown & Linehan, 1996). Despite these differences between self-mutilation and suicide attempts, many individuals who self-mutilate also attempt suicide or wish to die. It has been estimated that about half of individuals who self-mutilate also attempt suicide (e.g., Hillbrand et al, 1994).
Collectively, this group of suicidal and nonsuicidal self-injury will be referred to as parasuicide (Kreitman, 1977).
EATING DISORDERS: ANOREXIA NERVOSA, BINGE EATING, AND BULIMIA
It is critical to identify and refer someone with an eating disorder to the BIT because for many people it is life-threatening or can result in serious health issues.
Anorexia Nervosa is a serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss. There are four primary symptoms:
- Resistance to maintaining body weight at or above a minimally normal weight for age and height.
- Intense fear of weight gain or being “fat” even though underweight.
- Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation, or denial of the seriousness of low body weight.
- Loss of menstrual periods in girls and women post-puberty.
Eating disorders experts have found that prompt intensive treatment significantly improves the chances of recovery. Therefore, it is important to be aware of some of the warning signs of anorexia nervosa.
- Dramatic weight loss
- Preoccupation with weight, food, calories, fat grams, and dieting
- Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.)
- Frequent comments about feeling “fat” or overweight despite weight loss
- Anxiety about gaining weight or being “fat”
- Denial of hunger
- Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate)
- Consistent excuses to avoid mealtimes or situations involving food
- Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury–the need to “burn off” calories taken in
- Withdrawal from usual friends and activities
- In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns
Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences.
- Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as heart rate and blood pressure levels sink lower and lower.
- Reduction of bone density (osteoporosis), which results in dry, brittle bones
- Muscle loss and weakness
- Severe dehydration, which can result in kidney failure
- Fainting, fatigue, and overall weakness
- Dry hair and skin, hair loss is common
- Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm
BINGE EATING DISORDER
Binge Eating Disorder (BED) is a type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating. It is characterized by:
- Frequent episodes of eating large quantities of food in short periods of time
- Feeling out of control over eating behavior
- Feeling ashamed or disgusted by the behavior
- There are also several behavioral indicators of BED including eating when not hungry and eating in secret
The health risks of BED are most commonly those associated with clinical obesity. Some of the potential health consequences of binge eating disorder include:
- High blood pressure
- High cholesterol levels
- Heart disease
- Diabetes mellitus
- Gallbladder disease
Bulimia Nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating. It has three primary symptoms:
- Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
- Regular use of inappropriate compensatory behaviors such as self-induced vomiting, laxative or diuretic abuse, fasting, and/or obsessive or compulsive exercise.
- Extreme concern with body weight and shape.
Eating disorder specialists believe that the chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.
- Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
- Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
- Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury–the need to “burn off” calories taken in.
- Unusual swelling of the cheeks or jaw area.
- Calluses on the back of the hands and knuckles from self-induced vomiting.
- Discoloration or staining of the teeth.
- Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions. Withdrawal from usual friends and activities.
- In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
Bulimia nervosa can be extremely harmful to the body. The recurrent binge-and-purge cycles can impact the entire digestive system and purge behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.
- Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death. Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
- Inflammation and possible rupture of the esophagus from frequent vomiting.
- Inflammation and possible rupture of the esophagus from frequent vomiting.
- Tooth decay and staining from stomach acids released during frequent vomiting.
- Chronic irregular bowel movements and constipation as a result of laxative abuse.
- Gastric rupture is an uncommon but possible side effect of binge eating.
VIOLENCE AND THE VERBALLY AGGRESSIVE STUDENT
Signs and Symptoms
The most accurate predictor of violent behavior is past violent behavior. If an individual has a history of such behavior, she/he is more likely than someone with no history to engage in it again. If you have no prior information, it is necessary for you to be attentive to current behavior.
Frequently, assaultive behavior is predicted on the basis of observing hostile, suspicious, and agitated behavior. In the absence of the above symptoms, the presence of hyper-vigilance (i.e. looking around a lot), extreme dependency, or delusions and hallucinations may be causal factors. Other signs and symptoms that may indicate a loss of control are fearfulness or anger. Verbal communication may be loud and pressured.
Note: While the information below is focused on middle and high school students, much of the information can still be applicable to the college-age student.
Characteristics of Youth Who Have Caused School-Related Violent Deaths
The National School Safety Center offers the following checklist derived from tracking school-associated violent deaths in the United States from July 1992 to the present. After studying common characteristics of youngsters who have caused such deaths, NSSC has identified the following behaviors, which could indicate a youth’s potential for harming him/herself or others.
Accounts of these tragic incidents repeatedly indicate that in most cases, a troubled youth has demonstrated or has talked to others about problems with bullying and feelings of isolation, anger, depression and frustration. While there is no foolproof system for identifying potentially dangerous students who may harm themselves and/or others, this checklist provides a starting point.
These characteristics should serve to alert faculty, staff, and friends to address needs of troubled students through referrals to the Behavioral Intervention Team (BIT). Further, such behavior should also provide an early warning signal that safe school plans and crisis prevention/intervention procedures must be in place to protect the health and safety of all school students and staff members so that schools remain safe havens for learning.
- Has a history of tantrums and uncontrollable angry outbursts.
- Characteristically resorts to name calling, cursing or abusive language.
- Habitually makes violent threats when angry.
- Has previously brought a weapon to school.
- Has a background of serious disciplinary problems at school and in the community.
- Has a background of drug, alcohol or other substance abuse or dependency.
- Is on the fringe of his/her peer group with few or no close friends.
- Is preoccupied with weapons, explosives or other incendiary devices.
- Has previously been truant, suspended or expelled from school.
- Displays cruelty to animals.
- Has little or no supervision and support from parents or a caring adult.
- Has witnessed or been a victim of abuse or neglect in the home.
- Has been bullied and/or bullies or intimidates peers or younger children.
- Tends to blame others for difficulties and problems s/he causes her/himself.
- Consistently prefers TV shows, movies or music expressing violent themes and acts.
- Prefers reading materials dealing with violent themes, rituals and abuse.
- Reflects anger, frustration and the dark side of life in school essays or writing projects.
- Is involved with a gang or an antisocial group on the fringe of peer acceptance.
- Is often depressed and/or has significant mood swings.
- Has threatened or attempted suicide.
Developed by the National School Safety Center © 1998
PERMISSION TO REPRINT FOR PROFESSIONAL PURPOSE AS LONG AS CREDIT IS GIVEN TO NSSC.
While one or a few of these indicators does not necessarily identify or predict violent behavior, it is important to recognize high-risk factors which correspond to potentially violent students and a referral made to the BIT so the behavior can be evaluated and action taken, if deemed necessary.
Violent Drawings or Writings
Violent students often indicate their intentions before acting violently via drawings or writings. Violent poems, letters to friends, or letters to the intended victim are clear indications of violent potential. Hence, further assessment is warranted whenever a student uses age inappropriate violent drawings or writings. However, an overrepresentation of violence in writings and drawings that is directed at specific individuals (family members, peers, other adults) consistently over time may signal emotional problems and the potential for violence (Berman & Jobes, 1991). Because there is a real danger in misdiagnosing such a sign, it is important to seek the guidance of a qualified professional – such as a school psychologist, counselor, or other mental health specialist – to determine its meaning.
Threats of Violence Toward Others
Any threat of violence toward others should be immediately assessed and appropriate intervention actions should be taken to insure safety. Direct threats such as, “I’m going to kill him” as well as veiled threats such as, “Something big is going to happen to you after school” clearly are inappropriate and warrant immediate assessment and intervention. Threats should be assessed for: (a) lethality, (b) the degree to which a violent plan exists, and (c) the student’s ability to secure the indicated weapon or harm instrument (e.g., poison, automobile). Any threat indicated by a student which is realistic, well-planned, and highly lethal should be considered viable. Idle threats are a common response to frustration. Alternatively, one of the most reliable indicators that a youth is likely to commit a dangerous act toward self or others is a detailed and specific threat to use violence (Keller & Tapasak, 1997; Loeber, 1990). Recent incidents across the country clearly indicate that threats to commit violence against oneself or others should be taken very seriously. Steps must be taken to understand the nature of these threats and to prevent them from being carried out.
There exists a high correlation between students who torture animals and violence. Students who regularly torture animals or intentionally inflict harm upon animals should be assessed for violent ideation towards others.
Recent Relationship Break
Students who have recently experienced a relationship break (e.g., being jilted by a girlfriend or best friend) have an increased likelihood of being violent.
The vast majority of students who isolate themselves from peers or who appear friendless typically are not violent. However, one high-risk factor which has been strongly correlated with violent behaviors towards school peers is isolation. For this reason, students isolating themselves or reporting feelings of being isolated from others should be considered at greater risk.
Teased/Perception of Being Teased, Harassed, or “Picked On”
Violent students often have a hypersensitivity toward criticism. These students report perceptions of being teased, harassed or being picked on by those they were violent toward. Therefore, students indicating feelings that they are being teased, harassed, or “picked on” should be assessed to determine whether or not they either intend to harm or fantasize about harming others.
Everyone gets angry; anger is a natural emotion. However, anger that is expressed frequently and intensely in response to minor irritants may signal potential violent behavior toward self or others (Rothbart, Posner, & Hershey, 1995; Walker et al., 1995).
Being a Victim of Violence
Children who are victims of violence, including physical or sexual abuse, in the community, at school, or at home are sometimes at risk themselves of becoming violent toward themselves or others (Browne & Finkelhor, 1986).
Withdrawal from peers and familial supports can indicate the student is experiencing any of a number of concerns (e.g., depression, helplessness) which warrant assessment and intervention. When combined with other risk factors, social withdrawal may signal potential violence toward others.
Inappropriate Use or Access to Firearms
Students who inappropriately use firearms by shooting at people, homes, or vehicles, or have improper, unsupervised firearm access have a clear potential to harm others and act violently. No student should be allowed to posses a gun or weapon on school property or at school-related functions (e.g., dances, sporting events, etc.). Given the general impulsiveness of students and the dangers of immediate access to lethal weapons, this factor is one of the most important which should be assessed.
Although substance abuse does not cause students to be violent, students under the influence of psychoactive substances often fail to think logically and experience increased impulsivity. Thus, there exists a strong correlation between substance abuse and violent behaviors. Familial Stressors: Familial stressors can engender feelings of frustration, anger, and hopelessness among students as well as adults.
Noted by Peers as Being “Different”
On many occasions after student violence, peers and others will note that the perpetrating student was labeled as being “different” from peers or being associated with some group. Hence, students frequently labeled by peers as being “weird”, “strange”, “geeky”, etc. may be at increased risk for violent behaviors.
Excessive Feelings of Rejection
In the process of growing up, and in the course of adolescent development, many young people experience emotionally painful rejection. Children who are troubled often are isolated from their mentally healthy peers. Their responses to rejection will depend on many background factors. Without support, they may be at risk of expressing their emotional distress in negative ways, including violence (Coie, Dodge, & Kupersmidt, 1990, Rubin, Hymel, Lemare, & Rowden, 1989). Some aggressive children who are rejected by non-aggressive peers seek out aggressive friends who, in turn, reinforce their violent tendencies.
Feelings of Being Picked On and Persecuted
The youth who feels constantly picked on, teased, bullied, singled out for ridicule, and humiliated at home or at school may initially withdraw socially (Saarni, 1990). If not given adequate support in addressing these feelings, some children may vent them in inappropriate ways, including possible aggression or violence (Floyd, 1985; Greenbaum, 1988).
Intolerance for Differences and Prejudicial Attitudes
Everyone has likes and dislikes. However, an intense prejudice toward others based on racial, ethnic, religious, language, gender, sexual orientation, ability, and physical appearance – when coupled with other factors – may lead to violent assaults against those who are perceived to be different (Prothrew-Stith, 1987). Membership in hate groups or the willingness to victimize individuals with disabilities or health problems also should be treated as early warning signs.
Low School Interest
The genesis of this risk factor could come from any of a multitude of reasons which by themselves may not evoke violent behaviors. However, in combination with other possible violence related risk factors noted within this scale, students presenting with low school interest may have an inability to perform as well as they desire to and may feel frustrated by such inability. Additionally, these students may perceive themselves as belittled by those performing more favorably. Thus, when challenged to increase performance or when feeling harassed by those performing at higher levels, these students may become violent. For these reasons, this factor has been included.
Reference: ERIC Identifier: ED435894
Publication Date: 1999-00-00
Author: Juhnke, Gerald A. – Charkow, Wendy B. – Jordan, Joe – Curtis, Russell C. – Liles, Robin G. – Gmutza, Brian M. – Adams, Jennifer R.
Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC.
Reference: Dwyer, K., Osher, D., Warger, C., Bear, G., Haynes, N., Knoff, H., Kingery, P., Sheras, P., Skiba, R., Skinner, L., & Stockton, B. (1998). Early warning, timely response: A guide to safe schools: The referenced edition. Washington, DC: American Institutes for Research.
ALCOHOL AND OTHER DRUG ABUSE
Alcohol abuse on college campuses is a serious problem and can even involve those who do not drink. If you are concerned about a person’s abuse of alcohol or other drugs, it is important to make a referral to the Behavioral Intervention Team so the problem can be evaluated and an appropriate intervention determined. Keep in mind that this may help the person you are concerned about be more successful in school, possibly stay in school or most importantly, stay alive.
Signs and Symptoms
Alcoholism, also known as alcohol dependence, is a disease that includes the following four symptoms:
- Craving: A strong need, or urge, to drink.
- Loss of control: Not being able to stop drinking once drinking has begun.
- Physical dependence: Withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety after stopping drinking.
- Tolerance: The need to drink greater amounts of alcohol to get “high.”
Warning Signals of Alcohol and Other Drug Abuse
There are many signs of alcohol and other drug use, abuse, and addiction. None of these signs alone are conclusive proof of alcohol or other drug problems. Other conditions could be responsible for unusual behavior, such as an illness or reaction to a legally prescribed drug. Any one or a combination of these could be cause for alarm and could signal problems in general, as well as a substance abuse problem:
- Impairment of Mental Alertness: Lack of concentration, short-term memory loss, confusion, and inability to follow directions.
- Impairment of Mood: Depression, extreme or unpredictable moods swing, flat or unresponsive behavior, hyperactivity, loss of interest in one’s work/school results, nervousness, and volatility.
- Impairment of Motor Behavior: Hand tremors, loss of balance, loss of coordination, staggering, inability to work normally, slurred speech, and passing out from alcohol or other drug use.
- Impairment of Interpersonal Relationships: Detachment from or drastic change in social relationships, becoming a loner or becoming secretive, attempt to avoid friends or co-workers, loss of interest in appearance, change of friends, extreme change in interests, tendency to lose temper, being argumentative, or borrowing money and not repaying.
- Violation of University Rules, Impairment of Academic and Work Performance: Inability to perform work assignments at usual level of competence; missed deadlines; missed appointments, classes, or meetings; increased absenteeism or lateness; frequent trips from assigned or expected work area; accidents in the lab; complaining or feeling ill as an excuse for poor performance; coming to class, practice, or work intoxicated/high; legal or judicial problems associated with alcohol or other drug use; not scheduling morning classes, neglected school or work obligations for two or more days in a row. (Some individuals with substance abuse problems are still able to perform at a high academic level.)
Student may not actually be “under the influence” during class, but be using at night or on the weekends.
THE STUDENT IN POOR CONTACT WITH REALITY
Signs and Symptoms
These students have difficulty distinguishing “fantasy” from reality. Their thinking is typically illogical, confused, or irrational (e.g., speech patterns that jump from one topic to another with no meaningful connection); their emotional responses may be incongruent or inappropriate and their behavior may be bizarre and disturbing.
The student may experience hallucinations, often auditory, and may report hearing voices (e.g., someone is/will harm or control them). While this student may elicit alarm or fear from others, they generally are not dangerous or violent. However, there are some situations in which they can become violent (e.g., experiencing “command” hallucinations). These hallucinations are telling them what to do, such as “you must destroy that evil person.”
The student may also be experiencing delusions—false ideas about what is taking place or who one is. A delusion is a belief that is clearly false and that indicates an abnormality in the affected person’s content of thought. The false belief is not accounted for by the person’s cultural or religious background or his or her level of intelligence. The key feature of a delusion is the degree to which the person is convinced that the belief is true. A person with a delusion will hold firmly to the belief regardless of evidence to the contrary. Delusions can be difficult to distinguish from overvalued ideas, which are unreasonable ideas that a person holds, but the affected person has at least some level of doubt as to its truthfulness. A person with a delusion is absolutely convinced that the delusion is real.
If you cannot make sense of their conversation, it is important to report your observations and concerns to the Behavioral Intervention Team so the problem can be evaluated and addressed.