Bipolar Disorder Resources

by Band Back Together | Aug 17, 2018

My recovery from manic depression has been an evolution, not a sudden miracle. – Patty Duke

What is Bipolar Disorder?

Bipolar Disorder is a mood disorder sometimes called manic-depressive illness or manic-depression, that characteristically involves cycles of depression and elation or mania. The moods can shift from high to low rapidly, or over the course of days or weeks with intervals of “normal” moods in between. These cycles are much more severe than the mood swings that everyone goes through.

Bipolar disorder often develops in the late teen or early adult years. It may be difficult to detect the onset of bipolar disorder, as the symptoms may appear to be separate problems, not pieces of a larger problem. Many people with bipolar disorder suffer for years before they are properly diagnosed.

People who have bipolar disorder experience distinct and intense emotional states called “mood episodes.” Mania is an overly joyful or excited mood, whereas a sad, hopeless state is a depressive episode. Sometimes, a mood episode contains symptoms of both mania and depression, which is called a “mixed state.”

These mood episodes bring extreme changes in energy, activity, sleep and behavior. The signs and symptoms of depressive and manic states are described in further detail below.

What Causes Bipolar Disorder?

Doctors aren’t entirely positive what causes bipolar disorder. We do know that bipolar disorder often runs in families – children with a parent or sibling with bipolar disorder are 4-6 times more likely to develop bipolar disorder. There’s growing evidence that  environmental and lifestyle choices may also have an effect on bipolar disorder.

The exact cause of bipolar disorder is unknown, but several factors may be involved, such as:

• Biological differences. People with bipolar disorder appear to have physical changes in their brains. The significance of these changes is still uncertain but may eventually help pinpoint causes.
• Genetics. Bipolar disorder is more common in people who have a first-degree relative, such as a sibling or parent, with the condition. Researchers are trying to find genes that may be involved in causing bipolar disorder.

Risk Factors for Bipolar Disorder:

Factors that may increase the risk of developing bipolar disorder or act as a trigger for the first episode include:

Genetics

Bipolar disorder tends to run in families. Children with a parent or sibling with the disorder have a higher chance of developing it than those without affected family members.

Identical twins don’t have the same risk of developing the illness. It’s likely that genes and environment work together in the development of bipolar disorder.

Environment

Sometimes a stressful event or major life change triggers a person’s bipolar disorder. Examples of possible triggers include the onset of a medical problem or the loss of a loved one. This kind of event can bring about a manic or depressive episode in people with bipolar disorder.

Drug abuse might trigger bipolar disorder. An estimated 60 percent of individuals with bipolar disorder are dependent on drugs or alcohol. People with seasonal depression or anxiety disorders may also be at risk for developing bipolar disorder.

Brain structure

Functional magnetic resonance imaging (fMRI) and positron emission technology (PET) are two types of scans that can provide images of the brain. Certain findings on brain scans may be associated with bipolar disorder. More research is needed to see how these findings specifically impact bipolar disorder and what this means for treatment and diagnosis.

Stress

Periods of high stress, such as the death of a loved one or other traumatic event may increase the risk for developing bipolar disorder.

Signs and Symptoms of Bipolar Disorder:

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and unusual behaviors. These distinct periods are called “mood episodes.” Mood episodes are drastically different from the moods and behaviors that are typical for the person. Extreme changes in energy, activity, and sleep go along with mood episodes.

What Are The Signs of a Depressive State?

While the following symptoms are not all experienced by each individual with bipolar disorder, these are the most common signs of a depressed state in an individual with bipolar disorder:

• Sadness and anxiety
• Loss of energy
• Feelings of guilt, hopelessness, or worthlessness
• Loss of interest or enjoyment from things that were once pleasurable
• Difficulty concentrating
• Uncontrollable crying
• Difficulty making decisions
• Increased need for sleep
• Insomnia
• Change in appetite causing weight loss or gain
• Thoughts of death or suicide
• Attempting suicide

What Are The Signs of Mania?

Mania is much much more than just having extra energy to burn. It’s a mood disturbance that makes you abnormally energized, both physically and mentally. Mania can be severe enough to require you to be hospitalized.

Mania occurs in people with bipolar I disorder. In many cases of bipolar I, manic episodes alternate with periods of depression. However, people with bipolar I don’t always have depressive episodes.

As with any illness, the symptoms a person may experience during a manic episode vary dramatically. Here are some of the more common examples of manic behavior for those who have bipolar disorder:

• Excessive happiness, hopefulness, and excitement
• Sudden changes from being joyful to being irritable, angry, and hostile
• Restlessness, increased energy, and less need for sleep
• Rapid talk, talkativeness
• Easily distracted
• Racing thoughts
• High sex drive
• Tendency to make grand and unattainable plans
• Tendency to show poor judgment, such as deciding to quit a job
• Inflated self-esteem or grandiosity — unrealistic beliefs in one’s ability, intelligence, and powers; may be delusional
• Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions)

What is Hypomania?

Hypomania is a mild-to-moderate level of mania, which includes symptoms similar to the signs of mania as listed above, but tend to be less extreme. Those with bipolar disorder with hypomanic features may be misdiagnosed, as those with hypomania may attribute their elevated mood with happiness.

Hypomania is a milder form of mania. If you’re experiencing hypomania, your energy level is higher than normal, but it’s not as extreme as in mania. Other people will notice if you have hypomania. It causes problems in your life, but not to the extent that mania can. If you have hypomania, you won’t need to be hospitalized for it.

Hypomanic episodes may include the following symptoms:

• Periods of time with an especially energetic mood.
• Feeling more self-confident than normal.
• Being very talkative or speaking faster than usual.
• Feeling hyper.
• Having a hard time concentrating.
• Being more irritable or angry.
• Needing less sleep than normal.
• Having more interest in sex.
• Uncharacteristic spending sprees.

In severe cases, the person may think about ending their life, and they may act on those thoughts.

Psychosis can occur in both manic and depressive episodes during which a person may be unable to differentiate between fantasy and reality. Such as they may believe during a “high” that they are famous, or have high-ranking social connections, or that they have special powers. During a depressive episode, they may believe they have committed a crime or that they are ruined and penniless.

Symptoms of psychosis may include delusions, which are false but strongly felt beliefs, and hallucinations, involving hearing or seeing things that are not there.

Signs and symptoms of bipolar I and bipolar II disorders include other features, such as anxious distress, melancholy, psychosis, or others. The timing of symptoms may include diagnostic labels such as mixed or rapid cycling. In addition, bipolar symptoms may occur during pregnancy or change with the seasons.

Children and teenagers with bipolar disorder are more likely to have temper tantrums, rapid mood changes, outbursts of aggression, explosive anger, and reckless behavior.

These features must be episodic rather than chronic to receive a diagnosis of bipolar disorder.

It is possible to manage all these symptoms with appropriate and consistent treatment

 Types of Bipolar Disorder:

Bipolar I Disorder:

Defined primarily by manic or mixed episodes that last at least seven days or by manic symptoms so severe they require immediate hospitalization. Generally, someone with Bipolar I also has depressive episodes lasting two or more weeks. The symptoms of depression and the symptoms of mania must be a major change in normal behavior. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible.

Bipolar II Disorder:

Bipolar II Disorder is a mood disorder characterized by one or more periods of depression and at least one episode of hypomania, which is a milder high than the mania experienced with Bipolar Disorder.

Because they’re milder, hypomanic episodes can often go unrecognized and as a result Bipolar II Disorder is often misdiagnosed as depression. Several studies have found that the risk of suicide is higher for those with Bipolar II than Bipolar I Disorder, likely because it’s often not diagnosed and therefore not treated properly.

However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania. A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from.

Between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives.

Cyclothymic Disorder

Cyclothymia is mild form of bipolar disorder, in which two episodes of hypomania alternate with episodes of mild depression for at least two years. The symptoms of a person with Cyclothymic Disorder do not meet the diagnostic criteria for other types of bipolar disorder. With cyclothymia, you experience periods when your mood noticeably shifts up and down from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat down. Between these cyclothymic highs and lows, you may feel stable and fine.

Although the highs and lows of cyclothymia are less extreme than those of bipolar disorder, it’s critical to seek help managing these symptoms because they can interfere with your ability to function and increase your risk of bipolar I or II disorder.

Cyclothymia symptoms alternate between emotional highs and lows. The highs of cyclothymia include symptoms of an elevated mood (hypomanic symptoms). The lows consist of mild or moderate depressive symptoms.

Cyclothymia symptoms are similar to those of bipolar I or II disorder, but they’re less severe. When you have cyclothymia, you can typically function in your daily life, though not always well. The unpredictable nature of your mood shifts may significantly disrupt your life because you never know how you’re going to feel.

Treatment options for cyclothymia include talk therapy (psychotherapy), medications and close, ongoing follow-up with your doctor.

Rapid-Cycling Bipolar Disorder:

four episodes of major depression, mania, hypomania or mixed symptoms within a year. Some people with Rapid-Cycling Bipolar Disorder have one or more episodes a week or even a day. This seems to be a more common form of bipolar disorder in those who have severe bipolar disorder and may be more common in those who were diagnosed with bipolar disorder at a young age.

Bipolar Disorder NOS (Not Otherwise Specified)

In general, Bipolar NOS is most commonly ascribed when a mood disorder is characterized by depression alternating with short episodes of hypomania (a milder form of mania). Oftentimes, the mood swings are rapid, occurring within days of each other. By and large, children and adolescents are most frequently diagnosed with NOS as they will be least likely to have a previous history of mood dysfunction.

From a psychiatric standpoint, bipolar disorder NOS is taken just as seriously as any other form of mood disorder. The presumption is that there is a problem and that it will be likely be definitively diagnosed in the future. By assigning the NOS diagnosis now, the person will be less likely to slip through the cracks should another mood episode occur.

There are no specific criteria as to when a doctor should make a bipolar NOS diagnosis. That said, the Diagnostic and Statistical Manual of Mental Disorders (DSM) issued by the APA does provide examples as to when it may be appropriate:

• The person has experienced alternating manic or depressive symptoms, but the episodes are too short to meet the criteria for inclusion.
• The person has experienced both hypomania and depression, but the episodes are too short to qualify as a cyclothymic disorder.
• The person may have had multiple episodes of hypomania but no depressive episode.
• The person has had a manic or mixed episode after having been previously diagnosed with either schizophrenia or a psychotic episode.
• The person meets the criteria for bipolar disorder, but the doctor is concerned that the symptoms may be caused by recreational drugs, alcohol, or a neurological disorder.

How Often Do People With Bipolar Disorder “Cycle?”

Some people can cycle from depressed to manic in a matter of hours but for most, the cycle is a few weeks apart. Every patient is different and the cycles and signs/symptoms manifest in different ways.

A cycle is the period of time in which an individual goes through one episode of mania and one episode of depression (or hypomania and depression). As for how often these cycles occur, there is, unfortunately, no definitive answer.

The frequency and duration of cycles are as varied as the individuals who have them. A study in 1992 found that 35 percent of people with bipolar disorder had only one cycle in a 5-year period, while 1 percent of the same group went through a complete cycle about every 3 months. On average, people with bipolar will have one or two cycles yearly. In addition, there is a seasonal influence—manic episodes occur more often in the spring and fall.

This change or “mood swing” can last for hours, days, weeks, or even months. Typically, someone with bipolar disorder experiences one or two cycles a year, with manic episodes generally occurring in the spring or fall.
Triggers in Bipolar Disease

Certain conditions are known to trigger symptoms in people with bipolar disease. Understanding these triggers—and avoiding them—can minimize symptoms and limit the number of cycles a person experiences. These include:

• Insufficient amounts of sleep
• Altercations with loved ones
• Alcohol and drug misuse
• Certain antidepressants and other medications
• A change in seasons
• Pregnancy and other hormonal conditions
• Grief over the death of a friend or family member

Possible Complications of Bipolar Disorder:

When you struggle with bipolar disorder, you may be euphoric and highly energetic one day, and anxious and sad the next. Because people with bipolar disorder bounce back and forth between manic and depressive symptoms, it can cause problems that affect every aspect of their lives. Though some people can find themselves extremely productive and creative in the manic phase, more often they are affected by distorted thinking and impaired judgment that can lead to further issues.

Left untreated, bipolar disorder can result in serious problems that affect every area of your life, such as:

• Substance abuse
• Legal problems
• Financial problems or crises
• Relationship troubles
• Isolation and loneliness
• Promiscuous behavior
• Poor work or school performance
• Missed work or school
• Problems related to drug and alcohol use
• Suicide or suicide attempts
• Damaged relationships
• Poor work or school performance

Co-Occurring Disorders:

Oftentimes, Bipolar Disorder is accompanied by another serious mental illness.

The combination (or the conditions alone) can sometimes lead to angry or violent behavior and, in some cases, even suicide. These disorders include:

• Depression, a generalized state of apathy, hopelessness or sadness
• Anxiety disorders, such as generalized anxiety disorder, panic disorder, paranoia, phobias, and post-traumatic stress disorder (PTSD)
• Attention-deficit hyperactivity disorder (ADHD), which can often be confused with bipolar disorder symptoms, especially in children, or can coexist with bipolar disorder

Many of the problems and conditions associated with bipolar disorder, such as drug and alcohol abuse, can often worsen symptoms of the disease. Some people find themselves suffering from guilt or low self-esteem following their behaviors when they are in the depressed phase of the condition. Understandably, this can be a troubling issue not just for patients, but for those around them who may be affected, including friends, family members and co-workers.

How Is Bipolar Disorder Diagnosed?

The best way to be properly diagnosed with bipolar disorder is through talking with a doctor or psychiatrist, who will perform a screening and full work-up to determine a diagnosis. Keeping track of patterns in mood and overall mood are the most critical diagnostic tools. Those who have bipolar disorder are more likely to seek treatment during a depressive state rather than a manic state. It’s critical that a full medical history is sought before being diagnosed as simply “depressed.”

To determine if you have bipolar disorder, your evaluation may include:

• Physical exam. Your doctor may do a physical exam and lab tests to identify any medical problems that could be causing your symptoms.
• Psychiatric assessment. Your doctor may refer you to a psychiatrist, who will talk to you about your thoughts, feelings and behavior patterns. You may also fill out a psychological self-assessment or questionnaire. With your permission, family members or close friends may be asked to provide information about your symptoms.
• Mood charting. You may be asked to keep a daily record of your moods, sleep patterns or other factors that could help with diagnosis and finding the right treatment.
• Criteria for bipolar disorder. Your psychiatrist may compare your symptoms with the criteria for bipolar and related disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association.

How Is Bipolar Disorder Treated?

Once a diagnosis of bipolar disorder has been made, a treatment plan will be formed. Generally treatment for bipolar disorder involves medication (typically a “cocktail” of medications of various types) and talk therapy will typically help bring some sense of normalcy. Learning coping mechanisms is invaluable.

Treatment

Treatment is best guided by a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist) who is skilled in treating bipolar and related disorders. You may have a treatment team that also includes a psychologist, social worker and psychiatric nurse.

Bipolar disorder is a lifelong condition. Treatment is directed at managing symptoms. Depending on your needs, treatment may include:

• Medications. Often, you’ll need to start taking medications to balance your moods right away.
• Continued treatment. Bipolar disorder requires lifelong treatment with medications, even during periods when you feel better. People who skip maintenance treatment are at high risk of a relapse of symptoms or having minor mood changes turn into full-blown mania or depression.
• Day treatment programs. Your doctor may recommend a day treatment program. These programs provide the support and counseling you need while you get symptoms under control.
• Substance abuse treatment. If you have problems with alcohol or drugs, you’ll also need substance abuse treatment. Otherwise, it can be very difficult to manage bipolar disorder.
• Hospitalization. Your doctor may recommend hospitalization if you’re behaving dangerously, you feel suicidal or you become detached from reality (psychotic). Getting psychiatric treatment at a hospital can help keep you calm and safe and stabilize your mood, whether you’re having a manic or major depressive episode.

The primary treatments for bipolar disorder include medications and psychological counseling (psychotherapy) to control symptoms, and also may include education and support groups.

Proper treatment of bipolar disorder is imperative for those who struggle with bipolar disorder, as it can help control mood swings and other symptoms.

Bipolar disorder is a life-long illness, so treatment will be long-term to manage and control symptoms of the disorder.

Medications to Treat Bipolar Disorder:

Many people with bipolar disorder have to try a number of medications before a combination is found that controls the symptoms. These may include:

• Mood stabilizers. You’ll typically need mood-stabilizing medication to control manic or hypomanic episodes. Examples of mood stabilizers include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal).
• Antipsychotics. If symptoms of depression or mania persist in spite of treatment with other medications, adding an antipsychotic drug such as olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris) may help. Your doctor may prescribe some of these medications alone or along with a mood stabilizer.
• Antidepressants. Your doctor may add an antidepressant to help manage depression. Because an antidepressant can sometimes trigger a manic episode, it’s usually prescribed along with a mood stabilizer or antipsychotic.
• Antidepressant-antipsychotic. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine. It works as a depression treatment and a mood stabilizer.
• Anti-anxiety medications. Benzodiazepines may help with anxiety and improve sleep, but are usually used on a short-term basis.

Living With Bipolar Disorder:

Like liver disease or diabetes, Bipolar Disorder is a chronic condition. With the help of loved ones and proper treatment, those who have Bipolar Disorder can live healthy, happy and rewarding lives.

Make healthy choices: The first and most important thing a person with bipolar can do for him or herself is to learn to make healthy choices to minimize the symptoms and take control of your life. Healthy choices begin with medication and proper supervision by a therapist.

Proper symptom management: With proper symptom management, you will learn to hope again, you will learn to feel good and well, and that you’re able to cope with the high highs and low lows of bipolar disorder.

Become an advocate for yourself: no one knows you like, well, you. So advocate for proper treatment and take an active role in your treatment. Don’t be afraid to tell your therapist and treatment team if something isn’t working for you. Speak up. Ask questions. Advocate, advocate, advocate.

Research: Learn everything you can about bipolar disorder and examine how bipolar disorder affects you. This is a major component of treating bipolar disorder.

Be patient: while you’re ready to feel normal again, patience is key. Often finding a proper treatment, or finding a treatment that works for YOU, takes patience, time and energy. It’s okay to be frustrated by this, but frustration isn’t a reason to stop treatment.

Proper medication: follow your medication regime as it was prescribed to you. Don’t stop taking it without first talking to your doctor about your decision.

Therapy is your BFF. While medication can even out mood and manage the symptoms of bipolar disorder, therapy can help teach you proper coping techniques.

Keep tabs on your moods and your feelings: You may find it helpful to keep a “mood diary” to watch for patterns. It’s vital to watch your moods as they swing and learn about the things that trigger a manic or a depressive episode. Common triggers include:

• Stress
• Financial problems
• Changing of the seasons
• Fighting with a loved one
• Lack of sleep

Turn to friends and family for support. It may be hard and shameful to admit that you have a mental illness, but the support and comfort offered by friends can make a world of difference.

Support group: Find and attend a support group for people who have bipolar disorder. Not only are these groups excellent for meeting others who have the same disorder, you can also compare coping strategies.

Build new relationships and friendships: try community activities, emailing old friends, going out for coffee with a loved one. Social isolation and loneliness can make the mood swings of bipolar disorder worse.

Build a structure into your life. Developing and following a routine (making sure it includes eating, sleeping, exercise, work, relaxing, and hanging out with friends) can really provide stability in your life.

Bedtime: make sure to go to bed at the same time each night – lack of sleep can lead to mania and it’s healthy for your body to get the proper amount of sleep it needs to function.

Reduce stress: cut off any excess stress in your life. Stress can trigger both mania and depression in those with bipolar disorder, and chances are, there’s a way to minimize some of the stress as well as developing some effective coping mechanisms for the unavoidable stresses.

Avoid self-medication: don’t self-medicate with drugs or alcohol. Many of legal AND illegal drugs can trigger episodes of mania and depression.

My Loved One Has Bipolar Disorder:

Even though only 3 percent of the population is diagnosed as bipolar, chances are you will know someone who is. The best way to handle this is to realize that they simply have brain chemicals that aren’t exactly lined up right.

As long as they are not harmful to themselves or others, simply treat these people as you would any other person. However, the highs and lows can be difficult for those who are in daily contact with the person. There are support groups and books that will be of help finding coping skills for partners of Bipolar patients. A good therapist for caregivers is never a bad thing.

It’s vital to support your bipolar loved one as he or she goes through treatment.

Be understanding – no one was born wanting to be bipolar. If your loved one is undergoing treatment, be patient and understanding as he or she adjusts to new medications.

It’s no one’s fault that your loved one has bipolar disorder.

Encourage your loved one to seek professional help. Bipolar disorder is much more manageable for those who seek – and stick with – treatment.

Accept his or her limits – episodes of mania and depression are not something that your bipolar loved one can simply control or snap out of.

Accept your own limits, too. You can’t make someone who has bipolar disorder go to treatment – recovery is in the hands of your loved one.

Find – and attend – a support group for people with bipolar disorder. Go with your loved one and ask questions.

Learn all that you can about bipolar disorder – it may explain a lot of those behaviors your loved one copes with.

Additional Bipolar Disorder Resources:

Mood Tracker is a great tool for tracking shifts in moods as well as monitoring how much sleep the patient is getting, medications taken, and levels of anxiety and irritability.

“How to Survive When They’re Depressed: Living and Coping with Depression Fallout” by Anne Sheffield – A must-have book for someone living with a spouse or partner who battles depression and/or bipolar disorder. This book  will completely change your outlook on life and how life should look when living in the house with someone with mental illness.

Depression and Bipolar Support Alliance has education and research materials, information

Page last audited 8/2018

Coping With Grief

by Band Back Together | Aug 15, 2018

What Is Grief?

Grief is an emotion – a natural response to loss – and the emotional pain felt when something or someone is taken away from their loved one. Most people associate grief with the death of a loved person, but grief can be the result of many different situations. These situations can include:

• Miscarriage
• Pet Loss
• Loss of a long-loved dream
• Loss of a friendship
• Serious illness of a loved one
• Becoming chronically ill
• Divorce
• Breakup of a romantic relationship
• Trauma
• Losing a job

The greater and more profound the loss, the more intense the feelings of grief may be. It’s important to remember that even the smallest of losses can lead to grieving – moving to another city, graduating high school, changing jobs, retiring – these are all events that can lead to grief.

To read more about grief, please visit our grief resources.

Understanding Grief:

Losing a loved one – be it a friend, family member, beloved pet, or a child – is one of the most challenging parts of life. No matter how natural death is, the grief associated with losing a loved one comes with very strong emotions like depression, guilt, and anger. Many times, those who have lost a loved one feel both alone and socially isolated from the rest of the world, which is why it’s so important to have someone to lean on during the grieving process.

Knowing the stages of grief will help you understand some of the things they are feeling: denial and isolation, anger, bargaining, depression, and acceptance. Also knowing that there is no timeline on grief, that it can take a year or ten or forever, will help you understand the person you are trying to comfort.

What Are Some Common Signs Of Grief?

Losses and grief are as individual as the person experiencing it, but often, the emotions that are associated with grief and loss can be confusing, overwhelming, and scary. Here are some of the most common signs and feelings associated with grief and grieving:

Guilt – many people who are grieving report feeling guilty for things left unsaid to the deceased. Others may feel guilt if they are relieved that their loved one has passed from a chronic illness. Still others may feel guilt for not preventing the death – even if the death wasn’t preventable.

Shock – in the immediate time frame after a loss, many people feel shock and disbelief that their loved one has actually died. This may lead to feelings of numbness, disbelief that the death is real, and an inability to accept the truth.

Sadness – one of the most common signs of grief is an overwhelming sadness. Someone who is grieving may feel lonely, empty inside, despairing, or emotionally unstable.

Anger – whether or not the death was not anyone’s fault, many people feel anger and resentment after a loss. This anger may be directed at the deceased, yourself, God, the doctors who didn’t prevent the loss.

Fear – a large loss can trigger many fears and worries, anxiety and insecurity. Many people report panic attacks after the death of a loved one. The death of someone you love can remind you of your own mortality and make you wonder how you can face your life without that person.

How To Support Someone Who’s Grieving:

The death of a loved one is one of life’s most difficult experiences. The bereaved struggle with many intense and painful emotions, including depression, anger, guilt, and profound sadness. Often, they feel isolated and alone in their grief, but having someone to lean on can help them through the grieving process.

The intense pain and difficult emotions that accompany bereavement can often make people uncomfortable about offering support to someone who’s grieving. You may be unsure what to do or worried about saying the wrong thing at such a difficult time. That’s understandable. But don’t let discomfort prevent you from reaching out to someone who is grieving. Now, more than ever, your loved one needs your support. You don’t need to have answers or give advice or say and do all the right things. The most important thing you can do for a grieving person is to simply be there. It’s your support and caring presence that will help your loved one cope with the pain and gradually begin to heal.

Infertility Resources

by Band Back Together | Aug 11, 2018

What Is Infertility?

Most people will have the strong desire to conceive a child at some point during their lifetime. Understanding what defines normal fertility is crucial to helping a person, or couple, know when it is time to seek help. Most couples (approximately 85%) will achieve pregnancy within one year of trying, with the greatest likelihood of conception occurring during the earlier months. Only an additional 7% of couples will conceive in the second year. As a result, infertility has come to be defined as the inability to conceive within 12 months. This diagnosis is therefore shared by 15% of couples attempting to conceive. We generally recommend seeking the help of a reproductive endocrinologist if conception has not occurred within 12 months. However, there are various scenarios where one may be advised to seek help earlier.

Infertility means not being able to get pregnant after one year of trying (or six months if a woman is 35 or older). Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant:

• A woman’s body must release an egg from one of her ovaries (ovulation).
• The egg must go through a Fallopian tube toward the uterus (womb).
• A man’s sperm must join with (fertilize) the egg along the way.
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility can happen if there are problems with any of these steps.

Infertility is a disease of the reproductive system that impairs the ability to conceive a child. Infertility may be diagnosed after a couple has been having well-timed, unprotected sexual intercourse for a full year.

Infertility may also be diagnosed if a woman is under age thirty-five and has suffered multiple miscarriages (also called “recurrent pregnancy loss” or RPL).

While infertility can be one of the most isolating challenges a couple can face, being infertile is not uncommon. In fact, 10-15 percent of couples in the US are infertile.

Infertility can be caused by one single problem in either partner, or a combination of factors that lead to a couple being unable to conceive – or carry – a pregnancy to term.

There are many safe treatments that can help a couple overcome infertility and successfully carry a child to term.

What About Infertility Treatments And Insurance?

Fifteen states have either an insurance mandate to offer or an insurance mandate to cover some level of infertility treatment. Eight of those states have an insurance mandate that requires qualified employers to include IVF coverage in their plans offered to their employees: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island.

A study published in the New England Journal of Medicine (August 2002) found that the percentage of high-order pregnancies (those with three or more fetuses) was greater in states that did not require insurance coverage for IVF. The authors of the study noted that mandatory coverage is likely to yield better health outcomes for women and their infants since high-order births are associated with higher-risk pregnancies.

The Affordable Care Act (ACA) does not require coverage for infertility treatments. Those states with an infertility mandate that covers IVF may have chosen an Essential Health Benefits (EHB) benchmark plan that includes the IVF mandate. The EHB impacts the individual and small group markets only in each state.

What Are The Types of Infertility?

For many couples, having a child or children is one of the most important goals in their lives. Many people long to be parents and understandably so. Having children can bring great joy and purpose to our lives. Unfortunately, it is not easy for every couple to get pregnant and have a child.

In other cases, a couple may be able to have a child but then struggle to conceive or carry a second child. When a couple struggles to have a child, it is called infertility.

Infertility can take two forms: primary and secondary, but many of the causes and treatments are the same for each type of infertility.

They vary slightly, but overall are caused by the same problems and treated in the same ways. The biggest difference with these two different forms of infertility is the way that they may be perceived by others and the way that they may make you, as a couple, feel.

This resource page will focus upon Primary Infertility.

1.Primary Infertility is a diagnosis for couples who haven’t been able to conceive after a year of well-timed, unprotected sexual intercourse without any other children. Primary infertility refers to the type of infertility that a couple would be diagnosed with when they are unable to have a child at all.  A couple suffering with primary infertility is a childless couple that has never been able to conceive a pregnancy or has never been able to carry a pregnancy in order to achieve a live birth.

Having primary infertility can often lead perspective parents into a truly hopeless feeling. If you are unable to have a child, you may feel like it is impossible for you and that you will never have a child at all. You may long desperately to know what it is like to be a parent and have a child, and it is likely that you fear that you will never know that feeling.

These are all completely normal and understandable feelings.

2.Secondary Infertility occurs when couples have been pregnant at least once, but are unable to become pregnant again. This is the type of infertility that many people are unaware of. It is not uncommon to not realize that a couple that already has a child or children can suffer from infertility which is exactly what secondary infertility is.

Secondary Infertility is diagnosed when a couple has conceived a pregnancy and achieved a live birth before but is unable to achieve another pregnancy and live birth. Basically, the couple has a child or children, but is now unable to continue having children.

Secondary infertility comes with its own specific set of problems. It is not uncommon for people to lack understanding of what you are going through. Many people may look at it like since you already have a child or children, that it isn’t a big deal that you aren’t able to have more.

You even may struggle with a feeling of guilt for being unhappy about not being able to have more children. You may feel like you should be happy just having the child or children that you already have. It is important to remember that just because you want more children, it does not mean that you aren’t happy with the child or children that you do have.

It is still hard and unfair when you are unable to choose the size of your family, even if you are able to have one or some children. 

Risk Factors for Infertility:

While these are all risk factors for infertility, many times, couples find that none or many of these apply to their situation

Age. A woman’s fertility gradually declines with age, especially in her mid-30s, and it drops rapidly after age 37. Infertility in older women may be due to the number and quality of eggs, or to health problems that affect fertility. Men over age 40 may be less fertile than younger men are and may have higher rates of certain medical conditions in offspring, such as psychiatric disorders or certain cancers.

Tobacco use. Smoking tobacco or marijuana by either partner reduces the likelihood of pregnancy. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and a low sperm count in men.

Alcohol use. For women, there’s no safe level of alcohol use during conception or pregnancy. Avoid alcohol if you’re planning to become pregnant. Alcohol use increases the risk of birth defects, and may contribute to infertility. For men, heavy alcohol use can decrease sperm count and motility.

Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. A man’s sperm count may also be affected if he is overweight.

Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.

Exercise issues. Insufficient exercise contributes to obesity, which increases the risk of infertility. Less often, ovulation problems may be associated with frequent strenuous, intense exercise in women who are not overweight. Too much exercise can lead to ovulation problems.

Stress – unfortunately, we all face an enormous amount of stress in our lives and stress is thought to be a factor in infertility for some

Poor diet – eating a proper diet is imperative for both partners in order to achieve – and maintain – pregnancy

Sexually transmitted infections (STIs) – many times a person has an STI and is unaware of it. Unfortunately, some of these STIs can lead to infertility if left untreated

Hormonal Issues – Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

What Are The Symptoms Of Infertility?

Most couples are able to conceive a pregnancy within the first six months of well-timed, unprotected sexual intercourse. After 12 months of well-timed, unprotected sexual intercourse, about 90% of couples will achieve a pregnancy.

The remaining 10% will eventually conceive – with or without ART (assisted reproductive technology).

The primary symptom of infertility is the inability for a couple to become pregnant after a year of well-timed sexual intercourse. Other symptoms – such as abnormal menstrual cycles or hormonal problems – may not be noticed until after a couple has been unable to achieve pregnancy.

It’s time to make an appointment to see a doctor (begin with your normal gynecologist who may refer you to a doctor who specializes in fertility treatments) if any of the following symptoms are noted:

• Maternal age is over 34 and the couple has been trying to conceive for at least six months.
• You’re age 35 to 40 and have been trying to conceive for six months or longer
• You’re over age 40
• You menstruate irregularly or not at all
• Your periods are very painful
• You have known fertility problems
• You’ve been diagnosed with endometriosis or pelvic inflammatory disease
• You’ve had multiple miscarriages
• You’ve undergone treatment for cancer
• Past history of endometriosis or pelvic inflammatory disease.

Men should see a doctor if he has:

• Known low sperm count
• History of testicular, sexual, or prostate problems.
• You have a low sperm count or other problems with sperm
• You have a history of testicular, prostate or sexual problems
• You’ve undergone treatment for cancer
• You have testicles that are small in size or swelling in the scrotum known as a varicocele
• You have others in your family with infertility problems

What Causes Infertility?

Conception involves a complex process of ovulation and fertilization. Conception is not an isolated event but part of a sequential process involving ovulation (release of egg from ovary) gamete formation, fertilization (union of sperm and egg) and implantation into the uterine wall.

All of the steps during ovulation and fertilization need to happen correctly in order to get pregnant. Sometimes the issues that cause infertility in couples are present at birth, and sometimes they develop later in life.

Infertility causes can affect one or both partners. In general:

• In about one-third of cases, there is an issue with the male.
• In about one-third of cases, there is an issue with the female.
• In the remaining cases, there are issues with both the male and female, or no cause can be identified

What Are The Causes of Male Factor Infertility?

There are a great deal of things that can affect production of sperm, sperm count, sperm motility or the ability of the sperm to effectively fertilize the egg. The most common causes of male factor infertility are:

Paternal age over forty. Fertility may decrease with age for some men.

Abnormal spermatogenesis (creation of sperm) or function of the sperm. This can be caused by genetic defects, scarring from infections, or undescended testicles.

Issues with sperm delivery, which can include premature ejaculation, painful intercourse, retrograde ejaculation, genetic diseases, or structural problems with the male reproductive system.

Environmental overexposure to things like chemicals, pesticides

Heat (such as frequent use of a sauna or hot tubs) which can lower sperm count and impact sperm production.

Lifestyle issues: obesity, poor nutrition, smoking, substance abuse, or overuse of alcohol.

Abnormal sperm production or function due to undescended testicles, genetic defects, health problems such as diabetes or infections such as chlamydia, gonorrhea, mumps or HIV. Enlarged veins in the testes (varicocele) can also affect the quality of sperm.

Problems with the delivery of sperm due to sexual problems, such as premature ejaculation; certain genetic diseases, such as cystic fibrosis; structural problems, such as a blockage in the testicle; or damage or injury to the reproductive organs.

Overexposure to certain environmental factors, such as pesticides and other chemicals, and radiation. Cigarette smoking, alcohol, marijuana or taking certain medications, such as select antibiotics, antihypertensives, anabolic steroids or others, can also affect fertility. Frequent exposure to heat, such as in saunas or hot tubs, can raise the core body temperature and may affect sperm production.

Damage related to cancer and its treatment, including radiation or chemotherapy. Treatment for cancer can impair sperm production, sometimes severely.

What Are The Causes of Female Factor Infertility?

While the causes may overlap or vary, these are the most common cause of female infertility:

Ovulation disorders, which affect the release of eggs from the ovaries. These include hormonal disorders such as polycystic ovary syndrome. Hyperprolactinemia, a condition in which you have too much prolactin — the hormone that stimulates breast milk production — may also interfere with ovulation. Either too much thyroid hormone (hyperthyroidism) or too little (hypothyroidism) can affect the menstrual cycle or cause infertility. Other underlying causes may include excessive exercise, eating disorders, injury or tumors.

Uterine or cervical abnormalities, including abnormalities with the opening of the cervix, polyps in the uterus or the shape of the uterus. Noncancerous (benign) tumors in the uterine wall (uterine fibroids) may rarely cause infertility by blocking the fallopian tubes. More often, fibroids interfere with implantation of the fertilized egg.

Fallopian tube damage or blockage, often caused by inflammation of the fallopian tube (salpingitis). This can result from pelvic inflammatory disease, which is usually caused by a sexually transmitted infection, endometriosis or adhesions.

Primary ovarian insufficiency (early menopause), when the ovaries stop working and menstruation ends before age 40. Although the cause is often unknown, certain factors are associated with early menopause, including immune system diseases, certain genetic conditions such as Turner syndrome or carriers of Fragile X syndrome, radiation or chemotherapy treatment, and smoking.

Endometriosis – the tissue lining the uterus grows and implants itself outside of the uterus, causing damage to the major organs, including the reproductive organs.

PCOS (Polycystic Ovarian Syndrome) – is a condition in which the hormone androgen is elevated and causes ovulatory disorders.

Hyperprolactinemia – elevated levels of the hormone that stimulates lactation in women who aren’t pregnant or nursing can also affect ovulation.

Uterine Fibroids – benign tumors in the wall of the uterus are common – rarely they can cause blockage to the Fallopian tubes, inhibiting ovulation. More frequently, fibroids interfere with the implantation of a fertilized egg into the wall of the uterus.

Pelvic Adhesions – bands of scar tissue from previous surgeries, appendicitis, or other infections of the pelvic region can impair fertility.

Thyroid Problems – Hypothyroidsim or hyperthyroidism can impact fertility by interrupting the normal menstrual cycle of a woman.

Cancer and Cancer Treatment – cancers – especially those that affect the reproductive system, can severely impact a woman’s fertility. And the treatment of cancers – radiation and chemotherapy – can affect a woman’s reproductive function.

Medications – certain medications can temporarily affect fertility in women. Generally speaking, when the medication is stopped, fertility returns to normal.

Early Menopause – defined as the absence of menstruation and depletion of ovarian follicles prior to age 40. While it’s unknown why some women enter early menopause, it can be caused by disease, radiation, smoking, or chemotherapy.

Other conditions. Medical conditions associated with delayed puberty or the absence of menstruation (amenorrhea), such as celiac disease, poorly controlled diabetes and some autoimmune diseases such as lupus, can affect a woman’s fertility. Genetic abnormalities also can make conception and pregnancy less likely

How Is Infertility Treated?

Treatment of infertility depends on the root cause for the infertility. Up to 60% of those considered technically infertile became pregnant (numbers do not include IVF) upon receiving fertility treatments of treatments aimed at curing the underlying cause.

One out of every five couples diagnosed as infertile eventually becomes pregnant without treatment.

Treatment for infertility may be as simple as education about the proper timing for sexual intercourse to become pregnant.

Medications may be prescribed to promote ovulation, treat infections, or clotting disorders.

Assisted Reproductive Technology Procedures like IUI (intrauterine insemination) and IVF (in vitro fertilization) may be used.

How Is Infertility Prevented?

It’s extremely important to remember that most causes of infertility have nothing to do with you and your partner not practicing proper habits. Most of the time, infertility is not preventable. However, here are some things you can try to do to prevent infertility:

Couples

Have regular intercourse several times around the time of ovulation for the highest pregnancy rate. Having intercourse beginning at least 5 days before and until a day after ovulation improves your chances of getting pregnant. Ovulation usually occurs at the middle of the cycle — halfway between menstrual periods — for most women with menstrual cycles about 28 days apart.

Men

For men, although most types of infertility aren’t preventable, these strategies may help:

• Avoid drug and tobacco use and excessive alcohol consumption, which may contribute to male infertility.
• Avoid high temperatures, as this can affect sperm production and motility. Although this effect is usually temporary, avoid hot tubs and steam baths.
• Avoid exposure to industrial or environmental toxins, which can impact sperm production.
• Limit medications that may impact fertility, both prescription and nonprescription drugs. Talk with your doctor about any medications you take regularly, but don’t stop taking prescription medications without medical advice.
• Exercise moderately. Regular exercise may improve sperm quality and increase the chances for achieving a pregnancy.

Women

For women, a number of strategies may increase the chances of becoming pregnant:

• Quit smoking. Tobacco has multiple negative effects on fertility, not to mention your general health and the health of a fetus. If you smoke and are considering pregnancy, quit now.
• Avoid alcohol and street drugs. These substances may impair your ability to conceive and have a healthy pregnancy. Don’t drink alcohol or use recreational drugs, such as marijuana or cocaine.
• Limit caffeine. Women trying to get pregnant may want to limit caffeine intake. Ask your doctor for guidance on the safe use of caffeine.
• Exercise moderately. Regular exercise is important, but exercising so intensely that your periods are infrequent or absent can affect fertility.
• Avoid weight extremes. Being overweight or underweight can affect your hormone production and cause infertility

How To Cope With The Emotional Aspect of Infertility:

Whether you are coping with infertility or someone you love is trying to ride the roller coaster of infertility, there are a lot of emotions associated with infertility and the inability to get pregnant easily.

Here are some tips for coping with infertility:

Find and locate others (perhaps through a support group) that are experiencing the isolation and challenges of infertility. It’s a very lonesome time for many couples – having someone(s) around who are able to understand exactly what you are going through can be a lifesaver.

Don’t be afraid to tell others what you are going through – if they do not know, it’s impossible for them to be sensitive to what you are going through.

Be prepared to deal with the assholes who don’t understand WHY you feel so saddened about being unable to easily conceive. Prepare a list of comebacks to dish out to anyone who wants to trivialize what you’re going through.

Protect your feelings. If going to a baby shower is going to be tremendously challenging for you, simply do not go. Send a gift card and be done with it. You have enough things to deal with – don’t borrow trouble.

Be honest with your partner about your feelings, but do not expect your partner to mimic your feelings exactly. No two people grieve alike.

Speaking of grief, infertility is a loss and is allowed to be mourned. Being unable to conceive a child can be one of the greatest losses you will ever face.

If your grief and sadness become too powerful, don’t be afraid to talk to a mental health professional. He or she can help you as a sounding board and help to teach you coping strategies.

Additional Infertility Resources:

Resolve provides timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.

The InterNational Council on Infertility Information Dissemination, INC. (INCIID – pronounced “inside”) is a nonprofit organization that helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption or child-free lifestyles.

March of Dimes – Guidance and information for couples who are trying to get pregnant.

Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss – a book focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Page last audited 8/2018

PTSD And Veterans

by Band Back Together | Aug 11, 2018

What is PTSD in Veterans?

For very many veterans, returning from military service also means dealing with symptoms of post-traumatic stress disorder (PTSD). You may be having a hard time readjusting to life out of the military. Or you may constantly be feeling on edge, emotionally numb and disconnected, or close to panicking or exploding. But no matter how long the V.A. wait times, or how isolated or emotionally cut off from others you feel, it’s important to know that you’re not alone and there are plenty of things you can do to start feeling better. These steps can help you learn to deal with nightmares and flashbacks, cope with feelings of depression, anxiety or guilt, and regain your sense of control.

Post-traumatic stress disorder impacts 11-20 percent of Iraq and Afghanistan War veterans, approximately 12 percent of Gulf War veterans, and 15 percent of Vietnam veterans. In addition to the combat-related PTSD, roughly 1 in 4 women and 1 in 100 men utilizing the VA report instances of sexual assault, which can also result in prolonged traumatic stress.

What Causes PTSD in Veterans?

Post-traumatic stress disorder (PTSD), sometimes called “combat stress” or “shell shock,” happens after you experience severe trauma or a life-threatening event. It’s normal for your mind and body to be in shock after such an event, but this normal response becomes PTSD when your nervous system gets stuck between fight and flight syndrome. Post-traumatic stress disorder (PTSD) can occur after you have been through a trauma. A trauma is a shocking and dangerous event that you see or that happens to you. During this type of event, you think that your life or others’ lives are in danger.

Read more about PTSD

Your nervous system has two automatic or reflexive ways of responding to stressful events:

Mobilization, or fight-or-flight, occurs when you need to defend yourself or survive the danger of a combat situation. Your heart pounds faster, your blood pressure rises, and your muscles tighten, increasing your strength and reaction speed. Once the danger has passed, your nervous system calms your body, lowering your heart rate and blood pressure, and winding back down to its normal balance.

Immobilization occurs when you’ve experienced too much stress in a situation and even though the danger has passed, you find yourself “stuck.” Your nervous system is unable to return to its normal state of balance and you’re unable to move on from the event. Immobilization is PTSD.

Recovering from PTSD involves transitioning out of the mental and emotional war zone you’re still living in and helping your nervous system return to normal.

Going through trauma is not rare. About 6 of every 10 men (or 60%) and 5 of every 10 women (or 50%) experience at least one trauma in their lives. Women are more likely to experience sexual assault and child sexual abuse. Men are more likely to experience accidents, physical assault, combat, disaster, or to witness death or injury.

PTSD can happen to anyone. It is not a sign of weakness. A number of factors can increase the chance that someone will develop PTSD, many of which are not under that person’s control. For example, if you were directly exposed to the trauma or injured, you are more likely to develop PTSD.

PTSD And The Military:

When you are in the military, you may see combat. You may have been on missions that exposed you to horrible and life-threatening experiences. These types of events can lead to PTSD.

The number of Veterans with PTSD varies by service era:

• Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF): About 11-20 out of every 100 Veterans (or between 11-20%) who served in OIF or OEF have PTSD in a given year.
• Gulf War (Desert Storm): About 12 out of every 100 Gulf War Veterans (or 12%) have PTSD in a given year.
• Vietnam War: About 15 out of every 100 Vietnam Veterans (or 15%) were currently diagnosed with PTSD at the time of the most recent study in the late 1980s, the National Vietnam Veterans Readjustment Study (NVVRS). It is estimated that about 30 out of every 100 (or 30%) of Vietnam Veterans have had PTSD in their lifetime.

Other factors in a combat situation can add more stress to an already stressful situation. This may contribute to PTSD and other mental health problems. These factors include what you do in the war, the politics around the war, where the war is fought, and the type of enemy you face.

Another cause of PTSD in the military can be military sexual trauma (MST). This is any sexual harassment or sexual assault that occurs while you are in the military. MST can happen to both men and women and can occur during peacetime, training, or war.

Among Veterans who use VA healthcare, about:

• 23 out of 100 women (or 23%) reported sexual assault when in the military.
• 55 out of 100 women (or 55%) and 38 out of 100 men (or 38%) have experienced sexual harassment when in the military.

There are many more male Veterans than there are female Veterans. So, even though military sexual trauma is more common in women Veterans, over half of all Veterans with military sexual trauma are men.

What Are Some Of The PTSD Symptoms of Veterans?

While you can develop symptoms of PTSD in the hours or days following a traumatic event, sometimes symptoms don’t surface for months or even years after you return from deployment. While PTSD develops differently from veteran to veteran, there are four symptom clusters:

Being on guard all the time, jumpy, and emotionally reactive, as indicated by irritability, anger, reckless behavior, difficulty sleeping, trouble concentrating, and hypervigilance.

Recurrent, intrusive reminders of the traumatic event, including distressing thoughts, nightmares, and flashbacks where you feel like the event is happening again. Experiencing extreme emotional and physical reactions to reminders of the trauma such as panic attacks, uncontrollable shaking, and heart palpitations.

Extreme avoidance of things that remind you of the traumatic event, including people, places, thoughts, or situations you associate with the bad memories. Withdrawing from friends and family and losing interest in everyday activities.

Negative changes in your thoughts and mood, such as exaggerated negative beliefs about yourself or the world and persistent feelings of fear, guilt, or shame. Diminished ability to experience positive emotions.

Suicide Prevention For Veterans With PTSD

It’s common for veterans with PTSD to experience suicidal thoughts. Feeling suicidal is not a character defect, and it doesn’t mean that you are crazy, weak, or flawed, it simply means that you are overwhelmed and need some help. If you are feeling suicidal, please seek help immediately. If you don’t feel you can talk to your friends and loved ones, there are a great number of suicide hotlines available that offer free, non-judgemental, confidential counseling. Here are some of the following suicide help lines. You are not alone, no matter how you feel. Things can get better. Please call:

In the US:

• call 911
• Visit the Online National Suicide Helpline
• call 1-800-273-8255

In Canada:

• CALL TOLL FREE 1.833.456.4566 Available 24/7.
• CHAT available 5pm-1am ET 
• Text 45645 Available 5pm-1am E

In the UK and ROI:

• Hotline: +44 (0) 8457 90 90 90 (UK – local rate)
• Hotline: +44 (0) 8457 90 91 92 (UK minicom)
• Hotline: 1850 60 90 90 (ROI – local rate)
• Hotline: 1850 60 90 91 (ROI minicom)
• Website: samaritans.org
• E-mail Helpline: jo@samaritans.org

In Australia, call:

• 13 11 14
• Online Crisis Support Chat
• https://www.lifeline.org.au/get-help/online-services/crisis-chat

Wordwide:

• Visit IASP to find a helpline in your country.
• Visit List of Worldwide Suicide Hotlines Via Wikipedia

Learning To Live With And Heal From PTSD In Veterans:

Step One: Regulate Your Nervous System

PTSD can leave you feeling completely vulnerable and totally helpless. However, you have more control over your nervous system than you may know. When you feel agitated, anxious, or out of control, these tips can help you change your arousal system and calm yourself.

Sensory input: We know that loud noises, certain smells, or the feel of sand in your clothes can instantly transport you back to the combat zone. Sensory input quickly calm you. Everyone responds a bit differently, so experiment to find what works best. Think of your time on deployment: what brought you comfort at the end of the day? Perhaps it was looking at photos of your family? Or listening to a favorite song, or smelling a certain brand of soap? Or maybe petting an animal quickly makes you feel calm?

Mindful breathing: To quickly calm yourself, begin by taking 60 breaths, focusing your attention on each breath. Breathe in, hold for a couple of seconds, breathe out. In with the good air, out with the bad. Count them – it helps your mind to focus on something other than your anxiety.

Reconnect emotionally: If you can react to uncomfortable emotions without becoming overwhelmed, you can make a huge difference in your ability to manage stress, balance your moods, and take back control of your life

Step Two: Move Your Thing

Making time for regular exercise has always been one of the keys to cope for veterans with PTSD. Not only does physical activity help to burn off adrenaline, exercise can release endorphins and improve your mood. And by really focusing on your body and how it feels as you exercise, you can even help your nervous system become “unstuck” and move out of the immobilization stress response.

Exercise that is rhythmic and engages both your arms and legs—such as running, swimming, basketball, or even dancing—works well if you stop feeling your feelings and focus your thoughts upon how your body feels.

Try to notice the sensation of your feet hitting the ground, for example, or the rhythm of your breathing, or the feeling of wind on your skin. Many veterans with PTSD find that sports such as rock climbing, boxing, weight training, and martial arts make it easier to focus on your body movements – obviously, if you don’t, you could get injured. Whatever exercise you choose, try to work out for 30 minutes or more each day—or if it’s easier, three 10-minute spurts of exercise are fine.

One of the great parts of being outside is that pursuing outdoor activities in nature like hiking, camping, mountain biking, rock climbing, whitewater rafting, and skiing can help challenge your sense of vulnerability and help you transition back into civilian life.

Seek out local organizations that offer outdoor recreation or team building opportunities, or, in the U.S., check out Sierra Club Military Outdoors, which provides service members, veterans, and their families with opportunities to get out into nature and get moving.

Step Three: Take Care of Yourself

The symptoms of PTSD in veterans, such as insomnia, anger, concentration problems, and jumpiness, can be hard on your body and eventually take a toll on your overall health. That’s why it’s so important to take care of yourself.

You may be drawn to activities and behaviors that pump up adrenaline, whether it’s caffeine, drugs, violent video games, driving recklessly, or daredevil sports. After being in a combat zone, that’s what feels normal. But if you recognize these urges for what they are, you can make better choices that will calm and care for your body—and your mind.

Relax: Relaxation techniques such as massage, meditation, or yoga can reduce stress, ease the symptoms of anxiety and depression, help you sleep better, and increase feelings of peace and well-being.

Find safe ways to blow off steam: Pound on a punching bag, pummel a pillow, go for a hard run, sing along to loud music, or find a secluded place to scream at the top of your lungs.

Support your body with a healthy diet: Omega-3s play a vital role in emotional health so incorporate foods such as fatty fish, flaxseed, and walnuts into your diet. Limit processed and fried food, sugars, and refined carbs which can exacerbate mood swings and energy fluctuations.

Get plenty of sleep: Sleep deprivation exacerbates anger, irritability, and moodiness. Aim for 7 to 9 hours of quality sleep each night. Develop a relaxing bedtime ritual (listen to calming music, take a hot shower, or read something light and entertaining), turn off screens at least one hour before bedtime, and make your bedroom as dark and quiet as possible.

Avoid alcohol and drugs: It can be tempting to turn to drugs and alcohol to numb painful memories and get to sleep. But substance abuse can make the symptoms of PTSD worse. The same goes for cigarettes. If possible, stop smoking and seek help for drinking and drug problems.

Step Four: Connect With Others

Connecting face-to-face doesn’t have to mean a lot of talking. But for any veteran with PTSD, it’s important to find someone who will listen without judging when you want to talk, or just hang out with you when you don’t. That person may be your significant other, a family member, one of your buddies from the service, or a civilian friend.

Volunteer your time or reach out to someone in need. This is a great way to both connect to others, feel good about yourself, while reclaiming your sense of power.

Join a PTSD support group. Connecting with other veterans facing similar problems can help you feel less isolated and provide useful tips on how to cope with symptoms and work towards recovery.

Connecting with Civilians

You may feel like civilians in your life can’t understand you since they haven’t been in the service or seen the things you have. But people don’t have to have gone through the exact same experiences to relate to painful emotions and be able to offer support. What matters is that the person you’re turning to cares about you, is a good listener, and a source of comfort.

You don’t have to talk about your combat experiences. If you’re not ready to open up about the details of what happened, that’s okay. You can talk about how you feel without going into a blow-by-blow account of events.

Tell the other person what you need or what they can do to help. That could be just sitting with you, listening, or doing something practical. Comfort comes from someone else understanding your emotional experience.

People who care about you want to help. Listening is not a burden for them but a welcome opportunity to help.

If Connecting Is Too Difficult

No matter how close you are to someone, PTSD can mean that you still don’t feel any better after talking. If that describes you, there are ways to help the process along.

Exercise or move. Before chatting with a friend, either exercise or move around. Jump up and down, swing your arms and legs, or just flail around. Your head will feel clearer and you’ll find it easier to connect.

Vocal toning. As strange as it sounds, vocal toning is a great way to open up to social engagement. Find a quiet place before you meet a friend. Sit straight and simply make “mmmm” sounds. Change the pitch and volume until you experience a pleasant vibration in your face.

Step Five: Flashbacks, Nightmares, and Intrusive Thoughts

For veterans with PTSD, flashbacks usually involve visual and auditory memories of combat. It feels as if it’s happening all over again so it’s vital to reassure yourself that the experience is not occurring in the present. Trauma specialists call this “dual awareness.”

Dual awareness is the recognition that there is a difference between your “experiencing self” and your “observing self.” On the one hand, there is your internal emotional reality: you feel as if the trauma is currently happening. On the other hand, you can look to your external environment and recognize that you’re safe. You’re aware that despite what you’re experiencing, the trauma happened in the past. It is not happening now.

State to yourself (out loud or in your head) the reality that while you feel as if the trauma is currently happening, you can look around and recognize that you’re safe.

Use a simple script when you awaken from a nightmare or start to experience a flashback: “I feel [panicked, overwhelmed, etc.] because I’m remembering [traumatic event], but as I look around I can see that the event isn’t happening right now and I’m not in danger.”

Describe what you see when look around (name the place where you are, the current date, and three things you see when you look around).

Try tapping your arms to bring you back to the present.

Tips For Grounding Yourself During A Flashback:

If you’re starting to disassociate or experience a flashback, try using your senses to bring you back to the present and “ground” yourself. Experiment to find what works best for you.

• Sight – Blink rapidly and firmly; look around and take inventory of what you see
• Movement – Move around vigorously (run in place, jump up and down, etc.); rub your hands together; shake your head
• Sound – Turn on loud music; clap your hands or stomp your feet; talk to yourself (tell yourself you’re safe, you’ll be okay)
• Taste – Suck on a strong mint or chew a piece of gum; bite into something tart or spicy; drink a glass of cold water or juice
• Touch – Splash cold water on your face; grip a piece of ice; touch or grab on to a safe object; pinch yourself; play with worry beads or a stress ball
• Smell – Smell something that links you to the present (coffee, mouthwash, your wife’s perfume) or a scent that has good memories

Step Six: Work through survivor’s guilt

Feelings of guilt are very common among veterans with PTSD. You may have seen people injured or killed, often your friends and comrades. In the heat of the moment, you don’t have time to fully process these things as they happen. But later—often when you’ve returned home—these experiences come back to haunt you. You may ask yourself questions such as:

• Why didn’t I get hurt?
• Why did I survive when others didn’t?
• Could I have done something differently to save them?

You may end up blaming yourself for what happened and believing that your actions (or inability to act) led to someone else’s death. You may feel like others deserved to live more than you—that you’re the one who should have died.

This is survivor’s guilt.

Healing from survivor’s guilt:

It’s important to remember that healing doesn’t mean that you’ll forget what happened or those who died. And it doesn’t mean you’ll have no regrets. What it does mean is that you’ll look at your role more realistically.

• Is the amount of responsibility you’re assuming reasonable?
• Could you really have prevented or stopped what happened?
• Are you judging your decisions based on full information about the event, or just your emotions?
• Did you do your best at the time, under challenging circumstances?
• Do you truly believe that if you had died, someone else would have survived?

Honestly assessing your responsibility and role can free you to move on and grieve your losses. Even if you continue to feel some guilt, instead of punishing yourself, you can redirect your energy into honoring those you lost and finding ways to keep their memory alive. For example, you could volunteer for a cause that’s connected in some way to one of the friends you lost. The goal is to put your guilt to positive use and thus transform tragedy, even in a small way, into something worthwhile.

Step Seven: Seek professional treatment

Professional treatment for PTSD can help you confront what happened to you and learn to accept it as a part of your past. Working with an experienced therapist or doctor, treatment may involve:

Cognitive-behavioral therapy (CBT) or counseling. This involves gradually “exposing” yourself to thoughts and feelings that remind you of the event. Therapy also involves identifying distorted and irrational thoughts about the event—and replacing them with more balanced picture.

Medication, such as antidepressants. While medication may help you feel less sad, worried, or on edge, it doesn’t treat the causes of PTSD.

EMDR (Eye Movement Desensitization and Reprocessing). This incorporates elements of CBT with eye movements or other rhythmic, left-right stimulation such as hand taps or sounds. These can help your nervous system become “unstuck” and move on from the traumatic event.

Effects of PTSD On Relationships:

PTSD can affect how couples get along with each other. It can also affect the mental health of partners. In general, PTSD can have a negative effect on the whole family.

Male Veterans with PTSD are more likely to report the following problems than Veterans without PTSD:

• Marriage or relationship problems
• Parenting problems
• Poor family functioning

Most of the research on PTSD in families has been done with female partners of male Veterans. The same problems can occur, though, when the person with PTSD is female.

Effects on marriage

Compared to Veterans without PTSD, Veterans with PTSD have more marital troubles. They share less of their thoughts and feelings with their partners. They and their spouses also report more worry around intimacy issues. Sexual problems tend to be higher in combat Veterans with PTSD. Lower sexual interest may lead to lower satisfaction within the relationship.

The National Vietnam Veterans Readjustment Study (NVVRS) compared Veterans with PTSD to those without PTSD.

The findings showed that Vietnam Veterans with PTSD:

• Got divorced twice as much
• Were three times more likely to divorce two or more times
• Tended to have shorter relationships

Family violence

Families of Veterans with PTSD experience more physical and verbal aggression. Such families also have more instances of family violence. Violence is committed not just by the males in the family. One research study looked at male Vietnam Veterans and their female partners. The study compared partners of Veterans with PTSD to partners of those without PTSD. Female partners of Veterans with PTSD:

• Committed more family violence than the other female partners
• Committed more family violence than their male Veteran partners with PTSD

Mental health of partners

PTSD can affect the mental health and life satisfaction of a Veteran’s partner. The same research studies on Vietnam Veterans compared partners of Veterans with and without PTSD. The partners of the Vietnam Veterans with PTSD reported:

• Lower levels of happiness
• Less satisfaction in their lives
• More demoralization (discouragement)
• About half have felt “on the verge of a nervous breakdown”

These effects were not limited to females. Male partners of female Veterans with PTSD reported lower well-being and more social isolation.

Partners often say they have a hard time coping with their partner’s PTSD symptoms. Partners feel stress because their own needs are not being met. They also go through physical and emotional violence. One explanation of partners’ problems is secondary traumatization. This refers to the indirect impact of trauma on those close to the survivor. Another explanation is that the partner has gone through trauma just from living with a Veteran who has PTSD. For example, the risk of violence is higher in such families.

Caregiver burden

Partners have a number of challenges when living with a Veteran who has PTSD. Wives of PTSD-diagnosed Veterans tend to take on a bigger share of household tasks such as paying bills or housework. They also do more taking care of children and the extended family. Partners feel that they must take care of the Veteran and attend closely to the Veteran’s problems. Partners are keenly aware of what can trigger symptoms of PTSD. They try hard to lessen the effects of those triggers.

Caregiver burden is one idea used to describe how hard it is caring for someone with an illness such as PTSD. Caregiver burden includes practical problems such as strain on the family finances. Caregiver burden also includes the emotional strain of caring for someone who is ill. In general, the worse the Veteran’s PTSD symptoms, the more severe is the caregiver burden.

Why are these problems so common?

The exact connection between PTSD symptoms and relationship problems is not clearly known. Some symptoms, like anger and negative changes in beliefs and feelings, may lead directly to problems in a marriage. For example, a Veteran who cannot feel love or happiness may have trouble acting in a loving way towards a spouse. Expression of emotions is part of being close to someone else. Not being able to feel your emotions can lead to problems making and keeping close relationships. Numbing can get in the way of intimacy.

Help for partners of Veterans with PTSD

The first step for partners of Veterans with PTSD is to gather information. This helps give you a better understanding of PTSD and its impact on families. Resources on the National Center for PTSD website may be useful.

Some effective strategies for treatment include:

• Education for the whole family about the effects of trauma on survivors and their families
• Support groups for both partners and Veterans
• Individual therapy for both partners and Veterans
• Couples or family counseling

VA has taken note of the research showing the negative impact of PTSD on families. PTSD programs and Vet Centers have begun to offer group, couples, and individual counseling for family members of Veterans.

Overall, the message for partners is that problems are common when living with a Veteran who has been through trauma. The treatment options listed above may be useful to partners as they search for better family relationships and mental health

How PTSD Can Affect The Family:

When a loved one returns from military service with PTSD, it can take a heavy toll on your relationship and family life. You may have to take on a bigger share of household tasks, deal with the frustration of a loved one who won’t open up, or even deal with anger or other disturbing behavior.

Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.

Sympathy: You may feel sorry for your loved one’s suffering. This may help your loved one know that you sympathize with him or her. However, be careful that you are not treating him or her like a permanently disabled person. With help, he or she can feel better.

Negative feelings PTSD can make someone seem like a different person. If you believe your family member no longer has the traits you loved, it may be hard to feel good about them. The best way to avoid negative feelings is to educate yourself about PTSD. Even if your loved one refuses treatment, you will probably benefit from some support.

Avoidance: Avoidance is one of the symptoms of PTSD. Those with PTSD avoid situations and reminders of their trauma. As a family member, you may be avoiding the same things as your loved one. Or, you may be afraid of his or her reaction to certain cues. One possible solution is to do some social activities, but let your family member stay home if he or she wishes. However, he or she might be so afraid for your safety that you also can’t go out. If so, seek professional help.

Depression This is common among family members when the person with PTSD causes feelings of pain or loss. When PTSD lasts for a long time, you may begin to lose hope that your family will ever “get back to normal.”

Anger and guilt: If you feel responsible for your family member’s happiness, you might feel guilty when you can’t make a difference. You could also be angry if he or she can’t keep a job or drinks too much, or because he or she is angry or irritable. You and your loved one must get past this anger and guilt by understanding that the feelings are no one’s fault.

Health problems: Everyone’s bad habits, such as drinking, smoking, and not exercising, can get worse when trying to cope with their family member’s PTSD symptoms. You may also develop other health problems when you’re constantly worried, angry, or depressed.

Helping a Veteran With PTSD

Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.

Family members may feel hurt, alienated, or discouraged because your loved one has not been able to overcome the effects of the trauma. Family members frequently devote themselves totally to those they care for and, in the process, neglect their own needs.

Social support is extremely important for preventing and helping with PTSD. It is important for family members to take care of themselves; both for their own good and to help the person dealing with PTSD.

Don’t take the symptoms of PTSD personally. If your loved one seems distant, irritable, angry, or closed off, remember that this may not have anything to do with you or your relationship.

Don’t pressure your loved one into talking. Many veterans with PTSD find it difficult to talk about their experiences. Never try to force your loved one to open up but let them know that you’re there if they want to talk. It’s your understanding that provides comfort, not anything you say.

Be patient and understanding. Getting better takes time so be patient with the pace of recovery. Offer support but don’t try to direct your loved one.

Try to anticipate and prepare for PTSD triggers such as certain sounds, sights, or smells. If you are aware of what causes an upsetting reaction, you’ll be in a better position to help your loved one calm down.

Take care of yourself. Letting your loved one’s PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout. Make time for yourself and learn to manage stress. The more calm, relaxed, and focused you are, the better you’ll be able to help your loved one.

Additional PTSD and Veterans Resources:

Real Warriors: A website to support the promotion of psychological health, reduce stigma of psychological health concerns and encourage help seeking behavior for service members, veterans and their families.

VA Caregiver Support website: Support for caregivers and loved ones of veterans who have PTSD.

Call the VA Caregiver Support Line: 1-855-260-3274

Sierra Outdoors Club: Military Outdoors organizes outdoor trips for veterans, other service members and their families, because we know that time spent in nature provides a unique experience to foster mental and physical health, emotional resiliency, and leadership development. For many veterans, spending time in the outdoors can also help ease the transition to civilian life.

VA Peer Support Groups: Peer support groups are led by someone like you who has been through a trauma. Groups often meet in person, but many groups also provide online (Internet) support.

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