When someone commits suicide, it’s a tragedy. When we are losing more soldiers to suicide than to the Afghanistan war, it’s a tragic epidemic.
In June of 2010, there were more than 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 situations to which they are exposed. Wartime pressures are high, and soldiers come back from combat showing signs of psychiatric illnesses and addictions. These factors can combine into a powerful cocktail that triggers thoughts of suicide. It’s 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. Yet this article is for everyone; it has been estimated that 65% (PTSD Research Quarterly) of the general population knows someone who has committed suicide.
Military efforts to reduce risk have improved and new programs are being created. But although suicide prevention rides on the shoulders of the government, it depends on other soldiers and civilians as well. It is imperative that we are armed with awareness and effective prevention measures.
Disorders Commonly Found Among Suicidal Soldiers
The military has identified Post Traumatic Stress Disorder (PTSD), other mental illnesses, and addiction as suicide risk factors. Understanding conditions like these can help individuals ascertain that someone is at risk and provide the support they need.
The following disorders are commonplace among soldiers who commit suicide. Some of the signs and symptoms will be explained in detail. Please note that when someone meets the following criteria, it does not necessarily mean they are suicidal. These are simply red flag disorders often associated with thoughts of self-harm. This is also not an exhaustive list of predictors; 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 body’s and the mind’s way of responding to an overwhelming situation involving fear. And, as often the case for soldiers, the threat of, or contact with, death.
PTSD is characterized by clusters of three kinds 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 in 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 results from not knowing when the next intrusive symptom will occur. This response mirrors the “fight” response to a stimulus. An example of an arousal symptom is an exaggerated startle response commonly referred to as “jumpiness” 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. If intrusive and arousal symptoms are painful enough, 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 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 improve 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 – low tolerance for stress
- Loss of energy – feeling fatigued or physically drained
- Feelings of low self worth or excessive guilt
- Concentration problems
- Changes in sleep pattern – either sleeping significantly more or less than normal
Anxiety can be described as a continuing state of hyper-vigilance. 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 acute 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
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 often exhibits problematic behavior (like aggressiveness or increased depression) when using alcohol yet continues to drink, abuse issues may be present.
Symptoms of addiction include:
- Marked increase in tolerance to the substance
- Withdrawal symptoms
- Difficulty cutting down or controlling use of substance
- Increased time and energy spent on obtaining and using the substance
- Compromised social and occupational roles (such as missing work due to a hangover)
- Negative consequences associated with use of substances
- Desire to cut down coupled with unsuccessful attempts
Dealing with Suicidal Thoughts
When assessing whether a soldier may be suicidal, it’s best if there’s open communication between the soldier and those around him. It’s very helpful to identify some of the 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.
The following is a list of warning signs a soldier may exhibit when he or she has suicidal thoughts or plans.
- One or more of the disorders discussed above
- Threatening to kill themself
- Talking about death or being “passively suicidal”
- Feeling like there is no reason to live
- Rage or uncontrolled anger – wanting to seek revenge
- Engaging in high risk activities
- Abusing drugs or alcohol
- Withdrawing from friends and family
- Dramatic mood changes – impulsiveness or poor self-control
- Irrational thinking or paranoia
- Sleeping too much or too little
- Giving away possessions
- Recent losses – physical, financial, or personal
- Family history of suicide
- History of abuse – physical, sexual, or emotional
- Feelings of being trapped, hopelessness, despair, shame, humiliation, disgrace or anger
- Making arrangements “just in case” they pass away
Soldiers May Deny the Presence of Suicidal Thoughts
In the best case, lines of communication regarding suicide should be open. In speaking with the soldier directly, a friend or loved one can identify himself or herself up as someone who is knowledgeable and can be helpful. However, there are times that soldiers may deny thoughts of suicide.
Here are a few reasons why this can happen.
- Soldiers may feel there’s stigma attached to having a mental disorder or suicidal thoughts. Many soldiers believe that, if they discuss these thoughts, they may be labeled as “crazy” or “unstable.”
- Soldiers do not want to be judged as being “weak.” They are taught to continue fighting despite pain. They believe that if they ask for help, it means that they are not able to handle challenges on their own.
- Soldiers may feel also fear that the person they confide in may “overreact” and hospitalize the soldier. If they are hospitalized for a psychiatric issue, there may be unknown consequences. They may even fear being discharged from the military.
The following are some risk factors specific to combat 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) can be reason enough to necessitate a screening for suicidal thoughts.
- Frequency and lengths of deployments
- Deployment to hostile environments
- Exposure to extreme stress
- Physical or sexual assault while in the military
- Service related injuries
- Being a sexual minority
Factors that May Decrease the Risk of Suicide
There are several factors that can serve to protect an individual from having thoughts of suicide. The protective factors listed below should be nurtured in any soldier whether they are currently deployed, on leave, or discharged.
- Positive social support
- Sense of responsibility to family
- Children in the home
- Life satisfaction
- Positive coping skills
- Positive problem-solving skills
How to Help a Soldier Who May be Suicidal
Some soldiers may exhibit outward signs of suicidal tendencies such as the characteristics and signs described above. Others may suffer more silently. Neither category is 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. If there is cause for concern, someone who wants to help should not only engage in some of the strategies below but enlist the assistance of a trained clinician as well.
Ask, ask, ask: The topic of suicide does not generally arise in casual conversation. If the soldier has any of the following warnings, it is important to ask whether he or she has any thoughts about harming himself or herself. Note that they may not be entirely truthful about his or her thoughts or feelings, they may working to reconcile his or her death without telling anyone. It is important to watch for the warning signs and intervene when appropriate.
Remember, asking questions like these will not hurt.
- Some individuals experiencing similar situations have had thoughts of harming themselves or committing suicide. Do you have any of these thoughts?
- Are you feeling hopeless about the future or even the present?
- Do you feel trapped?
- Have you ever thought of taking your own life attempted to?
Be willing to listen: Allow them to express their feelings without interpretation or judgment. Remember that it is reasonable to ask specific questions about particular feelings (such as, “Are you feeling hopeless?”).
Validate the soldier’s feelings: Don’t give a lecture on the values of life. Be prepared to listen and provide support.
Be available to them: Show interest and understanding. It’s vital that they know that there is care and support out there.
Offer hope: Remind the soldier that there are alternatives available.
Take action: Remove firearms, pills, and anything else that can be lethal.
Do not act shocked or ask why: Be careful not to have a negative reaction to their feelings or thoughts.
Get professional help: 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 an active resource 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.
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 caregivers 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. Find his article here.
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 suicidal tendencies need to be taken seriously and loved ones must take action.
If someone you care for is a soldier—or anyone else exposed to extreme stress—please try to learn all you can about suicide prevention, PTSD, depression, anxiety, and addiction. There are many trained professionals you can consult. Below are some of the resources available on the Internet.
Through opening up a dialogue about this serious topic, soldiers can be provided with the understanding and care 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.
- Psych Central’s PTSD Resources
- National Institute for Mental Health
- National Center for PTSD
- Military Pathways
- Military Family PTSD Resources
- Veterans and PTSD
- Depression and the Military
- Courage to Care – What Military Families Should Know About Depression (PDF)
This article Copyright © 2011 Dr. Amy Menna & Gift From Within. Reprinted here with permission.
Photo by US Army Africa, available under a Creative Commons attribution license.