Suicide Prevention Resources

by Band Back Together | Aug 18, 2018

If you are feeling desperate, alone or helpless, or know someone who is
call 1-800-273-TALK (8255)
to talk to a counselor at the National Suicide Prevention Lifeline.

What Is Suicide?

Suicide is one of the top 10 causes of death in the United States, accounting for around 40,000 deaths per year and an estimated 1 million deaths worldwide. It leaves behind more unanswered questions than any other cause of death. Friends and family members are left in a wake of uncertainty, most never knowing what events led to their loved one’s death.

Suicide is the act of purposely ending one’s own life. How societies view suicide varies widely according to culture and religion. For example, many Western cultures, as well as mainstream Judaism, Islam, and Christianity tend to view killing oneself as quite negative. One myth about suicide that may be the result of this view is considering suicide (suicidal ideation) to always be the result of a mental illness. Some societies also treat a suicide attempt as if it were a crime. However, suicides are sometimes seen as understandable or even honorable in certain circumstances, as in protest to persecution (for example, a hunger strike), as part of battle or resistance (for example, suicide pilots of World War II, suicide bombers), or as a way of preserving the honor of a dishonored person (for example, killing oneself to preserve the honor or safety of family members).

More than 800,000 people worldwide committed suicide in 2012, with many more suicide attempts annually. That translates into someone dying by suicide every 40 seconds somewhere in the world. More than 39,000 people reportedly kill themselves each year in the United States, making it the 10th leading cause of death.

The true number of suicides is likely higher because some deaths that were thought to be an accident, like a single-car accident, overdose, or shooting, are not recognized as being a suicide.

The higher frequency of completed suicides in males versus females is consistent across the life span, but the ratio of men to women who complete suicide decreases from 3:1 in wealthier countries to closer to 1.5:1 in less wealthy countries. In the United States, boys 10-14 years of age commit suicide twice as often as their female peers. Teenage boys 15-19 years of age complete suicide five times as often as girls their age, and men 20-24 years of age commit suicide 10 times as often as women their age.

Gay, lesbian, transgender, and other sexual minority youth are more at risk for thinking about and attempting suicide than heterosexual teens.

There are trends regarding the means of committing suicide as well. For example, the frequency of hanging, carbon monoxide poisoning, or other forms of self-suffocation increased from 1992 to 2006, while committing suicide by a gun has decreased during that period of time and has remained unchanged from 2012-2013.

Suicide is the second leading cause of death for people 15-29 years of age. Teen suicide statistics for youths 15-19 years of age indicate that from 1950-1990, the frequency of suicides increased by 300% and from 1990-2003, that rate decreased by 35%. However, from 1999 through 2006, the rate of suicide increased by about 1% per year and by about 2% per year from 2006 through 2014, both in the 10-24 years and the 25-64 years old age groups.

While the rate of murder-suicide remains low, the devastation it creates makes it a concerning public-health issue.

The rates of suicide can vary with the time of year, as wells as with the time of day. For example, the number of suicides by train tends to peak soon after sunset and about 10 hours earlier each day. Although professionals like police officers and dentists are thought to be more vulnerable to suicide than others, important flaws have been found in the research upon which those claims are based.

As opposed to suicidal behavior, self-mutilation is defined as deliberately hurting oneself without meaning to cause one’s own death. Examples of self-mutilating behaviors include cutting any part of the body, usually of the wrists. Self-tattooing is also considered self-mutilation. Other self-injurious behaviors include self-burning, head banging, pinching, and scratching.

Physician-assisted suicide is defined as ending the life of a person who is terminally ill in a way that is either painless or minimally painful for the purpose of ending suffering of the individual. It is also called euthanasia and mercy killing. In 1997, the United States Supreme Court ruled against endorsing physician-assisted suicide as a constitutional right but allowed for individual states to enact laws that permit it to be done. As of 2016, California, Oregon, Washington, and Vermont were the only states with laws in effect that authorized physician-assisted suicide, but a number of other states are in the process of considering it. Physician-assisted suicide seems to be less offensive to people compared to assisted suicide that is done by a non-physician, although the acceptability of both means to end life tends to increase as people age and with the severity of medical illness and the number of times the person who desires their own death repeatedly asks for such assistance.

Ethnically, the highest suicide rates in the United States occur in non-Hispanic whites and in Native Americans. The lowest rates are in non-Hispanic blacks, Asians, Pacific Islanders, and Hispanics. Former Eastern Bloc countries currently have the highest suicide rates worldwide, while South America has the lowest. Geographical patterns of suicides are such that individuals who live in a rural area versus urban area and the western United States versus the eastern United States are at higher risk for killing themselves. The majority of suicide completions take place during the spring.

In most countries, women continue to attempt suicide more often, but men tend to complete suicide more often. Although the frequency of suicides for young adults has been increasing in recent years, elderly Caucasian males continue to have the highest rate of suicide completion. Other risk factors for taking one’s life include poor access to mental-health care, single marital status, unemployment, low income, mental illness, a history of being physically or sexually abused, a personal history of suicidal thoughts, threats or behaviors, or a family history of attempting suicide. A lack of access to mental-health care has also been identified as increasing the likelihood of suicide. The means of attempting suicide can have particular risk factors as well. For example, individuals who attempt suicide by jumping from a height like a bridge may be more likely to be single, unemployed, and psychotic, while those who use firearms may more often have a history of legal issues, alcoholism, and certain personality disorders.

Data regarding mental illnesses as risk factors indicate that depression, manic depression, schizophrenia, substance abuse, eating disorders, and severe anxiety increase the probability of suicide attempts and completions. Nine out of 10 people who commit suicide have a diagnosable mental-health problem and up to three out of four individuals who take their own life had a physical illness when they committed suicide. Behaviors that tend to be linked with suicide attempts and completions include impulsivity, violence against others, and self-mutilation, like slitting one’s wrists or other body parts, or burning oneself.

Over 90% of those who die by suicide have a mental illness at the time of their death – the most common mental illness that leads to suicide is untreated major depression. Other mental illnesses that may lead to suicide include bipolar disorder and schizophrenia.

It’s very rare for someone to die by suicide due to a single cause. Usually, there are several reasons that someone chooses to die by suicide.

Risk factors for adults who commit murder-suicide include male gender, older caregiver, access to firearms, separation or divorce, depression, and drug abuse or addiction.

In children and adolescents, bullying and being bullied seem to be associated with an increased risk of suicidal behaviors. Specifically regarding male teens who ultimately commit murder-suicide by school shootings, being bullied may play a significant role in putting them at risk for this outcome. Another risk factor that renders children and teens more at risk for suicide compared to adults is having someone they know commit suicide, which is called contagion or cluster formation.

Generally, the absence of mental illness and substance abuse, as well as the presence of a strong social support system, decrease the likelihood that a person will kill him- or herself. Having children who are younger than 18 years of age also tends to be a protective factor against mothers committing suicide.

What Are Some Common Motivations For Suicide?

Left in the wake of a suicide, many suicide survivors try to understand why a loved one chose to end his or her life. Here are some of the common reasons for a suicide:

Suicide is a solution. Suicide is many things, but it is neither random nor pointless. To those who choose to end their lives, suicide is seen as an answer to an unsolvable problem or a way out of a horrible dilemma. Suicide is (somehow) the preferred choice to another set of dreaded circumstances, emotional pain, or disability, which the person fears more than death.

Suicide is a way to cease consciousness. Those who die by suicide want to end their conscious experience, which, for them, has become an endless stream of distressing, preoccupying thoughts. Suicide offers total oblivion.

Suicide stemming from frustrated psychological needs. People who have high standards and expectations are extra vulnerable to suicide when progress toward goals is suddenly frustrated. People who attribute failure and disappointment to their own shortcomings may view themselves as worthless, unlovable, and incompetent. In adults, suicide is often related to work or interpersonal problems. In teenagers, suicide is often precipitated by family turmoil.

Suicide may be a way to end intolerable psychological pain. Excruciating negative emotions (i.e. sadness, shame, guilt, anger, and fear) from any circumstance frequently serve as the foundation for suicide.

Suicide stems from ambivalence. Most of those who contemplate suicide – including those successful in carrying out their suicidal plans -are ambivalent. They do want to die, yet they also wish they could find another solution to their dilemma.

Suicide may be a response to hopelessness and/or helplessness. A pessimistic expectation about the future is even more important than other types of negative emotions (anger, depression) in predicting suicide. A suicidal person is convinced that nothing whatsoever can improve the situation; that no one else can help.

Suicide as a plan. Suicidal thoughts and plans are like tunnel vision. The suicidal person is unable or unwilling to engage in any effective problem-solving behaviors and may see everything in all or nothing terms.

Someone who dies by suicide has often spoken of his or her suicidal ideations. There’s a harmful myth that those who really want to die by suicide do not talk about it. However, at least 80% of those who do end up killing themselves have spoken to others about their plans or have attempted suicide before.

Suicide as an escape. Suicide provides a way to escape from intolerable circumstances.

Those who die by suicide may lack coping skills. During crisis periods that precipitate suicidal thoughts, people tend to use the response patterns they’ve used all of their life.

What Are Some of the Common Warning Signs For Suicide?

Warning signs that a person is imminently planning to kill themselves may include making a will, getting his or her affairs in order, suddenly visiting friends or family members (one last time), buying instruments of suicide like a gun, hose, rope, pills, or other forms of medications, a sudden and significant decline or improvement in mood, or writing a suicide note. Contrary to popular belief, many people who complete suicide do not tell their therapist that they plan to kill themselves in the months before they do so. If they communicate their plan to anyone, it is more likely to be someone with whom they are personally close, like a friend or family member.

While it may seem otherwise, suicide is rarely a spur of the moment idea. The strongest signs that someone is going to commit suicide are verbal, such as, “I cannot go on,” “I can’t do this anymore,” “Nothing matters,” “I’m thinking of ending it all.”

While many people do not exhibit any symptoms of suicide, approximately 75% of those who die by suicide do exhibit warning signs of suicide. Always take any warning signs of suicide very, very seriously.

Here are some warning signs that someone you love may be feeling suicidal:

• Becoming depressed and acting sad most of the time
• Losing interest in activities
• Talking or writing about death or suicide
• Sudden and dramatic change in mood
• Sudden change in personality
• Feeling hopeless/helpless without a reason to live.
• Feeling a strong rage
• Feeling trapped in a situation
• Acting impulsively
• Giving away possessions
• Getting affairs in order
• Writing a will
• Withdrawing from family and friends
• Abusing drugs and/or alcohol
• Looking for ways to kill oneself
• Feeling hopeless
• Change in sleeping and eating habits
• Performing poorly at work or school

People who take their lives tend to suffer from severe anxiety or depression, symptoms of which may include moderate alcohol abuse, insomnia, severe agitation, loss of interest in activities they used to enjoy (anhedonia), hopelessness, and persistent thoughts about the possibility of something bad happening. Since suicidal behaviors are often quite impulsive, removing guns, medications, knives, and other instruments people often use to kill themselves from the immediate environment can allow the individual time to think more clearly and perhaps choose a more rational way of coping with their pain. It can also allow the person’s caregivers or loved ones time to intervene.

Occupations That May Increase The Risk For Suicide:

Researchers reviewed more than 12,000 suicides that occurred in 17 states in 2012 using the CDC’s National Violent Death Reporting System, which provide statistics of violent deaths to help local decision-making, especially suicide prevention efforts. The dat provides a significant snapshot of how suicide rates can differ by occupation. Namely, it’s the first multistate study to look at suicide rates for all of the major occupational groups as defined by the Bureau of Labor Statistics.

Where men are about four times more likely to die from suicide than women, according to the CDC, male-dominated industries also saw higher rates of suicide. But experts note that women, too, are not immune to occupational hazards that can contribute to suicide risk.

Researchers found those who worked in farming, fishing and forestry – which together comprised one occupational group – had the highest rate of suicide: 84.5 suicides per 100,000 people working in these industries. The next highest overall suicide rates were found among individuals working in construction and extraction, at 53.3 per 100,000 people; then installation, maintenance and repair, at 47.9 per 100,000 people.

By comparison, the lowest rate of suicide overall was found among those who worked in the education, training and library occupational group, with 7.5 suicides per 100,000 people. Among women, the highest rates of suicide were found for those who worked in protective service occupations, such as police officers and firefighters: 14.1 suicides per 100,000 women working in these fields.

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.

Grief Resources

by Band Back Together | Aug 15, 2018

What Is Grief?

Grief is a normal human response to the loss of something or something significant. Grief is a journey toward healing and recovering from this significant loss. Grief reactions may be felt in response to physical losses (the death of a loved one) or in response to symbolic or social losses (divorce, loss of job). Either type of grief reaction involves something being taken away.

Read more about loss.

Read more about help with grieving.

Coping with the loss of someone or something you love is one of life’s biggest challenges. Often, the pain of loss can feel overwhelming. You may experience all kinds of difficult and unexpected emotions, from shock or anger to disbelief, guilt, and profound sadness. The pain of grief can also disrupt your physical health, making it difficult to sleep, eat, or even think straight. These are normal reactions to significant loss. But while there is no right or wrong way to grieve, there are healthy ways to cope with the pain that, in time, can ease your sadness and help you come to terms with your loss, find new meaning, and move on with your life.

Before healing from grief may begin, one must accept and manage the pain of loss. Grief is as individual as each person experiencing it. There is no right or wrong way to grieve.

Grief is a very natural process but we, as highly intelligent humans, often think we can ignore our bodies and hearts and just “get on with it.” Pay attention to your body, your heart, your soul and your family. They will never lead you astray.

Grief is a natural response to loss. It’s the emotional suffering you feel when something or someone you love is taken away. The more significant the loss, the more intense your grief will be. You may associate grieving with the death of a loved one—which is often the cause of the most intense type of grief—but any loss can cause grief, including:

1. Divorce or relationship breakup
2. Loss of health
3. Losing a job
4. Loss of financial stability
5. A miscarriage
6. Death of a pet
7. Selling and moving from the family home
8. A loved one’s serious illness
9. Loss of a friendship
10. Traumatic responses
11. Retirement
12. Loss of a dream

Even subtle losses in life can trigger a sense of grief. For example, you might grieve after moving away from home, graduating from college, or changing jobs. Whatever your loss, it’s personal to you, so don’t feel ashamed about how you feel, or believe that it’s somehow only appropriate to grieve for certain things. If the person, animal, relationship, or situation was significant to you, it’s normal to grieve the loss you’re experiencing. Whatever the cause of your grief, though, there are healthy ways to deal with the pain and eventually come to terms with your loss.

What Are Some of the Symptoms of Grief?

While loss affects people in different ways, many of us experience the following symptoms when we’re grieving. Just remember that almost anything that you experience in the early stages of grief is normal—including feeling like you’re going crazy, feeling like you’re in a bad dream, or questioning your religious or spiritual beliefs.

Emotional Symptoms of Grief:

Shock and disbelief. Right after a loss, it can be hard to accept what happened. You may feel numb, have trouble believing that the loss really happened, or even deny the truth. If someone you love has died, you may keep expecting them to show up, even though you know they’re gone.

Sadness. Profound sadness is probably the most universally experienced symptom of grief. You may have feelings of emptiness, despair, yearning, or deep loneliness. You may also cry a lot or feel emotionally unstable.

Guilt. You may regret or feel guilty about things you did or didn’t say or do. You may also feel guilty about certain feelings (e.g. feeling relieved when the person died after a long, difficult illness). After a death, you may even feel guilty for not doing something to prevent the death, even if there was nothing more you could have done.

Anger. Even if the loss was nobody’s fault, you may feel angry and resentful. If you lost a loved one, you may be angry with yourself, God, the doctors, or even the person who died for abandoning you. You may feel the need to blame someone for the injustice that was done to you.

Fear. A significant loss can trigger a host of worries and fears. You may feel anxious, helpless, or insecure. You may even have panic attacks. The death of a loved one can trigger fears about your own mortality, of facing life without that person, or the responsibilities you now face alone.

Physical Symptoms of Grief:

We often think of grief as a strictly emotional process, but grief can and will involve physical problems, including:

• Fatigue
• Nausea
• Lowered immunity
• Weight loss or weight gain
• Aches and pains
• Insomnia

Normal Patterns of Grief:

Grieving is a highly individual experience; there’s no right or wrong way to grieve. How you grieve depends on many factors, including your personality and coping style, your life experience, your faith, and how significant the loss was to you.

Inevitably, the grieving process takes time. Healing happens gradually; it can’t be forced or hurried—and there is no “normal” timetable for grieving. Some people start to feel better in weeks or months. For others, the grieving process is measured in years. Whatever your grief experience, it’s important to be patient with yourself and allow the process to naturally unfold.

Several patterns of grief have been identified and documented, but it is important to remember that grief is as individual as the person experiencing it.

Early Phase of grieving is marked by shock, dismay and disbelief. It leaves a person feeling unproductive, dazed and mechanical as they try to function. This phase of grief may last hours, minutes, days or weeks, although thanks to psychological numbing, the person may not remember what has happened during this period.

Middle Phase of grief is marked by much intense pain with more intense reactions. The middle phase lasts many months. Even after life seems to be back to normal, a chance remark can cause those feelings to resurface.

Late Phase of grief is the process characterized by glimmers of hope, renewed sense of coping and a returning sense of well-being, and a renewed belief in life.

What Are The Five Stages of Grief?

The Five Stages of Grief were postulated by Elizabeth Kubler-Ross after interviewing 500 dying patients. It describes, in five separate stages, the model by which people cope with and handle grief, tragedy, and catastrophic loss.

These stages have been accepted as the Five Stages of Grief, although these stages are not meant to be completely linear or chronological stages. Nor does everyone dealing with a catastrophic loss experience the five stages in the same manner. Some stages may be missed, some re-experienced, while some may get stuck in one stage.

Grief is as unique as the person experiencing it.

1. Denial and Isolation. Commonly, when a person is faced with a catastrophic event, they feel denial. Their reaction is one of shock and disbelief: “I’m fine,” or “This cannot be happening to me.” Denial is a built-in coping mechanism allowing the pain to seep through the numbness in small increments. If all the pain hit at once, it would be debilitating. Those grieving may isolate themselves from social contacts while denying the loss.

2. Anger. The individual experiencing the loss realizes that denial cannot continue. The person becomes outraged, envious, and full of anger. Anger can be healing. While the anger may be directed toward no one at all, it may spill out into the grieving person’s relationships with other people. The anger shouldn’t escalate to a dangerous level, but a healthy amount is therapeutic. The anger you feel is an indication of the intensity of your love and loss. “Why me?” and “Who can I blame?” are common reactions during this stage of grief.

3. Bargaining. After the anger abates, those who are grieving enter a stage of bargaining with God. This stage is reminiscent of childhood days when children plead with their parents. It’s almost as though the bereaved is saying, “Now that I’m no longer angry, can I have a little more time?” Someone in this stage of grief may say things like, “Please just let me see my child get married” or “Please let me have a few more minutes with my loved one.”

4. Depression. When the bereaved realizes they cannot deal their way out of this situation, reality sets in. Depression leads to sadness, grief, as the full weight of what they have lost or are in the process of losing sinks in. The bereaved cries and mourns and wonders how they can continue. It may be helpful for those in this stage of grief to talk through their feelings with a counselor or even good friends. This stage, along with the others, will ebb and flow over weeks, months, or possibly years.

5. Acceptance. Acceptance is the most confusing stage of grieving. Though the bereaved accepts that they have experienced a significant loss, they are never truly “over it.” People on the outside of the situation will assume the bereaved has moved on. During acceptance, the bereaved learns how to live their “new normal.” It’s much like learning to walk again but without a limb. It will NEVER be like it was, but life can can be lived again.

Abnormal Grief Reactions:

Anticipatory Grief is the emotional response that occurs before the loss itself. The emotional response has many of the characteristics of grief itself with a couple exceptions. With anticipatory grief, one hopes that the loss one anticipates will not occur. The uncertainty and wishing it would happen while dreading the finality of the loss make the grieving process more unstable.

Chronic Sorrow is the presence of pervasive grief in people with chronic illnesses, their caregivers, and the bereaved. It’s thought to be a normal response to an incomplete or ongoing loss.

While grieving a loss is an inevitable part of life, there are ways to help cope with the pain, come to terms with your grief, and eventually, find a way to pick up the pieces and move on with your life.

1. Acknowledge your pain and loss
2. Accept that your grief can trigger many different and unexpected emotions
3. Understand that your grieving process will be unique
4. Seek out face-to-face support from people who care about you.
5. Support yourself emotionally by taking care of yourself physically.
6. Recognize the difference between grief and depression

Distinguishing between grief and clinical depression isn’t always easy as they share many symptoms, but there are ways to tell the difference. Remember, grief can be a roller coaster. It involves a wide variety of emotions and a mix of good and bad days. Even when you’re in the middle of the grieving process, you will still have moments of pleasure or happiness. With depression, on the other hand, the feelings of emptiness and despair are constant.

Other symptoms that suggest depression, not just grief, include:

Types of Grievers:

Grief is a very complicated emotion and one who is deeply grieving may feel as though he or she is “grieving wrong”. There are several types of grievers – none are wrong. All are normal:

The Intuitive Grievers

A person who is an Intuitive Griever feels the experience of grief with great intensely. He or she may be helped by expressing his or her grief emotionally, often by crying. One of the best ways for the Intuitive Griever to cope with his or her grief is to express his or her emotions about the grief freely and openly, possibly in a group setting.

Common Characteristics of Intuitive Grievers include:

• Expresses his or her feelings openly.

• Anguish is expressed with sorrow with tears.

• An Intuitive Griever is not afraid to find support in other people.

• He or she allows the proper time to fully experience the inner pain.

• During the grief process, he or she may become physically exhausted or riddled with anxiety.

• During the grief process, he or she may experience long periods of confusion.

• The confusion may make way toward an inability to concentrate.

• Has the ability to openly discuss the grief.

• May benefit from support groups.

The Instrumental Griever

The Instrumental Griever feels grief, but less intensely and more physically. He or she may use thinking and problem-solve as ways of coping with the grieving experience. The Instrumental Griever must have a tangible, physical way to express the grief. He or she may be reluctant to talk about feelings.

Common Characteristics of Instrumental Grievers Include:

• He or she may push aside feelings of grief in order to cope with the present situation.

• Chooses active ways of expressing grief.

• May be hesitant to discuss his or her feelings.

• May use humor to express his or her feelings as well as to manage anger.

• Feelings may only be expressed in private.

• Needs – and seeks – solitude to reflect upon the grief and adapt to the loss.

• He or she may not find a support group setting an ideal place to discuss his or her feelings.

The Dissonant Griever:

The Dissonant Griever handles grief one way but feels uncomfortable with the manner in which they experience grief. A Dissonant Griever may feel that openly expressing his or her feelings about the grief may be inappropriate. Or, an Instrumental Griever may feel guilt and shame for being unable to express his or her emotions about the grief in the way that an Intuitive Griever can.

These conflicting feelings make it uncomfortable for the Dissonant Griever to deal with their grief and, therefore, harder for them to grieve

What Is Complicated Grief?

Complicated grief is grieving that is incapacitating, usually over a long period of time, and involves disorganized, depressed behavior. Professional help is always needed in cases of complicated grief.

Symptoms of Complicated Grief:

• Excessive focus on the loss
• Continued and intense longing/pining
• Difficulty accepting the loss
• Feeling numb or detached
• Distracting or consuming sorrow
• Feelings of bitterness
• Difficulty enjoying life
• Depression
• Trouble moving on
• Difficulty performing normal routines
• Withdrawal from family and friends
• Thoughts that life is pointless
• Irritability or agitation
• Distrust

Abbreviated Grief: Abbreviated grief is grief that is short-lived but genuine. It may occur in situations in which the deceased is quickly replaced (by remarriage or something similar).

Absent Grief: Absent grief is a situation in which there are no outward signs of grieving following the loss of a loved one. Absent grief may be grief that is stuffed down deep inside only to emerge in other ways like irritability, anger, or depression.

Ambiguous Loss: Ambiguous loss is a loss that is unseen or unaccepted socially as a “valid” loss. This may include a miscarriage, loss of a pet, or losing someone who has been slowly dying.

Converted Grief: Converted grief is grief that is displayed through excessive physical or psychological symptoms that are not linked by the person to their loss.

Delayed Grief: Delayed grief involves the postponement of grief for weeks, months and years. Delayed grief can abruptly be ended by subsequent losses or losses of others that are similar to their own.

Disenfranchised Grief: Disenfranchised Grief is a type of sorrow not publicly or socially recognized and the reality of the loss is unrecognized by society. Society may, in fact, stigmatize the grieving of the loss. This may occur with abortions, suicide, drug overdose, or other socially unacceptable deaths.

Distorted Grief: Distorted grief is morbid grief reaction in which anger and guilt are the two distorted types of emotions displayed.

Inhibited Grief: For those who have inhibited grief, there is some outward evidence that the person is grieving, but his or her reactions are less than expected in respect to the loss. This may occur with people who have unresolved issues with the dead or other negative emotions regarding the loss.

When You Should Call The Doctor:

If you’re experiencing symptoms of complicated grief or clinical depression, call your doctor (if you don’t have a therapist yet) right away. Left untreated, complicated grief and depression can lead to significant emotional damage, life-threatening health problems, and even suicide. But treatment can help you get better.

• Contact a grief counselor or professional therapist if you:
• Feel like life isn’t worth living
• Wish you had died with your loved one
• Blame yourself for the loss or for failing to prevent it
• Feel numb and disconnected from others for more than a few weeks
• Are having difficulty trusting others since your loss
• Are unable to perform your normal daily activities

Memorial pages on Facebook and other social media sites have become popular ways to inform a wide audience of a loved one’s passing and to reach out for support. As well as allowing you to impart practical information, such as funeral plans, these pages allow friends and loved ones to post their own tributes or condolences. Reading such messages can often provide comfort for those grieving the loss.

Of course, posting sensitive content on social media has its risks. Memorial pages are often open to anyone with a Facebook account. This may encourage people who hardly knew the deceased to post well-meaning but inappropriate comments or advice. Worse, memorial pages can also attract Internet trolls. There have been many well-publicized cases of strangers posting cruel or abusive messages on memorial pages.

To gain some protection, you can opt to create a closed group on Facebook rather than a public page, which means people have to be approved by a group member before they can access the memorial. It’s also important to remember that while social media can be a useful tool for reaching out to others, it can’t replace the face-to-face support you need at this time

Grief in Children:

Naturally children will display grief differently than adults. Children who are unable to express their complex feelings of loss may act out through increased demands for food, love, and attention or exhibiting babyish behavior. Because children have a limited ability to consider the world outside their own sphere of influence, they may blame themselves for a loss. It is important to address this concern with children and reassure them that the loss was not their fault.

If your grief is so intense that you have thoughts of suicide, please pick up the phone and dial 911.

In addition, the National Suicide Prevention Hotline is open 7 days a week, 24 hours per day: 1-800-273-8255.

Additional Grief and Grieving Resources:

GriefShare is an international website which helps individuals locate local grief recovery support groups in the US, Canada, UK, New Zealand, Australia, and South Africa. 

GriefNet.org allows people who are grieving to set up an online memorial to their loved ones. 

Page last audited 8/2018

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