February 28, 2012 — In the wake of the tragedy at a high school in Chardon, Ohio, a multitude of questions remain, including whether bullying and domestic violence were 2 of the main triggers that caused a teenage boy to embark on a shooting rampage.
According to eyewitness accounts, a 17-year-old boy took out a gun in the school's cafeteria yesterday morning and without speaking began shooting his peers. By the time the rampage was over, 5 teenagers were seriously injured, including 3 who have now died. Of the other gunshot victims, 1 is currently in serious condition and the other is listed as "stable."

Chardon High School, site of a recent shooting. REUTERS/Ron Kuntz
ABC News reported that the suspected shooter told police after his capture that he was the victim of bullying. According to other news reports and students at the high school, he was also described as an "outsider and outcast," although he had "some friends." He also reportedly had a rocky home life.
Although classmates offered differing opinions to reporters about whether the suspected shooter was a victim of school bullying, the general consensus was that the boy was relatively isolated in the community.
"Bullying isn't simple name calling. It's more intense, more severe, and more protracted. And the victim feels more and more isolated and hopeless," adolescent and adult psychiatrist John Sharp, MD, from Harvard Medical School in Boston, Massachusetts, told Medscape Medical News.
"Sometimes, there's a desire there to turn the tables and to, in fact, become the aggressor. And it happens when everything piling up just feels like it's too much."
Psychosis Not Common
Dr. Sharp added that a violent incident does not usually occur because someone "snapped" but is actually an event that is planned, as appeared to be the case in the Chardon shootings.
"This person came in with a loaded gun and, with intention, committed this terrible crime. Obviously this was something he had thought about and planned in advance," said Dr. Sharp. He added that psychosis is not usually part of the equation.
"In surveys, it's been shown that someone who snaps is psychotic about 15% to 20% of the time. That's a lot, but the majority of the time, it's not psychosis. It's just a state of desperation," said Dr. Sharp.
We all have our limits…[and there's] only so much that we can take. When something becomes intolerable, the only way to move on productively is to successfully reach out for help.
"We all have our limits, [and there's] only so much that we can take. At that point, when something becomes intolerable, the only way to move on productively is to successfully reach out for help."
According to an article published in 2011 in Morbidity and Mortality Weekly Report (MMWR), from the Centers for Disease Control and Prevention, and reported at the time by Medscape Medical News, 15.6% of high school students have been victims of bullying, and 6.5% were both bullying victims and perpetrators.
The same report showed that victims of bullying were 3 times more likely to report being physically hurt by a family member and witnessing family violence than students not involved in school bullying.
Domestic Violence
With a population of about 5400, the town of Chardon, which is just outside of Cleveland, was described yesterday as the type of community "where everyone knows everyone else."
Reportedly, the suspected shooter would catch a bus from Chardon High School to another school that specializes in at-risk kids. He was also living with his grandmother; his father reportedly had a history of violence against women, including violence against the shooter's mother, according to the Cleveland newspaper The Plain Dealer .
In addition, CNN reports that both the boy's mother and father had been arrested for domestic violence in the past.
Although it may seem that these types of events are occurring more and more often, they are actually still relatively rare, said Dr. Sharp.
Such events leave people searching for easy answers so that they can be prevented in the future. Unfortunately, there are no easy answers.
Nevertheless, notes Robert Findling, MD, director of the Division of Child and Adolescent Psychiatry at University Hospital Case Medical Center and professor of psychiatry and pediatrics at Case Western Reserve University in Cleveland, Ohio, such events leave people searching for "easy answers so that they can be prevented in the future. Unfortunately, there are no easy answers."
"One cannot definitively identify where and when such things can occur. That's the bad news. The good news is, one, the seriousness of bullying is now better recognized, and two, these catastrophes are newsworthy because they remain uncommon. "
Ominous Signs
Why do some victims of bullying and violence turn their frustrations inward, seeking solace through alcohol or other substances or attempt/commit suicide, whereas others project outward?

Officials and investigators confer outside of Chardon High School. REUTERS/Ron Kuntz
"This is a vital question, the answer to which is unknown," answered Dr. Findling.
Echoing Dr. Sharp, he added that most teenage victims of bullies do not seem to be psychotic.
"It should be pointed out that psychotic disorders are conditions in which a teenager’s perceptions and thought processes are affected. Fortunately, most youngsters with psychotic illnesses, like schizophrenia, are not violent," said Dr. Findling.
Dr. Sharp noted that an important protective barrier against these types of tragedies is supportive primary relationships with at least 1 parent-like figure. "That can really make all the difference," he said.
In addition, he noted that social media can also often provide clues or warnings about potentially dangerous behaviors. In this case, the suspected shooter supposedly uploaded photos on Facebook of himself with guns and in December posted a poem that included the phrases, "now feel death not just mocking you...feel small beneath my might." The poem ended with, "Die, all of you."
"That's pretty dark," said Dr. Sharp. "A lot of times, we see people writing dark things, and it doesn't necessarily mean they're going to become violent. But is this something new? Are these behaviors changing and getting darker and darker? Maybe that's a clue to a process that's going on."
He reported that some of his colleagues are starting to advocate for a system that can monitor social media for these types of "warning clues" by minors.
"Maybe it's protective to try to consider some sort of intervention. Maybe some sort of outreach after the social media postings could have made a difference in Chardon. I don't know."
However, he noted that no single sign necessarily means an adolescent will do something dangerous.
"You can't just point to a person becoming more introverted or suddenly wearing black or can't account for their time. I think the people who can tell what are and are not warning signs are therapists who work with this population, [plus] coaches, teachers — people who are around these situations every day," said Dr. Sharp.
The problem is that people who are getting bullied and feeling desperate and maybe preparing to either withdraw or explode have changes that can be subtle. So it can take a little while to notice these sometimes small changes over time.
"The problem is that people who are getting bullied and feeling desperate and maybe preparing to either withdraw or explode have changes that can be subtle. So it can take a little while to notice these sometimes small changes over time."
Important Questions
Dr. Sharp also recommended that clinicians who treat children and adolescents should always ask whether they are being bullied.
"Ask open-ended questions and really explore what's going on with these kids at each visit and then pay attention to the changes that are occurring," he said.
Examples of questions to ask a child who reports being bullied include the following:
How do the kids who are doing the bullying act?
How do you react to the situation?
How do you make yourself feel better afterwards?
How long does it take to get into a better mood?
What happens when you go home?
Do you tell your parents about what is going on?
If so, what do they do that makes things better or worse for you?
What are you writing about?
How do other kids react to you?
"You ask all these questions of a specific nature to try to make it easier for an adolescent who has a private life to try to share that with you," said Dr. Sharp.
Bullying Is Serious
Dr. Findling noted that there are currently no definitive methods to stop bullying, although several models have been studied.
The seriousness of bullying is now better appreciated than in the past. It is with that knowledge that definitive prevention methods might be developed in the future.
"That is the bad news. The good news is that bullying is now not just written off as something that is not important. The seriousness of bullying is now better appreciated than in the past. It is with that knowledge that definitive prevention methods might be developed in the future," he said.
"It is important to note that such programs are likely to need tailoring to suit the age of the child, the setting in which the bullying might take place, and the severity of the bullying that might be occurring. So, one size is not likely to fit all."
After a violent incident, such as a shooting, has occurred, children and adolescents in the affected community should be closely monitored by their parents, and they should be aware that counseling is available if they want to talk about their experiences.
"Acknowledgement is good, as is providing stability. Chardon is shutting down the schools for a bit, but you want them to reopen soon and normalize things in a way that acknowledges what happened," said Dr. Sharp.
"For clinicians treating this population, it's important to elicit what their biggest concerns are and then address that. Partnership, empathy, respect for what someone has gone through, and legitimization are all part of the bedrock of treatment here."
Medscape Medical News © 2012 WebMD, LLC
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Cite this: Chardon Shooting: Was Bullying a Factor? - Medscape - Feb 28, 2012.
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