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Understand the etiology of workplace violence

August 31, 2015
by H. Steven Moffic, MD
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On August 26, the worst kind of workplace violence took place: the murder of two employees of station WDBJ-TV in Roanoke, Va., by a former co-worker.

Our own mental healthcare workplaces are not immune to murder, either, even if we are experts in mental disorders. Though also rare, psychiatrists and other staff have been murdered at our workplaces. Moreover, despite our general expertise, we are not good at predicting future violence.

In some way, this is the tip of the workplace dissatisfaction iceberg. Workplace violence can range from these rare murders to harassment and inappropriate blaming.

These concerns should lead us to try to understand the etiology of these workplace problems so that they can possibly be prevented. Much of the initial attention after these murders is naturally to try to understand the perpetrator.

The perpetrator

Allowing for our limited knowledge of him, and the ethical admonition to not to try to diagnose someone you do not personally examine (the "Goldwater Rule"), several aspects of his life do stand out. His long history of intermittent anger, aggression and inappropriate blame of others suggests some paranoid personality traits. His prior boasting and need to film his killings, with a camera in one hand and a gun in the other, is consistent with some pathological narcissism. As if that combination wouldn't be lethal enough in itself, add some likely PTSD due to the event in which he was fired and escorted out that same station over two years ago. On top of that humiliation, triggers of that trauma were likely rekindled over and over by living right across the street from the news station.

The named perpetrator apparently had very little treatment. Personality traits and/or disorders are notoriously hard to treat and are best caught early. Perhaps annual mental health check-ups over one's lifetime can help.

When considering how severe they may have become in his case, perhaps less stringent regulations against involuntary hospitalization are necessary. Why wait until some actual violent behavior occurs that is coupled with mental illness before involuntary outpatient or inpatient treatment can be established?

Thankfully, individuals like this perpetrator are very rare. Nevertheless, his history should stimulate us to prepare for lesser risks.

Confidentiality laws make it difficult to screen our would-be employees effectively. That was reflected in the continued employment of the perpetrator even after he had trouble in multiple workplaces. Without obtaining relevant information from prior jobs, using a group perspective, as well as psychological tests, can help reveal any red flags.

Perhaps the fact that our employees are in the behavioral health field to do good things makes them less risky. However, if we in our profession believe we tend to be less physically aggressive, we still can be psychologically aggressive and take revenge through various verbal means.

Our added risk is that every day we’re seeing patients who can potentially be dangerous. We have the right and need to decide which sort of patients may be too risky for our settings and not treat them.

Safety rules

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...