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When someone commits suicide,
it is a tragedy. When we are losing more soldiers
to suicide than the Afghanistan war, it is an
epidemic. In June of 2010, there were over 32
confirmed or suspected suicides among soldiers.
Studies confirm that individuals in the military
are at higher risk than the general population
due to the conditions in which they are exposed.
Wartime pressures are at a high, and soldiers
are coming back from combat showing signs of
psychiatric illnesses and addictions. These
risk factors provide a cocktail conducive to
thoughts of suicide. It is time to take a closer
look at them.
This article
is about prevention. It will detail some of
the warning signs soldiers' exhibit prior to
a suicide attempt and will discuss preventive
measures. This article is for everyone as it
has been estimated that 65% (PTSD Research Quarterly)
of the general population know someone who has
died by suicide. Military efforts to reduce
risk have been improved and new programs are
being created. Suicide prevention rides on the
shoulders not only of the government, but reaches
to other soldiers as well as civilians. It is
imperative that we are armed with awareness
and prevention.
Disorders
Commonly Found Among Suicidal Soldiers
The military
has identified Post Traumatic Stress disorder,
other mental illnesses and addiction as a predictor
of risk for suicide. Knowledge of these disorders
will equip individuals to identify when someone
is at risk and provide the support they need.
The following disorders are commonplace among
soldiers who commit suicide. They will be explained
in detail as to some of the signs and symptoms.
Please note that meeting the following criteria
does not necessarily mean that someone is suicidal.
These are simply red flag disorders associated
with thoughts of self-harm. This is not an exhaustive
list of predictors and soldiers may exhibit
other behaviors that signal concern.
Post
Traumatic Stress Disorder
Post Traumatic
Stress Disorder (PTSD) may result from exposure
to a traumatic event. It is the bodies and the
mind's way of responding to an overwhelming
situation involving fear and, often seen in
soldiers, the threat or witnessing of death.
PTSD
is characterized by three clusters of symptoms:
intrusive, arousal, and avoidance. All three
of these need not be present to be concerned
about the possibility of suicide among a soldier.
• Intrusive
Symptoms: These are symptoms that literally
intrude a soldier's life. They are thoughts
and feelings associated with combat that come
"out of the blue." Intrusive symptoms
may come in the form of nightmares, flashbacks,
or negative reactions to anything associated
with combat or the military in general.
• Arousal
Symptoms: When someone is experiencing
intrusive symptoms, their anxiety will begin
to peak. This is a result of not knowing when
the individual will experience the next intrusive
symptom. This response mirrors the "fight"
response to a stimuli. An example of an arousal
symptom is an exaggerated startle response commonly
known as being "jumpy" or "watchful
waiting." The soldier may feel "on
edge" all the time as if something is going
to harm him or her. These symptoms may manifest
themselves in irritability or explosiveness.
• Avoidance
Symptoms: It is normal to want to avoid
something that is painful. Intrusive and arousal
symptoms are painful enough to where the soldier
may make every attempt to avoid the pain associated
with them. This is the "flight" response.
Avoidance symptoms include not wanting to talk
about the combat or military experience, not
remembering key events, "checking out"
when reminders of the trauma are presented,
or engaging in drug and alcohol use.
Depression
Depression
is common in individuals who have thoughts of
suicide. It is important to note that there
is a normal depression that comes along with
having a traumatic event in the past. This does
not necessarily mean that it will lead to suicide.
Some symptoms
of depression include:
• Feelings
of helplessness and hopelessness - feeling as
if nothing will get better and there is nothing
that one can do to better the situation
• Loss in interest in daily activities
• Loss of ability to experience joy and
pleasure
• Appetite or weight changes - either
losing or gaining a significant amount of weight
• Irritability and restlessness - tolerance
level of stress is low
• Loss of energy - feeling fatigued or
physically drained
• Low feelings of self worth or excessive
guilt
• Concentration problems
• Changes in sleep pattern - either sleeping
significantly more or less than normal
Anxiety
Anxiety can
be described as a constant state of hypervigilance.
It is constantly feeling as if something bad
is about to happen. Anxiety can manifest itself
both mentally and physically. Symptoms of anxiety
vary from person to person. Some individuals
may feel more panic at certain times, while
others may feel nervous about everything no
matter what the significance.
Symptoms of
anxiety include:
• Feelings
of panic or fear
• Feeling uneasy most of the time
• Obsessive thoughts
• Negative thoughts about the future
• Ritualistic behavior such as checking
doors or washing hands
• Problems sleeping
• Sweaty or tingling hands
• Shortness of breath
• Heart palpitations
• Muscle tension
• Inability to stay calm
• Explosiveness
Addictions
At times, addiction
may accompany a history of trauma or the disorders
described above. A simple description of addiction
is continued use despite consequences associated
with the use of a substance. To illustrate,
if a soldier continues to have problematic behavior
(i.e. aggressiveness or increased depression)
when using alcohol yet continues to use it,
abuse issues may be present.
Symptoms of
addiction include:
• Marked
increase in tolerance to the substance (i.e.
are able to use considerably more than they
were able to in the past)
• Withdrawal
symptoms
• Difficulty
cutting down or controlling use of substance
• Increased
time and energy spent on obtaining and using
the substance
•Social
and occupational roles may be compromised by
substance use (i.e. missing work due to a hangover)
• Negative
consequences associated with use of substances
• Desire
to cut down coupled with unsuccessful attempts
Warning
Signs
Following is
a list of warning signs a soldier may exhibit
when he or she has suicidal thoughts or plans.
It is important, when assessing the situation,
that there is open communication with the soldier
as well as those around him. It would be helpful
to identify some of these issues from speaking
directly to the soldier. Other times, a discussion
with a loved one may be an avenue to evaluate
the signs and discuss the level of concern.
If there are signs, a trained professional may
be able to help. Please refer to the references
listed below.
1. Disorder
listed above
2. Threatening to kill themselves
3. Talking about death or being "passively
suicidal"
4. Feeling like there is no reason to live
5. Rage or uncontrolled anger - wanting to seek
revenge
6. Engaging in high risk activities
7. Abusing drugs or alcohol
8. Withdrawing from friends and family
9. Dramatic mood changes - impulsivity or poor
self-control
10. Irrational thinking or paranoia
11. Sleeping too much or too little
12. Giving away possessions
13. Recent losses - physical, financial, or
personal
14. Family history of suicide
15. History of abuse - physical, sexual, or
emotional
16. Having feelings of being trapped, hopelessness,
despair, shame, humiliation, disgrace or anger
17. Making arrangements "just in case"
they passed away
Reasons
Soldiers may Deny the Presence of Suicidal Thoughts
Lines of communication
regarding suicide should be open. In speaking
with the soldier directly, one opens him or
herself up as someone who is knowledgeable and
can be helpful. However, there are times that
the above references signs may be present and
the soldier may deny them. Here are a few reasons
why soldiers deny any suicidal thoughts or plans.
1. The belief
of a stigma that goes along with mental illness
or suicidal thoughts. Many soldiers believe
that, if they discuss these thoughts, they may
be labeled as "crazy" or "unstable."
2. Fear of
being judged for being "weak." Soldiers
are taught to continue fighting despite pain.
They believe that if they ask for help, it means
that they are not able to handle it on their
own.
3. Soldiers
may feel also fear that the person they tell
may "over react" and hospitalize the
soldier. If hospitalized for psychiatric disturbance,
there may be consequences unknown to them or
they may fear being discharged from the service.
Veteran
Specific Risks
The following
are some risk factors specific to veterans.
Remember that being in combat, dealing with
death, or simply having to live two lives (that
of a soldier and that of a civilian) is enough
to necessitate a screening for suicidal thoughts.
The following are specific risks for suicidal
thoughts or behaviors:
1. Frequency
and lengths of deployments
2. Deployment to hostile environments
3. Exposure to extreme stress
4. Physical or sexual assault while in the military
5. Service related injuries
6. Being a sexual minority
Factors
that may Decrease the Risk of Suicide
There are several
factors that serve to protect an individual
from having thoughts of suicide. The protective
factors listed below should be fostered in any
soldier whether they are on leave or discharged.
1. Positive
social support
2. Spirituality
3. Sense of responsibility to family
4. Children in the home
5. Pregnancy
6. Life satisfaction
7. Positive coping skills
8. Positive problem-solving skills
9. Counseling
How
to Help
Some soldiers
may exhibit outward signs of suicidality such
as the characteristics and signs described above.
Others may suffer more silently. Neither of
these are beyond help. Opening up a dialogue
about thoughts of self-harm is imperative. It
is important that the soldier get back to a
state where he or she again feels safe and secure.
It is strongly encouraged that, if there is
cause for concern, one must not only engage
in some of the strategies below but enlist the
assistance of a trained clinician.
1. Ask,
ask, ask - The topic of suicide does not
generally flow into normal conversation. If
the soldier has any of the following warnings,
it is important to ask whether he or she has
any thoughts to harm himself or herself. It
is important to note that they may not be entirely
truthful about his or her thoughts or feelings.
The soldier may be trying to reconcile his or
her death but not want to tell anyone. It is
important to watch for the warning signs and
intervene when appropriate. Remember, asking
will not harm anything.
Some questions
to ask are:
a. Some individuals
experiencing the same situation as you have
had thoughts of harming themselves or committing
suicide. Do you have any of these thoughts?
b. Are you
feeling hopeless about the future or even the
present?
c. Do you feel
trapped?
d. Have you
ever thought of taking your own life or had
a suicide attempt?
2. Be willing
to listen - allow them to express their feelings
without interpretation or judgment. Remember
that it is reasonable to ask specific question
about particular feelings (i.e. are you feeling
hopeless).
3. Validate
the soldier's feelings. Don't give a lecture
on the values of life. Be prepared to listen
and provide support.
4. Be available
to them. Show interest and understanding. It
is important that they know that there is care
and support out there.
5. Offer hope
that there are alternatives available.
6. Take action
in removing firearms, pills, and anything else
that can be lethal.
7. Do not act
shocked or ask why. Be careful not to have a
negative reaction to their feelings or thoughts.
8.Get professional
help. It is important to ask a trained counselor
to intervene. Professional support is necessary
when dealing with suicidal thoughts. Do not
agree to keep it a secret. Encourage them to
attend counseling or reach out to their support
system. If the soldier is referred to counseling,
it would be helpful to have someone go with
him or her. Be a resource that is active in
his or her recovery. Offer to go with the soldier
to appointments and follow up.
A Word
for Caregivers
Caring for
others can be a wonderful and rewarding experience.
At the same time, it can be stressful. Caregiver
burnout, also known as compassion fatigue, happens
when individuals focus on others at the expense
of their own self-care. It is important to note
that anything that has to do with combat or
the military experience can be stressful both
for the soldier and those who love and care
for him or her.
Some signs
of compassion fatigue can mirror what some soldiers
go through when they return from service. Symptoms
of PTSD, depression, anxiety, and addiction
can all be manifestations of compassion fatigue.
It is important that care givers take care of
their own emotional well being in addition to
being there for others.
Counseling
for caregivers may prove to be beneficial not
only to the caregiver, but to the soldier. If
the caregiver is better equipped with knowledge
and adequate self-care, he or she is apt to
provide more supportive care. Dr. Frank Ochberg,
the Founder of Gift from Within has written
an excellent article for partners of patients
with PTSD. His article can be found at http://www.giftfromwithin.org/html/partners.html
Conclusion
Suicide is
a serious and very real problem with individuals
returning from service. The military has been
responding to this epidemic but the responsibility
also rests on the shoulders of those who love
and care for soldiers. Signs and symptoms of
suicidality need to be taken seriously and protective
measures need to be taken. Please try and learn
all you can about suicide prevention, PTSD,
depression, anxiety, and addiction. There are
also trained professionals in this area. Below
are some of the resources available on the internet.
Through opening
up a dialogue about this serious topic, soldiers
will be provided with the understanding and
care that they need. Military personnel continue
to serve this country on a daily basis. It is
imperative that we serve them as well.
Amy Menna has
a Ph.D. in Counselor Education and Supervision.
She is a Licensed Mental Health Counselor, and
Certified Addictions Professional. She is in
private practice and lives in Tampa, Florida.
Resources
Post Traumatic
Stress Disorder
•National
Institute for Mental Health - http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
• National Center for PTSD - http://www.ptsd.va.gov/
• Information and Links for PTSD - http://www.ptsdinfo.org/
• DVD: PTSD & Veterans: A Conversation
with Dr. Frank Ochberg
PTSD and the
Military
• Military
Pathways - https://www.militarymentalhealth.org/Welcome.aspx
• PTSD Resources - http://giftfromwithin.org/html/military-family-resources.html
• Veterans and PTSD: http://giftfromwithin.org/html/veterans-and-ptsd.html
Depression
• Depression
and the Military - http://www.militarymentalhealth.org/resources/what-military-families-should-know-about-depression.aspx
• Courage to Care - What Military Families
Should Know About Depression - http://www.centerforthestudyoftraumaticstress.org/csts_items/CTC_depression_family_sheet.pdf
Anxiety
• National
Institute for Mental Health - Anxiety Disorders
- http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml
• Anxiety Disorders Association of America
- http://www.adaa.org/
Addictions
• National
Institute on Drug Abuse - http://www.nida.nih.gov/NIDAHome.html
• Substance Abuse Mental Health Services
Administration - http://www.samhsa.gov/
• National Institute on Drug Abuse - http://www.nida.nih.gov/NIDAHome.html
• Substance Abuse Mental Health Services
Administration - http://www.samhsa.gov/
• Trauma Addiction: Safety and Stabilization
for the Addicted Survivor of Trauma Dr. Eric
Gentry
©
Dr. Amy Menna & Gift From Within 2011 -
http://www.giftfromwithin.org/
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