Coping With a Suicide

by Band Back Together | Aug 18, 2018

Coping With A Death By Suicide:

The World Health Organization (WHO) estimates that over a million people die at their own hands each year. A suicide is not only a tragic loss of a life, but it leaves the survivors gasping, prostrate with grief and unanswered questions.

Read more about suicide prevention.

Grief is a universal experience all human beings encounter. Though death inevitably touches our lives, research shows that many people grieve in varying and different ways. From the textures of emotions, to length of time in mourning, to even the kinds of rituals and remembrances that help heal the irreplaceable loss. Grieving the death of a loved one is never, ever easy.

Suicide, however, has been described as a death like no other … and it truly is. Death by suicide stuns with soul-crushing surprise, leaving family and friends not only grieving the unexpected death, but confused and lost by this haunting loss.

In addition to the shocking, tragic loss of a suicide, survivors of suicide face many social stigmas. Suicide survivors suffer in many, many ways: someone they loved dearly has died, usually in a shocking unexpected way, the death may be considered a taboo for others. The grief surrounding a suicide is compounded by a society that is unable to fully feel and understand the pain of their grief.

Suicide survivors suffer a unique kind of pain – here are some ways to help a suicide survivor heal from their tragic loss. It is important for relatives, friends and the larger community to support people throughout the grief process.  The following are some suggestions on how to assist survivors directly.

Respect the timing and pacing of an individual’s grief process.  It is a difficult journey.  Encourage them to make choices that are right for them.

Be courageous – approach those that have lost a loved one by suicide. Let them know you heard.  Ask them how they really are.  This is important even if it has been some time since the actual death.

What Makes Suicide Grief So Hard To Handle?

Research has long known that suicide survivors move through very distinctive grief issues. Family and friends are prone to feeling significant bewilderment about the suicide. Why did this happen? How did I not see this coming? Overwhelming guilt about what they should have done more of or less of —become daily, haunting thoughts. Survivors of suicide loss often feel self-blame as if somehow they were responsible for their loved one’s suicide. Many also experience anger and rage against their loved one for abandoning or rejecting them—or disappointment that somehow they were not powerful enough, loved enough or special enough to prevent the suicide.

The grief process is always difficult, but a loss through suicide is like no other, and the grieving can be especially complex and traumatic. People coping with this kind of loss often need more support than others, but may get less. There are various explanations for this. Suicide is a difficult subject to contemplate. Survivors may be reluctant to confide that the death was self-inflicted. And when others know the circumstances of the death, they may feel uncertain about how to offer help. Grief after suicide is different, but there are many resources for survivors, and many ways you can help the bereaved.

The death of a loved one is never easy to experience, whether it comes without warning or after a long struggle with illness. But several circumstances set death by suicide apart and make the process of bereavement more challenging.

A traumatic aftermath. Death by suicide is sudden, sometimes violent, and usually unexpected. Depending on the situation, survivors may need to deal with the police or handle press inquiries. While you are still in shock, you may be asked whether you want to visit the death scene. Sometimes officials will discourage the visit as too upsetting; at other times, you may be told you’ll be grateful that you didn’t leave it to your imagination. “Either may be the right decision for an individual. But it can add to the trauma if people feel that they don’t have a choice,” says Jack Jordan, Ph.D., clinical psychologist and co-author of After Suicide Loss: Coping with Your Grief.

You may have recurring thoughts of the death and its circumstances, replaying the final moments over and over in an effort to understand — or simply because you can’t get the thoughts out of your head. Some suicide survivors develop post-traumatic stress disorder (PTSD), an anxiety disorder that can become chronic if not treated. In PTSD, the trauma is involuntarily re-lived in intrusive images that can create anxiety and a tendency to avoid anything that might trigger the memory.

Stigma, shame, and isolation. Suicide can isolate survivors from their community and even from other family members. There’s still a powerful stigma attached to mental illness (a factor in most suicides), and many religions specifically condemn the act as a sin, so survivors may understandably be reluctant to acknowledge or disclose the circumstances of such a death. Family differences over how to publicly discuss the death can make it difficult even for survivors who want to speak openly to feel comfortable doing so. The decision to keep the suicide a secret from outsiders, children, or selected relatives can lead to isolation, confusion, and shame that may last for years or even generations. In addition, if relatives blame one another — thinking perhaps that particular actions or a failure to act may have contributed to events — that can greatly undermine a family’s ability to provide mutual support.

Mixed emotions. After a homicide, survivors can direct their anger at the perpetrator. In a suicide, the victim is the perpetrator, so there is a bewildering clash of emotions. On one hand, a person who dies by suicide may appear to be a victim of mental illness or intolerable circumstances. On the other hand, the act may seem like an assault on or rejection of those left behind. So the feelings of anger, rejection, and abandonment that occur after many deaths are especially intense and difficult to sort out after a suicide.

Need for reason. “What if” questions may arise after any death. What if we’d gone to a doctor sooner? What if we hadn’t let her drive to the basketball game? After a suicide, these questions may be extreme and self-punishing — unrealistically condemning the survivor for failing to predict the death or to intervene effectively or on time. Experts tell us that in such circumstances, survivors tend to greatly overestimate their own contributing role — and their ability to affect the outcome.

“Suicide can shatter the things you take for granted about yourself, your relationships, and your world,” says Dr. Jordan. Many survivors need to conduct a psychological “autopsy,” finding out as much as they can about the circumstances and factors leading to the suicide, in order to develop a narrative that makes sense to them. While doing this, they can benefit from the help of professionals or friends who are willing to listen — without attempting to supply answers — even if the same questions are asked again and again.

Sometimes a person with a disabling or terminal disease chooses suicide as a way of gaining control or hastening the end. When a suicide can be understood that way, survivors may feel relieved of much of their what-if guilt. “It doesn’t mean someone didn’t love their life,” says Holly Prigerson, Ph.D., associate professor of psychiatry at Harvard Medical School. Adds Dr. Prigerson, “The grieving process may be very different than after other suicides.”

A risk for survivors. People who’ve recently lost someone through suicide are at increased risk for thinking about, planning, or attempting suicide. After any loss of a loved one, it’s not unusual to wish you were dead; that doesn’t mean you’ll act on the wish. But if these feelings persist or grow more intense, confide in someone you trust, and seek help from a mental health professional.

These mistaken assumptions plague survivors of suicide loss for a very long time. Many struggle for years trying to make sense of their loved one’s death—and even longer making peace—if at all—with the unanswerable questions that linger.

Society still attaches a stigma to suicide. And as such, survivors of suicide loss may encounter blame, judgment or social exclusion – while mourners of loved ones who have died from terminal illness, accident, old age or other kinds of deaths usually receive sympathy and compassion. It’s strange how we would never blame a family member for a loved one’s cancer or Alzheimer’s, but society continues to cast a shadow on a loved one’s suicide.

What also makes grieving different is that when we lose a loved one to illness, old age or an accident, we retain happy memories. We can think back on our loved one and replay fond memories, share stories with joyful nostalgia. This is not so for the suicide survivor. They questions the memories, “Where they really good?” “Maybe he wasn’t really happy in this picture?” “Why didn’t I see her emotional pain when we were on vacation?” Sometimes it becomes agonizing to connect to a memory or to share stories from the past—so survivors often divorce themselves from their loved one’s legacy.

Survivors of suicide loss not only experience these aspects of complicated grief, they are also prone to developing symptoms of depression and post-traumatic stress disorder—a direct result from their loved one’s suicide. The unspeakable sadness about the suicide becomes a circle of never ending bewilderment, pain, flashbacks, and a need to numb the anguish.

Suicide Grief in Children and Adolescents

Children and Adolescents

Children grieve in what is called “grief spurts”, they rapidly cycle through their grief and it may be apparent for only minutes at a time. The child may feel for a moment and then quite happy a short time later. They tend to grieve physically with bursts of excess energy.

The child’s response to death is very much age dependent and individualized, previous loss can also play a role in a child’s understanding of what has occurred. Young children (5 and under) are concrete in their thought processes and will not likely understand the permanence of death until they become older.

Children will express their grief through behavior. Some will act out, some will withdraw, some will become anxious in their attachments fearing something else bad might happen. It is normal to see regression in children who are bereaved (i.e. tantrums in children who are well beyond the “terrible twos)

Children and Adolescents Bereaved as a Result of Suicide:

Trying to navigate the path of grief after a death by suicide is tremendously complex to say the least. It is like desperately trying to untangle a knotted ball of string that has woven in upon itself, as soon as one thread is pulled another tightens.

This path can be especially confusing and frightening for children and teens who do not yet have the intellectual ability, the coping skills, life experience to assist them in this process.

One of the most helpful things for a child or teen at this point is the presence of caring and compassionate adults who can listen and support without judgment. Adults who will allow them to grieve in the way that they want to, not how anyone else thinks they should. Teens will tell you there should be  “no shoulds”.

Research suggests that child and adolescent bereavement can be internalized as a traumatic event. A trauma response can be considered an even stronger  possibility if the child witnessed the suicide, found the body and/or was exposed to emergency personnel attending at the scene of the death. Until the death is ruled a suicide the police operate under the assumption that it might have been a homicide. This in and of itself is incredibly frightening for adults so one can easily understand how confusing and scary this might be when viewed through the eyes of a child or teen.

Suicide Grief in Children

One of the most difficult decisions that adults face is what to tell the children about a death that has occurred as a result of suicide. Discussing death with a child can be heart-wrenching in and of itself without the added layer of explaining suicide.

Finding an age appropriate response to the truth of the cause of death is the direction that most experts will advocate: there is no need to go into the details of the death but speaking in broad terms in child friendly language is important. There are two primary reasons why honesty, although difficult, is required.  Children thrive when they are raised in an environment where they can trust the adults they interact with. When children are not told the truth of the nature of the death it can have long lasting impacts. Most children are quite intuitive and will feel the disconnect between what they are told and what is really happening, this can further destabilize them at an already volatile time. If a child is not told of the suicide and finds out later they will “re-grieve”, they will cycle back through their grief experience and relive it all over again as they reshape their view of the deceased and those who did not tell them the truth.

What happens next?

Unfortunately many children who lose a loved one are teased and some seriously bullied. When the death is a result of suicide children too suffer under the stigma of the cause of death. Other parents may create a distance between their own children and the bereaved child. Teachers too, who are so important in a child’s life can have negative reactions’ In this respect the child can be further marginalized and left without community supports at a time when it is most crucial.  It is important to teach the bereaved child how to respond if bullying occurs.

Typically the child will work through their feelings about the death through play and art. It can be useful to provide them with a number of outlets to work through their grief. Children are often very physical in their grief so keeping them active can be beneficial. Many care providers might find this difficult as adults tend to see a decrease in their energy while children become more energetic. In these circumstances it is worth considering having a trusted adult or teen to take the role of “playmate”.

A child may express the desire to die as well. This can be very alarming for many adults. Often what the child means is that they want to see their loved one again, to be reunited but it doesn’t mean that they truly want to die. As mentioned, young children  don’t understand fully the permanence of death. Of course if the child acts in ways that indicate something further than a passing desire to reunite with their loved one, medical intervention should be sought.

The child will come to a period where they will attempt to re-organize their life in response to the family changes, again one might see this primarily in shifts in play. Control issues will often surface in response to their lack of control over the death. It is important to provide the child with as much control over their life as is reasonable for their age.

In our experience, in order to make sense of the death children will try to understand a causal factor. This search often leads them to some distorted thinking about their own role in the suicide. Such thoughts might manifest as: if I had been a “good” boy/girl Mommy would not have died, Daddy died because I didn’t want to go the movie with him etc. Many children, like adults, feel guilt over things they did or didn’t do and what they did or didn’t say.

As the child moves through the developmental levels they will come to understand the death differently and will cycle back and appear to grieve all over as the impact of the  loss hits them at deeper and broader levels.

The impact of bereavement of death due to suicide can hit on a multiplicity of levels. Academics can be affected, behaviours can change, psychosomatic issues can manifest, social engagement can shift. It is important to remember that child development, childhood bereavement and exposure to trauma all  come together in a very complex relationship where each impacts the other.

Suicide Grief in Adolescents

Along with many of the factors listed above, grief for teens has an added complexity as a result of their stage of development. Adolescents want to fit in with their peer group, this is how they further develop their sense of self. Yet, when death directly impacts their life they are instantaneously different than their peers.  When the death is of a peer (classmate or teammate) there is the added component of teens facing their own mortality at a time when, developmentally, they still feel invincible.

The majority of bereaved teens express a sense of isolation and loneliness that seems to be even more pervasive when the death was by suicide. The longer term impact of this experience appears to be a lack of trust of relationship, an overarching sense that they will be abandoned by whomever they connect with. Asteens move through adolescence they may develop grieving patterns similar to adults (i.e decreased energy). Often, teens will keep and wear an article of clothing of the deceased. This can cause adults some concern but it is normal.

Teens appear to be exposed to potentially more triggering environments than children. Films viewed or books read at school, activities in drama class and even the use of the term“suicides” as an exercise in gym class can be very difficult for these teens to deal with. Added to that they can feel even more isolated if they publicly react and more closed off if they say nothing.

Helping teens to find a voice to express their experience can be difficult. For teens especially the ability to be surrounded by others their age who have had a similar tragedy touch their life can be very beneficial to their healing process.

Understanding The Motivations Behind Suicide:

While no single reason can account for each suicidal act, there are common characteristics associated with completed suicides. Perhaps they can help you to understand why someone you love died by suicide.

1) The common purpose of suicide is a solution. Suicide is many things, but it is neither random nor pointless. To those who choose to end their own lives, suicide is 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.

2) The common goal of suicide is to cease consciousness. Those who die by suicide want to end the conscious experience, which, for them, has become an endless stream of distressing, preoccupying thoughts. Suicide offers oblivion.

3) The common stressor in suicide is 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 come to 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.

4) The common stimulus in suicide is intolerable psychological pain. Excruciating negative emotions (i.e. sadness, shame, guilt, anger, and fear) from any circumstance frequently serve as the foundation for suicide.

5) The common internal attitude in suicide is 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.

6) The common emotion in suicide is hopelessness and/or helplessness. A pervasive 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.

7) The common cognitive state in suicide is constriction. 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.

8 ) The common interpersonal act in suicide is communication of intent. 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.

9) The common action in suicide is escape. Suicide provides a way to escape from intolerable circumstances.

10) The common consistency in suicide is life-long coping patterns. During crisis periods that precipitate suicidal thoughts, people tend to use the response patterns they’ve used all of their life.

How To Cope With A Loved One’s Suicide:

If you are reading this because you are trying to cope with a loved one’s suicide, let me tell you that I am so very sorry for your loss. Here are some tips for learning to survive the suicide of a loved one:

One of the biggest challenges a suicide survivor faces is the struggle to answer, “why?” Here is a guide to understand the most common motivations behind a suicide.

Deal with the facts of the suicide – the “hows” and the “whys” of a suicide can help alleviate any doubts that the death was, indeed, a suicide.

Grief is as unique as the person who experiences it – your grief will be different than anyone else’s.

Don’t compare your grieving process to someone else’s. We all grieve differently.

It’s okay to grieve – grieving the loss of a loved one from suicide means that you loved, you really loved, this person.

It’s also okay to heal. Don’t let your healing process be overshadowed by guilt for “not grieving enough.”

You may experience physical complaints (insomnia, headaches, exhaustion) that are brought about by your emotions. Talk to your general doctor about these symptoms and see what can be alleviated.

Cry if you want to cry. Don’t be afraid to let it out. And if you don’t or can’t cry? That’s okay too. Everyone grieves differently.

You will struggle with the “why” of a suicide until you’ve gotten your answer, an answer that makes sense to you, or no longer need to know why.

You might feel crazy as you run the gamut of feelings – anger, guilt, confusion, forgetfulness, those are all very common reactions. You’re not going nuts – you’re grieving a very difficult loss.

It’s okay to feel overwhelmed by your feelings.

Find at least one person who gives you the permission to grieve and lean on them.

Remember that you can postpone grief, but you can’t outrun it. If you’re living with unresolved grief, it becomes harder and harder to cope with other every day stresses. Let your grief out. Although it may be tempting, don’t throw yourself into work or other projects as a means to avoid your grief. You must deal with your grief.

Now is the time to let others know that you need help. Chances are, many people are simply unsure of how to help you. Tell them what you need, even if it’s someone to make a run to the store for you or throw in a load of laundry.

Don’t be too proud to ask for help.

Don’t withdraw from the world. Keep in touch with other people – friends, family, spiritual leaders. Use them for support, comfort, and healing.

Surround yourself with people who will listen when you need to talk and those who simply offer a shoulder if you’d rather be silent.

Prepare yourself for anniversary reactions – holidays, birthdays, anniversaries and other significant dates will be very painful reminders for you and can amplify your sense of loss.

On those special days, don’t force yourself to do or be anything. Allow yourself to do whatever it is you feel like doing – if that’s dumping an old family tradition because it’s too painful? So be it.

There will be setbacks – some days, months, and years will be better and worse than others. That’s okay. Grief and grieving doesn’t follow a straight line.

Find a support group in the area for suicide survivors. There can be a lot of strength in knowing that others have experienced a suicide as well. In a support group for suicide survivors, you can share your story, learn other coping techniques, and lean on one another for support.

Commemorate your loved one in a tangible way. Plant a tree. Dedicate a bench. Plant a garden. Create a scrapbook of memories. Put together a shadow box for the wall. These are things that can help you to feel connected to your loved one.

Write it out. Take some time to write a post for The Band about the suicide.

Keep a private journal and make writing in it a priority. Writing is one of the most effective forms of therapy.

Don’t abuse alcohol or prescription drugs as a means to cope. In the end, it will only hurt you.

Don’t concentrate all your energy on comforting others reeling from the suicide – it may be your way of avoiding the grief.

Be prepared for others to say cruel and thoughtless things to you about the suicide – they may be lashing out in grief.

It may feel like it, but not everyone is blaming you for the suicide.

The old way of thinking was that suicide should be hushed up, never discussed; but it’s come to light that this is a bad way to handle a suicide. Talk about the suicide. Talk about your feelings.

Guilt. It sucks. Talk about your feelings of guilt with someone you love and trust.

The suicide is not your fault. You will probably feel that you could’ve done something more to prevent it, but that’s not the case. You cannot assume responsibility for the actions of another. PERIOD.

Forgive yourself – the suicide is not your fault. You couldn’t prevent it.

Try setting up a picture of your lost loved one and talk to it. It may help to articulate all of the things you’d wished you could say to the person.

Depression is very common in suicide survivors. If you find it to be prolonged or particularly hard to deal with, seek professional help. Learn more about depression here.

Know when you can no longer manage on your own – and seek professional help. Trained grief experts are available to help you learn to cope with the grief.

Let the anger out. There’s lots of anger surrounding a suicide and it has to go somewhere. Chop wood. Scream. Hit a punching bag. Punch a pillow.

Take your grief one day, one second, one moment at a time.

You didn’t have a choice or any control over the suicide, but you DO have the choice to live through the aftermath. Choose to live.

How To Help A Suicide Survivor Heal:

When a loved one loses someone from suicide, you want so badly to help, but it’s so hard to know what to do. Here are some tips for helping to comfort a suicide survivor.

Make a special effort to go to the funeral home. The shock, denial, and shame are overwhelming for the suicide survivors. They need all the support they can get.

Suicide survivors may be a bit more paranoid due to the guilt associated with a suicide. The guilt is only increased by noting that certain people did not attend the funeral of their loved one. If you cannot attend the funeral, make an effort to send flowers, a note, a text, an email, ANYTHING, to let them know you’re thinking of them.

You may not know what to say to a suicide survivor at the funeral – simply treat the death as you would any other death, “I’m so very sorry for your loss.”

Don’t be afraid to cry openly if you were close to the person who died. Often, your tears will help the suicide survivors see that they are not alone in their grief.

The grief following a suicide is extremely complex. Survivors of suicide don’t simply “get over” their loss. Instead, they can hope to reconcile themselves to face the reality.

Don’t be surprised or alarmed by the range and intensity of their feelings – grief can sneak up on a suicide survivor and overwhelm them with their intense feelings when least expected.

Survivors of suicide may struggle with extreme explosive emotions – guilt, shame, and fear – much more so than any other type of death.

Be patient with and understanding of the feelings of your loved one as he or she grieves the suicide.

Helping a suicide survivor means that you must break down the silence surrounding the death – it begins with being an active listener.

Being physically present and willing to listen without judgment is critical for your friend. Being able and willing to listen is the best way to allow your loved one to just talk.

The feelings and thoughts a suicide survivor may feel can be very scary and hard to acknowledge. Worry less about what you say and concentrate on the words your loved one shares.

Often, suicide survivors want to share the same story again and again. Listen attentively each time. This repetition is part of the suicide survivor’s healing process.

Remember: you don’t have to have the answer to help your loved one.

Allow suicide survivors to talk, but don’t push them.

Survivors of suicide need help to come to an understanding of the reason their loved one suicided – this is extremely important for those who survive a suicide.

Give your loved one permission to express his or her feelings about the suicide without fearing criticism.

Tears are a natural and appropriate reaction to the pain associated with a suicide – don’t be afraid of the tears.

Remember that not everyone who grieves will cry – everyone expresses their feelings differently.

Grief is not restricted to a certain time-table.

Respect the need for a suicide survivor and their family to grieve. The grief of family members of someone who has suicided may be kept a secret. If the suicide cannot be openly discussed, the grief may go unhealed.

You may be the only one willing to listen and talk to the suicide survivors – you are more important than you know.

Know that the grief of a suicide is unique and that no two people will react the same way.

Anniversaries and holidays may be especially hard for a suicide survivor – these dates emphasize the absence of someone who is no longer alive.

Pain is a part of the normal grieving process – you cannot (and shouldn’t try) to take it away from a suicide survivor.

Use the name of the person who has died when talking to suicide survivors – using his or her name can be comforting and reminds the grieving survivors that you haven’t forgotten this important person.

Support groups for survivors of suicide can be one of the best ways for suicide survivors to heal. In a support group, suicide survivors can connect with others who have experienced the same type of loss and share their stories. You can help by locating a support group for suicide survivors for your loved one.

Let your loved one teach you about their feelings of faith and spirituality. They may believe that those who die by suicide are doomed to hell. Rather than contradict them, just listen and learn, non-judgmentally.

Survivors of suicide struggle to know why their loved one suicided – if they ask you, “why?” simply say, “I don’t know – maybe I’ll never know.”

Be aware that the guilt for a suicide survivor is often so painful that it’s sometimes easier to deny that it happened – be patient and understanding of this. Denial can give the suicide survivor a breather before the reality sinks back in.

Suicide survivors have the right to be extra sensitive – often others will deliberately avoid the survivor, pretend not to know the person, or ignore any type of contact made. This compounds the guilt the suicide survivor already feels.

People will often make cruel, vicious remarks to a suicide survivor – this hurts the survivor intensely. Don’t repeat the remarks and do what you can to go to the source to let them know that their words hurt the suicide survivor.

How Not To Help A Suicide Survivor:

Cliches and other trite comments are often more wounding than saying nothing at all. Cliches often diminish the loss by giving simple solutions to very hard realities. Avoid them.

“You’re holding up so well.”

“Time heals all wounds.”

“You’ll get over it in time.”

“Think of what you have to be thankful for.”

“You have to be strong for your children (or others).”

“Well, he (or she) was crazy.”

“I know just how you feel.”

“Snap out of it.”

“Stop wallowing.”

Avoid passing judgment or providing simple reasons for the suicide.

Don’t allude to the mental state of the person who suicided – you don’t know if this person was “crazy” or “mentally ill,” and it further complicates the feeling of the suicide survivor.

The grief of a suicide survivor is unique – don’t criticize what you think of as “inappropriate” behavior.

Learn more about grief and grieving here.

Don’t try to comfort the suicide survivor by saying, “it was a terrible accident.” The suicide survivor must deal with the fact that their loss was due to a suicide.

Don’t compare your grief about other deaths to your loved one – the grief of a suicide is very different than most other types of deaths.

Don’t tell stories to suicide survivors about your friend or someone else you know who tried to commit suicide, which means you totally understand how they feel. Whomever you knew who attempted suicide lived, theirs did not.

Don’t go over the signs of suicide with a suicide survivor, as the suicide has already taken place. Saying things like, “there must have been some signs of depression,” only compounds the suicide survivor’s guilt.

Page last audited 10/2018

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

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

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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