Heya! I had a similar diagnosis back in the day (later "upgraded" to schizophrenia) - back when I cared what psychiatrists said to me.
I'm more familiar with the extremely strong compulsions to harm myself than the paranoia - and I have (and do on occasion) act on them. I don't know, for me sometimes it's the fastest way "out" to act on them, though mine never get as violent as yours sound. I had a therapist for a while who made me act out all my destructive obsessions on children's toys, which helped a lot. I eviscerated a lot of dolls and teddies, though :-/