The spread of endemic school violence in the United States from urban black, Hispanic, and other minority areas to white suburbia and smaller communities has alarmed the nation. Contrary to common belief, the incidence of school violence has been fairly stable except in the areas of violence against females and gang membership. The culture of violence and easy availability of guns is a major contributing factor. The relationship between school violence, suicidality and psychiatric disorders, specifically depressive disorders, conduct disorder, and alcohol and drug abuse are discussed within the framework of the psychological autopsy of suicide in children and adolescents. There are striking similarities between acts of school violence and suicidality. Specific guidelines are provided regarding clinical assessment of potentially violent youth with emphasis on exploration of attachment behavior in various developmental stages.