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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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