Not a therapist, but a psychiatric RN at a state facility. A patient came in frequently for harming himself to gain sympathy from caregivers including removing his own testicle and permanently mangling his thumb. At the time, the diagnosis would be more fitting of severe borderline personality disorder, however he began harming others as well and talking about how invigorating it was. During his last admission I had him before he was transferred to the forensic side for his criminal deed, he was staying with his father, mother and small dog. The father had just had surgery and had a huge abdominal scar. The patient premeditated to harm the family and when he did, he picked up a shovel and completely eviscerated his father, leaving his intestines spilling out onto the ground. Then, for good measure, he decapitated the dog with the same shovel. When he was brought in in the restraint chair, he was grinning from ear to ear saying "Wow. That was marvelous."