THE SUICIDE RISK IN POST COMBAT RELATED STRESS SYMPTOMS. By Nicki Bartram, M.C., L.P.C. ACMF Symposium Planning Partner

Transcription

1 THE SUICIDE RISK IN POST COMBAT RELATED STRESS SYMPTOMS By Nicki Bartram, M.C., L.P.C. ACMF Symposium Planning Partner

2 LEARNING OBJECTIVES What is combat stress? How does it work post deployment? Symptoms of combat stress Suicide statistics Theory of military suicide in the combat deployed Theory of military suicide in the non deployed

3 FOOD FOR THOUGHT

4 DEFINITION OF STRESS Stress is how the body and mind react when dealing with challenging or threatening situations

5 POST-COMBAT STRESS FLIGHT OR FIGHT RESPONE: Hard-wired instinct for survival begins when we perceive something as a threat The brain alerts the body to danger and physical changes occur

6 HOW OUR BRAIN REACTS TO STRESS Blood supply + rational mind = Blood supply + primitive mind =

7 The amygdala + decoding emotions = alarm signals to the rest of the body. The prefrontal cortex + amygdala = how to confront the danger. The connections from the prefrontal cortex to the amygdala enable us to exercise a certain conscious control over our anxiety. However, the longer the connection is in place, the greater the risk that this faculty can could create anxiety by allowing us to imagine the failure of a given scenario or even the presence of dangers that do not actually exist.

8 In Post-Combat Stress, the fight or flight state in the amygdala: 1. Remains activated Or 2. Easily turns on

9 EFFECTS OF COMBAT STRESS d8yogfawji&list=pln_blkfyk82zoy m1rluuldx4iefdpmq_9&feature=sh are&index=5

10 RE-LIVING THE EVENT Flashbacks Nightmares Intrusive memories/feelings of intense distress Physical reactions

11 AVOIDANCE OF SITUATIONS RELATED TO THE EVENT Avoiding/refusing activities, places, people, thoughts, or feelings that remind you of the trauma Inability to remember important aspects of the trauma Feeling detached /loss of interest

12 INCREASED ANXIETY AND EMOTIONAL AROUSAL Irritability or outbursts of anger Difficulty concentrating Hyper-vigilance or on constant red alert Feeling jumpy and easily startled

13 OTHER COMMON SYMPTOMS Depression and hopelessness Guilt, shame, or self-blame Feelings of mistrust and betrayal Feeling alienated and alone Physical aches and pains Substance abuse Anger and irritability

14 If the body continues to respond as though it were under threat, then the physical, mental, and emotional batteries become drained: SUICIDAL THOUGHTS AND FEELINGS

15 SUICIDE DATA AND THEORIES Some of the following material and clips may evoke strong emotions. Please take care of yourself and leave if you need to. There are trained professionals on hand to talk with.

16 ACTIVE DUTY ARMY 2013 SUICIDE INFORMATION For CY 2013 ending in Sept: 115 potential activeduty suicides, 58 have been confirmed as suicides and 57 remain under investigation. Updated active-duty suicide numbers for CY 2012: 185 (171 have been confirmed as suicides and 14 remain under investigation). U.S. Department of Defense Release No: October 31, 2013

17 ARMY RESERVE 2013 SUICIDE INFORMATION For CY 2013, ending in Sept: there have been 112 potential not on active duty suicides, 70 Army National Guard and 42 Army Reserve. 81 have been confirmed as suicides and 31 remain under investigation. CY 2012: 140, 93 Army National Guard and 47 Army Reserve. 138 have been confirmed as suicides and 2 remain under investigation. U.S. Department of Defense Release No: October 31, 2013

18 THOMAS JOINER: THE INTERPERSONAL THEORY OF SUICIDE Sense of thwarted belongingness Perceived burdensomeness Acquired capability for suicide

19 EXERCISE Rotate to the right and write examples of what you think each term means

20 THWARTED BELONGINGNESS A sense on the part of the individual that they lack meaningful connections to others, or previously solid relationships have become strained or lost. The view taken here is that this need to belong is so powerful, that when satisfied, it can prevent suicide even when perceived burdensomeness and the acquired ability to enact lethal self-injury are in place. By the same token, when the need is thwarted, the risk for suicide is increased. This perspective is similar to the classic work of Durkheim (1897), who proposed that suicide results, in part, from failure of social integration. Thomas Joiner (2005)

21 "The one transcendent factor that we seem to have, if there's any one that's associated with suicide, are fractured relationships of some sort." LTG Eric Schoomaker, 42nd Surgeon General of the United States Army

22 PERCEIVED BURDENSOMENESS I hate myself. I'm terrible. I'm not good at anything. There's no point in me hanging around here ruining other people's lives. I've got to get out of here. I've got to figure out a way to get out of my life. A sense on the part of the individual that they are a burden to the world, someone who not only fails to make meaningful contributions, but is also a liability. Thomas Joiner (2005)

23 ACQUIRED CAPABILITY FOR SUICIDE Involves the degree to which an individual is able to enact a lethal suicide attempt. Repeated exposure to escalating experiences involving pain and provocation, such as. Repeated physical pain and injuries (e.g., childhood physical abuse) Repeated exposure to emotional neglect Repeated witnessing or engaging in violence Past suicidal behavior to include painful self injury.may increase an individual s acquired capability for suicide. Thomas Joiner (2005)

24 Those who Desire Suicide Perceived Burdensomeness Thwarted Belongingness Those Who Are Capable of Suicide Serious Attempt or Death by Suicide

25 EXERCISE Rotate to the right and come up with examples of how this could apply to a service member or veteran.

26 JOINER S THEORY FOR NON COMBAT DEPLOYED SUICIDES Thwarted belongingness may actually increase risk when service member/veteran are not in a group, eg: didn t deploy, Guard/Reserve, and separated/retired military. Perceived burdensomeness may be relevant to function & relative to the group norm, eg: those left on rear detachment while others deploy. Military as a whole is theoretically exposed to more pain and provocation through universal experiences like basic training, military job specialty training, and training in the use of firearms. This may increase acquired capability.

27 JOINER S THEORY FOR COMBAT DEPLOYED SUICIDES Thwarted belongingness may actually increase risk when service member/veteran is no longer part of a group, eg: deployed and now has no mission at home, medically retired military, loss of military identity, etc. Perceived burdensomeness may be relevant to function eg: feels like a failure to family in parenting and relationships when was a success in theatre, now has no job, mental or medical issues. Military in combat are exposed to war atrocities, heavy violence, and at times physical and emotional pain from loss, or having primitive brain turned on from the amygdala. This may increase acquired capability.

28 BE CREATIVE! Red Flags, recorded by former Army tank gunner Jeff Barillaro, (Solider Hard), and created as an urgent call for current troops as well as Iraq and Afghanistan veterans not to ignore or miss the sometimes-subtle yet often-obvious behavioral changes known to precede many suicides. U.S. Army, unofficially, is using the video as a prevention tool to help the branch stem an ongoing suicide crisis.

29 EXERCISE What do you hear the service member/veteran community saying are the causes?

30 RED FLAGS

31 RECOVERY The journey home marks the beginning of an internal war for service members. Give them the time they require to slowly turn the switch: The switch from violent to gentle The switch from tension to relaxation The switch from suspicion to trust The switch from anger to peace The switch from hate to love. Mark A. Smith, Lt Col USMCR TF 2/24 Commanding Officer, 24 MEU

32 QUESTIONS