Descriptions of High Risk Behaviors

• Depression
• Suicidal Behavior
• Parasuicidal Behavior and Self-Mutilation
• Mania
• 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

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.

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. 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.

Symptoms

• 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

Additional Information

THE MANIC STUDENT

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.

Symptoms

• 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.

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

Additional Information

THE SUICIDAL STUDENT

• 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 by a student who is threatening suicide, call 911 to report the emergency. Then report the incident to the Behavioral Intervention Team for follow-up.

Warning Signs of Suicide

• Observable signs of serious depression
  • Unrelenting low mood
  • Pessimism
  • Hopelessness
  • Desperation
  • Anxiety, psychic pain and inner tension
  • Withdrawal
  • 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.

Additional Information

PARASUICIDAL BEHAVIOR AND SELF-MUTILATION

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.

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.

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.

EATING DISORDERS: ANOREXIA NERVOSA, BINGE EATING, AND BULIMIA

ANOREXIA NERVOSA

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.

Warning Signs

• 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

Source: www.nationaleatingdisorders.org/anorexia-nervosa.

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

Health Consequences

• High blood pressure
• High cholesterol levels
• Heart disease
• Diabetes mellitus
• Gallbladder disease

Source: www.nationaleatingdisorders.org/binge-eating-disorder.

BULIMIA NERVOSA

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.

Warning Signs

• 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.

Source: http://www.nationaleatingdisorders.org/bulimia-nervosa

VIOLENCE AND THE VERBALLY AGGRESSIVE STUDENT

Signs

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

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).

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.

Animal Torturing
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.

Isolation
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.

Social Withdrawal
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.

Substance Abuse
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.

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.

Signs and 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.

Additional Information