Interpersonal Theory of Suicide
The Interpersonal Theory of Suicide (IPTS) proposes that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs- thwarted belongingness and perceived burdensomeness (and hopelessness about these states)- and further, that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior (Van Orden). Thwarted belongingness is comprised of a sense of isolation and a lack of meaningful and reciprocal relationships; perceived burdensomeness is comprised of self-hatred and a sense that others would benefit from one’s death more so than one’s continued life (Assavedo).
The concepts of thwarted belongingness and perceived burdensomeness are particularly relevant for veterans that have recently separated from the military. The life of a service member revolves around the concept of protecting the U.S. population and the freedoms it espouses; the importance of defending those interests is endlessly impressed upon every service member. Once the service member separates from that highly regimented lifestyle, the belongingness they felt of being a part of something bigger is stripped away and can weigh heavily on veterans. They quickly lose their existing support network of fellow service members and return to an area they have not lived in for a number of years. This sudden shift commonly results in veterans feeling alone and can spiral into isolation if left untreated, a common symptom of suicidal ideation.
The capability for suicide is comprised of an elevated tolerance for physical pain and a diminished fear of death and bodily harm (Assavedo). While genetics play a part in the capability for suicide, it is largely thought to emerge through repeated exposure to painful and/or provocative events, which lead to habituation to stimuli (e.g., pain, impending death) that would otherwise be highly aversive and serve as obstacles to suicidal behavior (Assavedo). The tolerance for any sort of pain is instilled on service members from the moment they begin initial training. In order to be successful in combat, one must learn to ignore pain and keep fighting until the enemy is defeated; this tenet is exemplified in the popular military ethos “train as you fight.” Service members must overcome pain quietly or risk being ridiculed as weak. While the American military approach of neglecting pain is effective in combat, it can have devastating consequences on veterans suffering from mental imbalance.
The Family Unit
The family unit can increase feelings of thwarted belongingness and perceived burdensomeness on veterans returning from deployment. Combat and non-combat deployments cause a great deal of stress on families of those deployed, and this stress likely contributes to family problems that arise during and after deployment (Selby). Stress within families does not end when the service member returns home from a deployment. Over 75% of married service members report some family readjustment issue post-deployment, with 66.6% reporting one or more concerns occurring on a weekly basis (Sayers e5). Readjustment issues such as feeling like a guest in their own home, children being cold toward them, being unsure of responsibilities in the home, and intimacy issues are problems commonly reported in service members that return with any level of depression, PTSD, or generalized anxiety disorders (Sayers e6).
Perceived burdensomeness is a significant risk for veterans with young children. Within the families of deployed service members, studies have found links between parental deployment and behavioral and academic problems in children, as well as child maltreatment and intimate spousal abuse (Selby). During long periods of absence, the deployed parent will inevitably miss milestones in their children’s development. It is not uncommon for children in these circumstances to not remember the deployed parent or may even be afraid of them. This can increase the anxiety on already struggling veterans and contribute to feelings of being a stranger within their own home.
Feelings of being a stranger in the veteran’s own home can be compounded by the delegation of responsibilities with their spouse. After a 7-12 month deployment, service members return home and may be tempted to rush to return to the pre-deployment “normal.” During that absence the spouse has stepped up to handle all household and child-raising responsibilities. After doing things their way for so long, the spouse may be reluctant to relinquish control.
Van Orden, Kimberly A, et al. “The Interpersonal Theory of Suicide.” Psychological Review, U.S. National Library of Medicine, Apr. 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3130348/.
Assavedo, Brittney L., Bradley A. Green, and Michael D. Anestis. "Military Personnel Compared to Multiple Suicide Attempters: Interpersonal Theory of Suicide Constructs." Death studies 42.2 (2018): 123-9. ProQuest. Web. 18 May 2020.
Selby, Edward A., et al. “Overcoming the Fear of Lethal Injury: Evaluating Suicidal Behavior in the Military through the Lens of the Interpersonal–Psychological Theory of Suicide.” Clinical Psychology Review, Pergamon, 13 Dec. 2009, http://www.sciencedirect.com/science/article/pii/S0272735809001858?casa_token=Btubpdsvk1cAAAAA%3AG_6mGxnVJpTiPd0WUxmyUzIzF2o0bt7Bi1zvd9TE43dY3lC3c7UUMYyVtArLEU_ioSbtJRFi/.
Sayers, Steven, et al. “Family Problems Among Recently Returned Military Veterans Referred for a Mental Health Evaluation.” Researchgate, Journal of Clinical Psychiatry, Mar. 2009, citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.941.6962&rep=rep1&type=pdf.