Feb 09

Smartphones and your love life

SmartphonesLoveLifeWexlerby Dr. Micaela Wexler

Do smartphones hurt relationships?
It turns out that smartphones and electronic gadgets can hurt our interpersonal interactions. What is worse, a recent study shows that intimate interactions are affected more than casual interactions.

A study published in the Journal of Social and Personal Relationships July 19, 2012 shows that the mere presence of a smart phone can interfere with conversations between two people.

Two experiments were done to measure quality of relationship and feelings of empathy. In the first experiment strangers were put in pairs, and sat in a room that contained only a table two chairs and a book on the table and another object. For half the pairs, the other object was a smartphone and for the other half, the object was a pocket notebook the same size as the smartphone.

In this experiment, the pairs of strangers were asked to discuss an interesting event that occurred in the past month. Following the 10 minute discussion, the participants filled out questionnaires that measure relationship quality over time. This questionnaire included questions such as, “It is likely that my partner and I could become friends over time.”

The group with the smartphone present reported lower relationship quality and less closeness. Few of them believed they could ever become friends with their partner, for example. The results showed a lower level of connection between the partners when a smartphone was present.

The second experiment measured the effect of smartphone presence on intimate conversations and casual conversations. The set up was the same, but the pairs of strangers were given different tasks. One half of those pairs in each group were given the task of discussing their feelings about plastic trees for 10 minutes. The other half in each group were given the task of discussing the most meaningful event that had occurred in the past year.

The results of this experiment spell trouble for couples.

Partner empathy and partner trust were the items most adversely affected by the presence of a smartphone. The groups discussing the plastic tree showed a small difference from each other; however the groups discussing a meaningful events showed a dramatic difference.

The smartphone groups scored lower on the question “I felt I could really trust my partner,” and “I felt my partner could understand my feelings.” That is not good for intimate, romantic relationships.

So, why is this? How can the mere presence of a smartphone lead to such dramatic differences?

First, anything that provides a source of instant gratification will stimulate the reward centers of our brains. Studies show that just thinking about a morning cup of coffee causes endorphins to rise.
ChildPsychiatrySnow9

When alcoholics just look at a drink or drive by a liquor store, the reward center in the brain fires up. It isn’t much of a stretch to realize a smartphone could have the same effect.

Smart phones are full of apps that provide instant gratification. Think of all the games you play you just can’t put down. That type of brain stimulation is addictive. We are all naturally driven to engage in those types of activities; we enjoy the endorphin rush these thrills give us. We can reliably feel good after playing one of these games, so we begin to depend on them.

When facing a stressful event, we crave that endorphin rush even more. For example, we crave our morning cup of coffee more on work days than weekends. So it is very likely that the mere presence of a smartphone is causing the reward center to fire away.

Except for that beginning stage, when everything is new and exciting, relationships do not provide a reliable endorphin rush. People with their complexities and needs are not very predictable: sometimes they thrill, sometimes they don’t. Our partner does not just offer fun and games. More often than not partners approach each other with topics that are stressful: bills, children, work conflicts, emotional needs and jealousies. Our brains respond to this, the parts of our brains dealing with danger are activated in the mere presence of anything that has been a source of stress. If there is a smartphone nearby, our partners lose out, because the reward center will always win.

So, what do we do? Smartphones are an ever present part of our lives.

I will confess, I am one of those people addicted to my smartphone. It is a significant part of my work as a rural psychiatrist. I get calls and text messages from all over the hospital and clinic all day long as well as several nights a week. Given the stressful nature of my job, I also began to rely on the endorphin rush provided by my games.

Dr. Wexler Smartphones

I have started to experiment with designated “no smartphone zones.” As a family psychiatrist, I advice families to keep gadgets away from the dinner table. For people who depend on their phone for work, as I do, I suggest the smartphone be placed away from the table. I have started forwarding my calls to a landline during dinner time with my partner or family. When a landline is not available, I have a special ring tone for the hospital. All other sounds are ignored. I will be the first to admit that implementing this plan is not easy.

For couples, I recommend no cell phones in the bedroom. I know how difficult this is to follow because I have yet to do it myself. But, given the results of these studies, I am sure I will reap the benefits when I finally banish the smartphone from the bedroom.

Another strategy that has worked for me came about by accident. I have an older version of the iPhone and I inadvertently updated the operating software. All my games stopped working! I was able to easily update my medical apps, but I couldn’t find newer FREE versions of my favorite games. Rather than buying new games, instead I went into my kindle and found free games through Amazon Prime. Now, whenever I need that endorphin rush I grab the kindle. Over time, my smartphone has become less associated with fun, so I’m probably not getting that endorphin rush. So, that might be a solution for you: take the games out of the smartphone and use a different device.

Smartphones can be used to enhance our relationships!

There are several apps specifically designed for couples.

SmartphonesLoveLife1

Couple is a free app available for both iPhone and android. It is similar to the Facebook app, except you each have just one friend. You can poke each other, share pictures, videos, texts and voice clips. It even has a feature called “thumb kiss” letting you touch thumbs in real time to get a “love vibration.”

Between is a similar app available for iPhone and android devices, but with the addition of a datebook and note sharing. The datebook is especially helpful for couples with busy lives because you can keep each other informed of your activities.

Icebreak for Couples is an app that couples can use to learn more about each other. It comes with activities they can share based on the answers to these questions.

Right now, my partner and I are using Between. We are loving it! The first thing we see when we open the app is our two pictures and the number of days we have known each other. For us, the calendar is crucial because we both have busy, fluctuating schedules in the medical field. I have the push notifications on, so I get alerts whenever she enters anything. We chat with each other using the app. We can send each other voice memos as well as texts.

If you find that you just can’t put your smartphone down, and are not able to adopt any of these strategies, then you need to examine the root cause of this behavior. You may need to see a therapist or psychiatrist to determine if you have an addiction, or if you have depression or anxiety that your are self medicating with your smartphone apps. You might need to take a good look at your relationship and your life. Behavior that is out of control should never be ignored, especially because help is available.

Dr. Micaela Wexler also blogs on child psychiatry topics at kidpsychdoc.com.

Jan 15

Want to lose weight? SLEEP!

BabySleepBy Dr. Micaela Wexler

Are you overweight? Are you getting enough sleep?

As I was getting ready to plan my New Year weight loss strategy, I was thrilled when I entered the words sleep and obesity in Google and found countless articles showing that lack of sleep, as in less than seven hours a night, leads to increase in weight. Sleep has been shown to affect the level of the hunger inducing hormone leptin secretion in children, and there is no reason to believe the same doesn’t happen to adults; sleep deprivation causes the decision making center of our brain to become less active, and leads to junk food cravings; sleep deprivation leads to decreased energy and motivation, which results in decreased exercising; sleep loss has a negative impact on metabolism, increasing the risk of obesity and diabetes.
LoseWeight
So, if people want to lose weight, instead of starving themselves or hitting the gym, why don’t they just SLEEP more?

As a psychiatrist who listens to people complain of insomnia all day long, I can tell you it isn’t that easy. Many of my patients with sleep problems are also overweight.

Sometimes the reasons people aren’t sleeping are obvious: They have a small baby, they are depressed or anxious, they work nights, they are worried about debt or losing their jobs, they don’t have a job, they have a job but work too many hours (that would be me).

Other times, the reasons are obvious to me and not to them: they have relationship conflicts, they are fighting with or attracted to someone at work, they are watching TV right at bedtime, they are sleeping with smart phones next to their heads and texting and posting all through the night. Some people just have bad sleep hygiene (again, that would be me).
MedicalIssuesInsomnia
Then there are the people with chronic insomnia who have medical issues preventing sleep, such as chronic pain, restless leg syndrome, obstructive sleep apnea, post traumatic stress disorder, severe mental illness, to name just a few.

So, if you aren’t getting enough sleep, you first need to rule out any medical issues. A medical sleep evaluation includes a physical exam, a medical history, a sleep history and a screening for depression or anxiety.

There are some things you can do in addition to your medical evaluation. Determine what your sleep hygiene is. Sleep hygiene consists of the activities you engage in during the two hours prior to bed time. Do you “work ’til you drop (like I do)? That will keep you up at night. You need to spend those two hours before bed time slowing things down. Don’t expect to fall asleep until at least two hours after you have stopped working. Find relaxing activities to do during that time, such as some stretching exercises followed by a bath. Get your clothes ready for tomorrow, regardless of whether or not you are planning on leaving the house. Plan what your day will be.
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Get yourself moving during the day. You can start with just 10 minutes of walking during lunch. You can also do a simple stretch or yoga routine before bed. Increasing your activity during the day will always lead to better sleep at night.

Anything you didn’t get done today, just put on the list for tomorrow. My feeling is this: if I didn’t get all my tasks done, it’s because I didn’t plan my day properly. Better luck tomorrow. I happen to work as a psychiatrist in a critically under served area, so I’m always going to have too much on my plate. That makes it easy for me to let myself off the hook, which I realize is not true for everyone.

Let’s say you’ve dutifully done your sleep hygiene and you STILL can’t sleep. Something that helps me is to keep a small notebook by my bed and write down the thoughts which are racing through my head. If I forget to put the notebook and pen under the pillow, then my toddler tears my thoughts to shreds the next morning, but, nothing is perfect. That usually means that since I didn’t see her sneak up and get it, then I did get to sleep.

I strongly recommend you use paper and pen rather than your smartphone. You will still be able to read it, even if you write in the dark. (Try it right now: close your eyes and write something with a pen.) And, your mind will be focused only on what you are writing, which is not possible with a smartphone.
SealsSleepWexlerPsychiatry

Writing these thoughts down will help you determine why you are not sleeping. You will be able to figure out if you have insomnia because you’re worried about work, or because you are depressed. If you find that you are writing thoughts that reflect hopelessness and doom, or that you are ruminating over the same things over and over again, or you have so many thoughts you can’t get them all written down, then you may need to see a psychiatrist or therapist. Or, both.

If I go too many nights in a row without writing in the dark at night, then I will do get insomnia again. Something that commonly happens to me when I write my thoughts down in the dark is that I dream solutions to my problems. Sometimes I dream that I forgot to put my notebook under my pillow again.
The bottom line is that we have an important weight losing tool at our disposal: sleep. Maybe I’m just lazy by nature, but the way I look at it, before I start starving myself or start killing myself in the gym to lose weight, I think I’m going to start with something a little bit easier: sleep.

Dr. Micaela Wexler also blogs on child psychiatry topics at kidpsychdoc.com.

Jan 10

Borderline Personality Disorder: what is it?

WexlerPsychiatryWinterBy Dr. Micaela Wexler

The following three fictionalized cases are examples of women with Borderline Personality Disorder.

Carol (not her real name) is 29 years old. She was brought to the emergency room by police after they were called by her girlfriend when Carol threatened to kill herself with a butter knife. This is Carol’s fourth time in the emergency room in the past year for suicidal behavior. Carol and her girlfriend had been fighting over “nothing” and when her girlfriend tried to leave the apartment, Carol became frightened, and at that moment she really did want to “just die.” This is not the first time Carol has done this to this girlfriend. Carol tells me she does things to push her girlfriend away, and then when her girlfriend responds, Carol becomes frightened, because she is afraid of being alone. Carol’s girlfriend tells me that when they are not fighting, they get along extremely well. Carol is fun, witty, spontaneous, and is very bright, which makes this behavior very puzzling to her girlfriend. Both Carol and her girlfriend tell me that Carol’s emotions “change at the drop of a hat.” On the day she was seen in the emergency room, Carol had been very happy, and suddenly flew into a rage when her girlfriend questioned some charges on the credit card Carol had borrowed to get gas. Carol had stopped to buy her girlfriend a “present,” a new pair of boots she felt her girlfriend needed for the snow and would not take the time to buy for herself. At the time she bought the boots, a month ago, her girlfriend had expressed gratitude, and, in fact, she was wearing those same boots in the emergency room. Carol had meant to tell her eventually that the boots had been charged on her girlfriend’s credit card, but had put it off, not wanting to ruin the moment. “I was afraid she would get angry at me for that and just dump me, and here she is, about to do exactly what I was afraid of.”

Cheryl (also not her real name) is 28 years old. She has three children under the age of five from three different relationships, and they were all taken into state custody after Cheryl had a string of admissions to the inpatient psychiatry unit for suicidal behavior and self-injurious behavior. These admissions all occurred following Cheryl’s break-ups with different men. She has a history of putting men she meets on a pedestal, and then breaking up with them when she either perceives a flaw, or discovers a genuine problem, such as a drug history or criminal history. In the past four months, Cheryl has had three break-ups, and the last one was violent because the man didn’t want to break up (and find another place to live), and led to Cheryl losing custody of her children. Cheryl’s pattern is the following: she meets a man, and idealizes him. She tells me, “this is the one,” and I hear her fantasizing about the wonderful life she and her children are now going to have because she finally met a really nice guy who “treats me like a queen.” Whenever I ask Cheryl to describe what she means when she says she is treated like a queen, she describes what to me sound like mundane actions: he bought her dinner once; he didn’t leave while she was still asleep, he filled her car up with gas when they used it to go out, he was nice to the kids, he didn’t complain when her babysitter cancelled at the last minute. Usually, Cheryl idealizes these men so quickly she doesn’t take time to get to know them very well. This puts her and her children in jeopardy. When she discovers they are spending the night because they are hiding from their meth dealer, or from the police, she feels genuinely betrayed. When she is forced to break up with them, Cheryl is left with feelings of emptiness alternating with feelings of despair. To cope with her feelings she cuts herself or bangs her head into the wall until she passes out.

Cindy (definitely not her real name) is 33 years old. She has been married for 8 years, and she and her husband have three children. She is employed full time, and is active in her church. When I first met her in clinic, she was wanting to be evaluated for Adult ADHD. She had just gone back to school part time, with plans to become a surgical nurse, and possibly “going all the way to becoming a nurse practitioner.” She was almost euphoric with excitement about her new plan. She presented to her next visit a month later in tears over her news that she had discovered her husband was being unfaithful and they would probably divorce. I advised her to get into therapy, and refilled her medications. At the next visit two months later, not a word was mentioned about either the divorce or school, something I didn’t notice until after she had left, because she had presented in a rage as she described an altercation she had at work with a fellow employee. She reported, “it might have gotten physical, I don’t know because I blacked out. They were going to try to send me to the unit, but [the other employee] is my brother-in-law’s cousin, and so we settled our fight before they could do that.” Cindy confessed to me that every few months, she will have a “huge drag out fight” with someone at work because “I don’t know how to say no, and then they just walk all over me and I snap.”

Each of these patients was evaluated further over the months, and they each met criteria for Borderline Personality Disorder. The disorder occurs by early adulthood. There is a pervasive pattern of unstable interpersonal relationships. They also have marked impulsivity, seen in different settings. They complain of emotions that are out of control with rapid mood swings and are sometimes mistakenly diagnosed with Bipolar Mood Disorder.

To meet criteria, the person has to have five or more of the following:

• Frantic efforts to avoid real or imagined abandonment expressed by becoming emotionally unstable when they PERCIEVE someone might be breaking up
• A pattern of unstable and intense interpersonal relationships
• Identity disturbance expressed by very low self-esteem
• Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
• Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
• Emotional instability due to significant reactivity of mood (e.g., intense sudden episodic depression, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
• Transient, stress-related paranoid thoughts or severe dissociative symptoms

How is Borderline Personality Disorder Diagnosed?

Borderline personality disorder is typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians, internists, some counselors and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. People outside of the health professions are not at all qualified to make this diagnoses. A person must be over the age of 18 to be diagnosed.

Most people with Borderline Personality Disorder suffer for years without a diagnoses or treatment, and it usually takes a crisis, such as those listed in the examples above, for the person with Borderline Personality Disorder to get identified.

Causes of Borderline Personality Disorder

At this time, the exact cause is not known. However, the theories which have the most support are those that subscribe to a biopsychosocial model of causation — that is, the causes of are likely due biological and genetic factors, social factors, and psychological factors. In other words, the nervous system a person was born with can put them at risk. People with BPD have bound found to have larger amygdalas than those without BPD. How a person was treated by their family in their early years seems to have a great influence. For example, people who were sexually abused as young children have a significantly higher rate of Borderline Personality Disorder than other people. Also, a person’s temperament, which is also influenced by the manner in which they were treated as children, can also put them at risk. Children whose feelings are invalidated, ie, a child cries and is told, “stop crying,” or “you’re okay, you’re not sad,” are at higher risk of developing Borderline Personality Disorder. Also, children who are emotionally abused or neglected have a higher rate of Borderline Personality Disorder as adults.

Treatment of Borderline Personality Disorder

Long term psychotherapy in the outpatient setting is the treatment of choice for Borderline Personality Disorder. There is a type of psychotherapy developed SPECIFICALLY for Borderline Personality Disorder by Dr. Marsha Linehan called Dialectal behavior therapy (DBT). This is the most widely used successful treatment for Borderline Personality Disorder. Dr. Linehan is a well known and respected psychologist on the faculty at the University of Washington, and she recently began to speak publicly about her own struggles during her early adulthood with Borderline Personality Disorder. By her own reports, she was a “cutter,” cutting herself excessively until she was finally treated.

Dialectical Behavior Therapy is a long term, intense therapy program, with both individual therapy and group therapy components. Clients (they are not referred to as patients) are given homework, and are taught skills to identify their emotions and to cope with their interpersonal relationships. Remaining in the outpatient setting, ie, not going to the hospital, is an important goal of treatment, and meeting this goal improves the prognosis for people with Borderline Personality Disorder.

Dr. Linehan has developed a web site, behavioraltech.org, outlining the rigorous qualifications therapists need to fulfill in order to be qualified to provide Dialectical Behavior Therapy.

Although Dialectical Behavior Therapy is the most widely used successful therapy, there is another therapy that has provided some results, and is often available in places that do not provide DBT. It is called General Psychiatric Management for Borderline Personality Disorder. As found in the APA Practice Guideline for the Treatment of Patients With Borderline Personality Disorder, it is described in the following way: “this coherent, high-standard outpatient treatment consists of case management, dynamically informed psychotherapy, and symptom-targeted medication management. Pharmacotherapy was based on the symptom-targeted approach but prioritized treatment of mood lability, impulsivity, and aggressiveness, as presented in the APA guideline.” This type of therapy requires a psychiatrist (a medical doctor). Although it is not as successful as DBT, it has been shown through research to offer some relief, and result in decreasing suicidal behavior.

For more information about Borderline Personality Disorder, click here.

kidpsychdoc.com – Child and Adolescent Psychiatry blog

Jan 05

When you lose a parent to suicide

PeaceWinter2By Dr. Micaela Wexler
The loss of a parent is devastating for any adult. As a psychiatrist, it is one of the most painful transitions I encounter. Your status in the world is dramatically changed. Immediately upon the death of your parent, you are plunged into a sea of nostalgia, and it is easy to feel unmoored. You are no longer being tugged by the larger vessel that guided you your entire life. Now YOU are that vessel that will have to take the lead. It is a transition that we all anticipate but for which we can never truly be prepared.

When the death is due to suicide, it is not a transition; it is a calamity. While an accidental death brings shock and denial, death from suicide generates horror, anger, guilt, confusion and shame. Add to this the fact that there is still a great deal of stigma about suicide, which can become a significant obstacle to getting help. This is most likely why people who have lost a parent to suicide are at increased risk for committing suicide themselves: the feelings are overwhelming and it is difficult to know where to turn.

It is natural to turn to family members for help. They are the ones who knew your parent best, they have been part of your entire life, and there is no need to overcome the stigma of suicide with them. However, they are not the best choice in the immediate aftermath for the simple reason too have suffered a tragedy and are devastated, and therefore unable to offer much support.
This is a time when psychiatric or mental health care is absolutely essential.

Psychiatrists and other mental health professionals are well aware of the magnitude of this event, and will treat it with the urgency it requires. Besides needing someone with whom to talk, chances are that the suicide has caused enough of a physiological shock that you also need at least a short course of pharmacological assistance until you start your recovery. A psychiatrist or therapist can assist you in this manner safely. (A therapist will refer you to a physician if you need medication.)

It’s difficult to think while in such a state of shock, so I have provided the following advice and information.

First, call your primary care physician and ask for a referral.

If that doesn’t work, call your local emergency room. They will give you the number to local resources.

If you feel utterly incapable of doing either of the two previous items, then you need emergency care. Call 911.

If you have a family member who has become non-functional due to a family member’s suicide, do not put yourself in the position of being their main support. This is risky for both of you, especially if you were also affected by the suicide.

Helping someone else before you have coped with your own feelings is simply a bad idea. You are very likely to bury your own feelings while giving someone inadequate care.

If you and your loved one were both hit by a car while crossing the street, no one would expect you to become the primary care provider. With a family suicide, you are even more incapacitated than you would be if you were hit by a car.

So, in the aftermath of a family suicide, get a psychiatrist or therapist to help you and your family.

For more information, please visit my post on losing a loved one to suicide.

Nov 14

Is your depression keeping you from losing weight?

By Dr. Micaela Wexler
If you are having trouble losing weight, it could be due to depression. As a family psychiatrist, this link is very obvious to me, but not to my patients. Studies show that depression and obesity are linked to each other. A meta analysis study published in JAMA in March 2010 shows a that depression can lead to obesity and obesity can lead to depression. (1) A study of Dutch teenagers, published in Obesity in March 2010, showed a clear association between weight status and suicidal behavior in obese adolescents. (2) The same link was found in a later study done on Korean teenagers. (3)
Depression causes physical changes which affect interest, sleep, appetite, sexual drive, and thought processes. Some types of depression cause people to eat and sleep more than normal. If you are having trouble finding the willpower to exercise it might be due to decreased motivation, which might be due to depression.

Are you finding it hard to lose weight even though you are exercising and sticking to your diet? This could also be due to depression because depression makes the body’s metabolism change. When a person is depressed chemical changes take place that make it harder to lose weight. Some of these changes can cause weight gain and fatigue.

Depression can also cause a change in eating patterns. The chemical imbalances caused by depression make it harder for people to connect hunger with food intake, which is why some depressed people eat even when they are not hungry. Or, they are hungry even after eating.

It is easy to blame your weight on lack of willpower. But, if you are having trouble losing weight, it is important to make sure you are not depressed. Besides causing weight gain, untreated depression can cause more serious problems like diabetes, heart disease, and suicide. And, studies show that treating depression leads to weight loss.

Do you feel sad or hopeless? Are you having trouble sleeping? Have you lost interest in things like hobbies or TV shows or fun activities? Do you have trouble motivating yourself to do things? Are you short-tempered? Do you have negative thoughts about yourself? All of these are signs that you might be depressed.

If you’re having any of these signs, go see a therapist or a doctor or call your local mental health center. Start treating your depression so it doesn’t keep you from losing weight.

1) Overweight, Obesity, and Depression
A Systematic Review and Meta-analysis of Longitudinal Studies FREE
Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD

2) Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: results from the 2003 E-MOVO project.
van Wijnen LG, Boluijt PR, Hoeven-Mulder HB, Bemelmans WJ, Wendel-Vos GC.

3) The relationship of weight-related attitudes with suicidal behaviors in Korean adolescents. Kim JS, Lee K. Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.

4) Pagoto S, Schneider KL, Whited MC, et al. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond). 2013 Mar 5. [Epub ahead of print]

Jul 12

Lost a family member to suicide? There is help.

By Dr. Micaela Wexler
If you have lost a family member to suicide, you should know that you and your surviving family members are at an increased risk for suicide. All family members should know the warning signs for suicide. An easy mnemonic has been developed by the American Association of Suicidology: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

If you are wishing you were dead yourself, or feel you have these signs, you must get help immediately. Call 911 if you don’t know what to do. Or, call one of the following numbers:
1-800-SUICIDE
1-800-273-TALK

If you just need someone to talk to, you should also call those numbers. They can point you to resources in your area.

Websites where you can go for help:

www.suicidology.org – American Association of Suicidology – has a section for survivors

allianceofhope.org - provides an online support group. They have different forums for the different types of survivors, ie parents, children, co-workers.

www.suicide.org – a list of resources for those at risk as well as resources for those who have lost a loved one to suicide.

www.suicide.com – created by a suicide attempt survivor to help people who are suicidal

attemptsurvivors.com – a good blog to help understand the WHY behind suicide, blog posts written by people who have survived a suicide attempt

No Time To Say Good-bye, surviving the suicide of a loved one, by Carla Fine – carlafine.com – the best book on this subject which I have read

It is normal to feel intense emotions: guilt, fear, anger, hopelessness. A death from suicide is different from any other death because it is a violent choice. Many family members find it difficult to get through each day after a loved one commits suicide.

Regardless of how you feel, suicide is NOT done to punish those left behind. A person commits suicide due to unbearable emotional pain.

While it is true that there are known warning signs for suicide, some people may give no warning at all: they may seem peaceful or happy before committing suicide. This is common for people who have decided and planned out their suicide, because they feel they have finally discovered a way out of their pain. These suicides are the most shocking and devastating for families.

Other people who commit suicide do give signs that families don’t notice until it is too late. The following are some of these signs:
- a preoccupation with death or the afterlife
- sadness, hopelessness, loss of interest in life or those around them
- giving away belongings
- sudden change from severe sadness to seeming to be at peace
- sudden interest in “clearing the air” about past conflicts, events
- hints about suicide
- reckless behavior
- self injurious behavior
- previous suicide attempts
- loss of appetite, weight, energy, decrease in activities
- constant negative comments about themselves

If you realize your loved one was showing these signs, you should not blame yourself. These signs are subtle, easy to miss. Suicide is difficult for most people to talk about or confront. And, many people who are not suicidal also show these signs.

Every member of the family will react to the suicide in a different way. There is no correct way to respond.

If the loved one was a teenager or child, the younger siblings will need extra care and attention.

In the immediate aftermath of a suicide, other family members, especially the PARENTS, will not be good sources of support.

Do not suffer alone. Go to the resources I’ve listed. Or contact me. I am not able to provide care through my web site, but I might be able to point you to someone who can.

And, a reminder: if you need IMMEDIATE help, call 911.