ADHD and Sleep Disorders

ADHD symptoms and ADHD treatments might cause sleep disorders. Learn more about childhood and adult ADHD and sleep problems, sleep disorders.

ADHD symptoms and ADHD treatments might cause sleep disorders. Learn more about childhood and adult ADHD and sleep problems, sleep disorders.

ADHD symptoms usually begin before the age of seven, but associated sleep disorders often do not appear until around age twelve. While disordered sleep symptoms are not typically considered in ADHD diagnosis, current research points to ADHD as a possible cause of sleep disorders. Some researchers though, believe that stimulant medication, common in the treatment of ADHD, may be the cause of sleep disorders in those diagnosed with ADHD.2

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) encompasses various hyperactive, impulsive and/or inattentive behaviors. An individual with ADHD may experience symptoms predominantly surrounding inattentiveness, hyperactive-impulsivity or a combination of both. ADHD is typically associated with children, but an estimated 60% of children continue to have symptoms as adults.

Inattentiveness symptoms include:

  • Difficulty paying attention to details; tendency to make careless mistakes
  • Distraction by irrelevant stimuli often interrupting ongoing tasks
  • Difficulties with concentration and mental focus
  • Difficulty finishing tasks or performing tasks that require concentration
  • Frequent shifts from one uncompleted activity to another
  • Procrastination
  • Disorganized work habits
  • Forgetfulness in daily activities (for example, missing appointments, forgetting to bring lunch)
  • Frequent shifts in conversation, not listening to others, not keeping one's mind on conversations and not following the rules of activities in social situations

Hyperactivity-impulsivity symptoms include:

  • Fidgeting, squirming when seated
  • Getting up frequently to walk or run around; jumping and climbing
  • Difficulty in playing quietly or engaging in quiet leisure activities
  • Being always on the go
  • Talking excessively
  • Impatience; intolerance to frustration; interruption of others

Adults with ADHD may experience restlessness instead of the hyperactivity symptoms above. Other common adult ADHD symptoms include:

  • Constant worry
  • Sense of insecurity; low self-esteem; underachievement
  • Mood swings, especially when disengaged from a person or project
  • Poor anger management
  • Inability to shift focus between mental activities

ADHD and Sleep Problems

The likelihood of a co-occurring sleep disorder with ADHD dramatically increases at the age of puberty and increases further with age.3 Both children and adults with ADHD commonly experience the following sleep disorders:

  • Sleep apnea
  • Restless leg syndrome
  • Parasomnias including REM behavior disorders and nightmares

Childhood ADHD and Sleep Problems

About half of parents of children with ADHD report their child has difficulty sleeping. The specific relationship between sleep disorders and childhood ADHD is unknown, but children who have difficulty sleeping may have trouble concentrating during the day and display irritability similar to ADHD. Restless leg syndrome is also associated with inattentiveness, moodiness and hyperactivity as in ADHD.

Bedwetting is also common in childhood ADHD.

Adult ADHD and Sleep Disorders

About three-quarters of adults with ADHD report symptoms of insomnia, primarily consisting of a delay, often of an hour or more, in getting to sleep.3 People commonly report racing thoughts with an inability to "turn their brain off" to fall asleep. Once asleep, ADHD sufferers often toss and turn to the point where their sleep partner may choose to sleep in another room. Adults with ADHD can awaken to even quiet sounds and often do not find sleep refreshing.

Perhaps due to nightly insomnia, once a person with ADHD gets to sleep, they can be extremely difficult to wake. It is common for people to sleep through two or three alarms and be combative and irritable on being woken, some not feeling fully awake until noon.3 Some researchers believe this is because the circadian clock in an adult with ADHD is incorrectly set to sleep between the hours of 4 a.m. and noon.

While some adults with ADHD can't get to sleep, others sleep at inappropriate times. Some find that when they are uninterested in the world around them they disengage to the point of falling asleep. This is known as intrusive sleep, but in a physical sense it is really closer to unconsciousness. Intrusive sleep can be misdiagnosed as narcolepsy but is actually differentiated by a unique series of associated brain waves.3

ADHD is also associated with substance abuse issues, which further complicate the treatment of sleep disorders.

References:

1Dodson, William M.D. ADHD Sleep Problems: Causes and Tips to Rest Better Tonight! ADDitude. Feb/March 2004 http://www.additudemag.com/adhd/article/757.html

2No listed author Attention Deficit Hyperactivity Disorder: ADHD in Adults WebMD. Accessed Aug. 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-adults

3No listed author Attention-Deficit/Hyperactivity Disorder: Symptoms of ADHD WebMD. Accessed Aug 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-symptoms

4No listed author ADHD and Sleep Disorders WebMD. Accessed Aug. 10, 2010 http://www.webmd.com/add-adhd/guide/adhd-sleep-disorders

5Peters, Brandon M.D. The Relationship Between ADHD and Sleep About.com. Feb. 12, 2009 http://sleepdisorders.about.com/od/causesofsleepdisorder1/a/ADHD_Sleep_2.htm

APA Reference
Tracy, N. (2019, September 8). ADHD and Sleep Disorders, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/adhd-and-sleep-disorders

Last Updated: September 18, 2019

Treatment of Addiction and Sleep Disorders

Treatment of sleep disorders accompanying addiction is key to addiction recovery. Learn about self-help and medication treatment of sleep disorders with addiction.

Self-Help Treatment of Addiction and Sleep Disorders

Addiction recovery can be threatened by the presence of a sleep disorder2, so it is critical that sleep quality be addressed during the withdrawal and recovery process. In addition to developing good sleep habits and creating an ideal sleeping space, self-help treatment options include:

While sleep medications for treatment of sleep disorders coupled with addictions are available, it is often preferable to use a holistic approach, minimizing sleep medication, and including lifestyle changes.

Sleep Medication Treatment of Addiction and Sleep Disorders

When are used in cases of addiction and sleep disorder, doctors carefully assess the risks of each medication for the individual. Sleep medications include antihistamines, antidepressants, sedative-hypnotics, antipsychotics or anticonvulsants. Typical choices are:

References:

1 Chakraburtty, Amal MD Drug Abuse, Addiction, and the Brain WebMD. Sep. 19, 2009 http://www.webmd.com/mental-health/drug-abuse-addiction

2 No listed author Insomnia and Alcohol and Substance Abuse New York State Office of Alcoholism and Substance Abuse Services. Accessed Aug. 10, 2010 http://www.oasas.state.ny.us/admed/fyi/fyiindepth-insomnia.cfm

APA Reference
Tracy, N. (2019, September 8). Treatment of Addiction and Sleep Disorders, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/treatment-of-addiction-and-sleep-disorders

Last Updated: September 18, 2019

Sleep Basics: Why We Sleep and the Sleep Cycle

Learn the sleep basics - why we sleep. How the sleep cycle, or the stages of sleep, work. Why your circadian clock, circadian rhythm, is the key to good sleep.

Why Do We Sleep?

Sleep is a process needed by the body as much as food or water and yet is not completely understood. While sleep outwardly appears to be exclusively restful, inwardly, sleep is actually a heightened state wherein molecules are constructed from smaller units in the body. This is known as anabolism. This process accentuates the growth and rejuvenation of immune, nervous, skeletal and muscular systems.

Sleep Cycle: The Stages of Sleep

Sleep is divided into two categories:

  1. rapid-eye movement (REM sleep)
  2. non-REM sleep

The American Academy of Sleep Medicine further divides non-REM sleep into stages N1, N2 and N3, N3 being the deepest level of sleep. Sleep usually progresses from N1 to N2 to N3 to N2 to REM sleep. Deep sleep tends to occur earlier in the night and REM sleep occurs just before waking.

  • During N1 sleep, people lose awareness of their physical surroundings and occasionally experience hallucinations or involuntary muscle twitches which may induce wakefulness.
  • Stage N2 sleep is characterized by a complete loss of environmental awareness and this stage occupies 45% - 55% of adult sleep.
  • Stage N3 sleep is the deepest sleep and is when parasomnias (undesirable sleep experiences) like night terrors, bedwetting, sleepwalking and sleep-talking can occur.
  • REM sleep is responsible for almost all dreams and accounts for about 20% - 25% of adult sleep. Muscle paralysis is experienced in this stage of sleep. This is thought to prevent the physical acting out of dreams4.

The disruption of any sleep stage, or the standard progression through the stages of sleep, can indicate a sleep disorder, and specific sleep disorders are typically associated with specific sleep stages. For example, sleepwalking, night terrors and the acting out of dreams is associated with REM sleep, whereas sleep paralysis is associated with stage N1 sleep.

Medications and other disorders such as depression are also known to affect the sleep cycle in specific ways. In depression, for example, people typically have difficulty in achieving and sustaining stage N3 sleep causing increased fatigue during the day (Read: Depression and Sleep Disorders).

The Circadian Clock

The sleep-wake cycle is controlled by the circadian clock. This clock is an inner time-keeping mechanism that works in tandem with body temperature fluctuations and enzymes to determine the ideal timing of correctly structured and restorative sleep 5. For example, if a person with correctly structured sleep typically wakes early, they are unlikely to be able to sleep in, even if sleep deprived. Disruption of the circadian clock (circadian rhythm) alters the sleep-wake cycle such that the person is no longer sleepy at night or alert during the day. This disruption can also alter when a person gets hungry.

References

APA Reference
Tracy, N. (2019, September 8). Sleep Basics: Why We Sleep and the Sleep Cycle, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/sleep-basics-why-we-sleep-and-how-sleeping-works

Last Updated: September 18, 2019

Alcoholism, Drug Addiction and Sleep Disorders

Drugs and alcohol alter the mechanisms of sleep. Insomnia or hypersomnia, increased sleep, can result from alcoholism or drug addiction. More on alcoholism, drug addiction, and sleep disorders.

Drug addiction is a chronic, often relapsing disease that causes compulsive drug seeking and use despite harmful consequences to the addicted individual and those around them1. Addiction is known to create changes in the brain over time, making the drug use more difficult to stop. People can become addicted to many substances such as:

  • Alcohol
  • Tobacco
  • Illegal drugs like heroin and cocaine
  • Legal drugs such as painkillers and tranquilizers

Addiction and Sleep Disorders

Addiction commonly produces or exacerbates sleeping disorders due to the way the brain changes during addiction, as well as how the addictive substances act on the brain. Withdrawal from drugs is also commonly associated with sleep disorders.

One of the impacts of addiction is circadian rhythm disruption. The circadian rhythm is the body's internal clock which tells us when to sleep and when to wake. When disrupted, the body begins to sleep at irregular times causing insomnia and other sleep disorders. Addiction often alters this clock by introducing stimulant-class drugs, such as cocaine, at times when the body would normally be asleep, like at night. Drug seeking behavior also commonly takes place at night, creating disruption. Additionally, it is thought the brain changes that occur during addiction directly impact the circadian rhythm.

Some drugs, like alcohol, appear to help improve sleep while actually decreasing sleep quality. Alcohol can initially help a person get to sleep; however, the second half of the night typically has fragmented and disrupted sleep. This appears to be due to the fact that alcohol suppresses REM sleep in the first half of the night causing an unnaturally high amount of REM sleep to occur in the second half of the night. Depressants, like alcohol, are also associated with sleep apnea - known to decrease sleep time and quality.

References:

1Chakraburtty, Amal MD Drug Abuse, Addiction, and the Brain WebMD. Sep. 19, 2009 http://www.webmd.com/mental-health/drug-abuse-addiction

2No listed author Insomnia and Alcohol and Substance Abuse New York State Office of Alcoholism and Substance Abuse Services. Accessed Aug. 10, 2010 http://www.oasas.state.ny.us/admed/fyi/fyiindepth-insomnia.cfm

APA Reference
Tracy, N. (2019, September 8). Alcoholism, Drug Addiction and Sleep Disorders, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/alcoholism-drug-addiction-and-sleep-disorders

Last Updated: September 18, 2019

Sleep Disorders Information Articles

In-depth, trusted information on sleep disorders, sleep problems, from symptoms to treatments. Plus mental health disorders and sleep problems, sleep disorders.

Sleep Disorders Information Articles

Sleep Disorders Information

Treatments for Sleep Disorders

Mental Health Disorders and Sleep Disorders

Psychiatric Medication and Sleep Problems

Sleep Disorders Videos and Resources

APA Reference
Writer, H. (2019, September 8). Sleep Disorders Information Articles, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/sleep-disorders-sitemap

Last Updated: September 18, 2019

Treatment of Bipolar with Sleep Disorders

How to treat a sleep disorder related to bipolar disorder. Treatment for bipolar insomnia, other sleep disorders using self-help and sleep medications.

Treating sleep disorders occurring with bipolar disorder is key, as treating the sleep disorder can also improve the symptoms of bipolar disorder. Sleep disorders are commonly treated with lifestyle changes and can include medication. Behavioral therapies, like the Interpersonal and Social Rhythm Therapy,2 are also available. These therapies can improve understanding of daily cycles and help to create consistent rhythms in an effort to stabilize mood.

Sleep Medications for Sleep Disorder with Bipolar Disorder

Treatment for Bipolar - Insomnia

Sedative-hypnotics like Lunesta are often prescribed to treat insomnia in bipolar disorder. A sedating antidepressant, mood stabilizers or antipsychotics may also be prescribed to treat both the mood and sleep disorder. Commonly prescribed medications include:

Bipolar and Sleep Problems: Key Points To Remember

The crucial things to remember for sleep disorders and bipolar:

  1. Find a way to work with a daily rhythm long-term as the need for a consistent rhythm isn't going to go away
  2. Loved ones should help provide a lifestyle where a consistent sleep/wake cycle is possible and encouraged
  3. Watch for oversleeping, insomnia, non-restorative sleep or a lack of need for sleep
  4. If a change in sleep pattern is noticed, a doctor should be informed as soon as possible

References:

1 Purse, Marcia. Mood Disorders and Sleep About.com. June 20, 2006 http://bipolar.about.com/cs/sleep/a/0002_mood_sleep.htm

2 Turim, Gayle. Bipolar Disorder and Sleep Problems Everyday Health. Oct. 23, 2008 http://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-and-sleep-problems.aspx

APA Reference
Tracy, N. (2019, September 8). Treatment of Bipolar with Sleep Disorders, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/treatment-of-bipolar-sleep-disorder

Last Updated: September 18, 2019

Bipolar Disorder and Sleep Problems

In-depth info on bipolar and sleep problems, like insomnia. Why many with bipolar disorder have a sleep disorder. How to improve bipolar disorder sleep.

Both, in cases of mania and depression in bipolar disorder, sleep disorders are common. In depressive episodes, a person with bipolar disorder is more prone to hypersomnia (excessive sleeping) as well as non-restorative sleep. In a manic phase, the person commonly feels less need for sleep (insomnia), sometimes staying up 20 hours at a time, or more.1

What is Bipolar Disorder?

Bipolar disorder is characterized by dramatic shifts in mood from mania (or hypomania) to depression. Typical manic symptoms include:

  • Racing thoughts
  • Elevated or irritable mood
  • Rapid, excessive speech; frequently changing topics
  • Decreased need for sleep
  • Grandiose beliefs
  • Increased goal-directed activity
  • Impulsivity and bad judgment

Symptoms of depression include:

  • Feelings of sadness, anxiety, irritability or emptiness
  • Feelings of hopelessness or worthlessness
  • Loss of enjoyment in things previously found pleasurable
  • Lack of energy
  • Difficulty thinking, concentrating or making decisions
  • Changes in appetite and weight
  • Thoughts of death or suicide
  • An increase or decrease in sleep

The Link Between Bipolar Disorder and Sleep

The human body has a built-in clock telling every cell in the body what time of day it is; this is known as the circadian clock or rhythm. This internal rhythm synchs to external cues such as the rising and setting of the sun and mealtimes, and directly affects when the body sleeps. While anyone can experience insomnia or another sleep disturbance when their circadian rhythm is disrupted, those with bipolar disorder seem to be particularly sensitive. Something as simple as staying up late to attend a party may disrupt the circadian rhythm enough to provoke insomnia.

Insomnia Can Predict or Cause Bipolar Depression or Mania

While a night of insomnia is normally considered simply a hassle, for a person with bipolar disorder it may signal an oncoming depression or manic episode. Studies have found that between 25 and 65 percent of bipolar patients experienced an interruption in circadian rhythm just prior to a manic episode. To make matters worse, a perceived lack of need for sleep is common in manic episodes. Once the mania begins, a person is likely to further deprive themselves of sleep, making the mania worse.

References:

1Purse, Marcia. Mood Disorders and Sleep About.com. June 20, 2006 http://bipolar.about.com/cs/sleep/a/0002_mood_sleep.htm

2Turim, Gayle. Bipolar Disorder and Sleep Problems Everyday Health. Oct. 23, 2008 http://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-and-sleep-problems.aspx

APA Reference
Tracy, N. (2019, September 8). Bipolar Disorder and Sleep Problems, HealthyPlace. Retrieved on 2019, September 20 from https://www.healthyplace.com/other-info/sleep-disorders/bipolar-disorder-and-sleep-problems

Last Updated: September 18, 2019

Why You Should Engage with Your Anxiety

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When you feel anxious, it is natural to look for ways to get rid of it immediately; engaging the anxiety fully isn't the most comfortable choice. In general, looking to get rid of anxiety is an effective response because it allows us to evade danger and survive. However, for chronic anxiety that isn't tied to immediate threats, it can be harmful to focus on avoiding or eliminating anxiety because this can actually exacerbate it.

If I told you not to think about what to eat for breakfast, it's likely that the first thing you'd think of is precisely that, and this is the same trap we fall into with anxiety when we attempt avoidance. Rather than giving us peace of mind, it just brings our anxiety to the forefront of our minds. So, is there a better option? I believe the answer is a resounding yes. You can choose to engage with your anxiety instead.

How I Learned to Engage with Anxiety

When I was in college and experiencing frequent panic attacks, I tried my best to avoid them initially. There was no way I'd engage that anxiety. So I ate, slept, and worked in ways that I thought would help me avoid panic, but it kept coming up anyways. What ended up reducing my panic was something entirely unexpected -- I allowed myself to be curious about panic. Instead of looking for ways to avoid it, I began looking for ways to learn from my panic. Although it took some time for this change in mindset to occur, once I embraced this curiosity, I stopped experiencing panic attacks almost entirely. 

Now, you may say there's nothing you're curious about with your anxiety, and you very well may be right. In my case, curiosity provided a productive avenue for me to engage with my anxiety, but there may be another avenue for you. For instance, you may be able to engage with your anxiety through drawing, music, or writing, each of which can provide positive opportunities to work through your anxiety. I'm not suggesting you draw or write when you're anxious as a way to escape, however. Instead, I believe that identifying ways to focus on your anxiety that aren't centered on yourself can reduce anxiety. By thinking about anxiety independently of ourselves, we limit its control over how we feel and attain a better understanding of its role in our lives. This can be a challenging process, so below I share three methods I use to put myself in a mindset that allows me to engage with anxiety in a productive, healthy way. 

Three Ways to Engage With Your Anxiety

  1. Identify a focal point. Start by finding an aspect of your anxiety that you can focus on without thinking primarily about yourself. This is a challenging process, but I found this very useful when I was experiencing frequent panic attacks. Eventually, I was able to embrace a mindset of curiosity because I began to see my panic as an opportunity to learn something that might help someone else in the future. Once I saw my panic attacks as valuable experiences that could provide insight into someone else's suffering, they lost the power to make me afraid, and instead became objects of my curiosity. The key, I believe, is that my own experiences were taken out of consideration and my focus became exclusively the hypothetical individual I could support precisely because of my panic. Now, you don't have to engage with your anxiety in the same way, but the idea is to find something about your anxiety that draws you out of yourself and fixes your attention on some "other". 
  2. Identify a reminder. One problem I had initially with this strategy was that it was hard to remember my new focal point when a panic attack first started. I would often go a minute or two without thinking about my curiosity, and eventually, I was able to remind myself and shift my attention. Keeping a post-it note, a journal, or even writing on your hand can be a great way to remind yourself to shift from focusing on your anxiety to your new focal point. Regardless of what reminder you use, it's important to have that reminder in place so that you don't forget to change your mindset. 
  3. Embrace patience. Initially, I would still worry about how long I'd feel anxious for, but eventually, I allowed myself to be patient and to just let myself flow with the experience. Changing the way you engage with anxiety can be a slow process, so embracing opportunities to practice without judging how long it takes to feel better is a crucial step towards reducing your anxiety. Change takes time, and although we often want immediate gratification, the path to sustainable results is a long and often circuitous one. 

I hope these strategies provide you with a starting point for engaging with your anxiety in a healthier, more productive manner. Although it can take time, shifting our attention from ourselves to another aspect of anxiety can provide new insights, novel experiences, and meaningful change. 

How to Cope with a Suicidal Partner

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Trigger warning: This post contains frank discussion of suicide.

Being in a relationship with a suicidal partner can be emotionally taxing and daunting. There is this complicated pattern in my dating life in that the partners I loved most have threatened suicide at least once. I am still trying to figure out exactly why I am drawn to individuals who experience such turmoil. Perhaps it is because I had suicidal ideations when I was in high school, and I feel like these partners understand me. Maybe I cannot compartmentalize the social worker in me when it comes to dating, and I want to try and "save" everyone I meet. Regardless, here are the things I wish I had known when I had a suicidal partner. 

What to Do If Your Partner Is Suicidal 

Urge Them to Seek Professional Help

When my former suicidal partners threatened suicide, I felt like it was my responsibility to reintroduce a will to live. In my mind, their lives were balancing upon everything I said and did. If I did not pick up their phone calls, I was sure I would be the one to blame if they were found dead. Although it can be painful to voice this to a partner, it is essential to tell your partner that you alone cannot save him or her; that person needs to seek professional help. I thought I could be the one to save my partners, but the truth is, I was highly unqualified. 

Listen to Your Partner and Give Your Partner Space to Talk

There is a flawed belief that talking about suicide with individuals experiencing ideations is dangerous and can push them to take their own lives. Research shows that this is not the case. Therefore, be there to listen to your partner and talk to that person about how he or she is feeling. Of course, keep an open mind and do not push your judgments onto your partner. You may not understand how your partner is feeling, but believe him or her and take in his or her feelings as truth. 

Do Not Blame Yourself 

No matter what your partner says, it is crucial not to blame yourself and not to take responsibility for how your partner is feeling. About six years ago, my long term partner broke up with me in a five-minute phone call. In this phone call, he told me he was dropping out of college and was highly suicidal. He cut off communication with nearly all of his friends, and for months, I felt like his life was my responsibility. I believed that if he died, it would have been my fault. This belief weighed heavily on me and resulted in intense emotional turmoil. 

When a Partner's Threat of Suicide Turns into Emotional Abuse 

Although I am a firm believer that suicide threats should be taken seriously, there have been times in my life where these threats have kept me in sticky and emotionally abusive situations. When your partner threatens suicide only when you are doing something that he or she doesn't approve of, this can quickly turn into a form of manipulation. I once dated someone who would threaten to kill himself whenever I tried to end the relationship. As a result, I stayed in this relationship much longer than was healthy for me. If you suspect that your partner may be manipulating you in such a fashion, I encourage you to seek out professional support. 

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources, and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.

Are Suicide Attempts Under-Reported?

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Trigger warning: this post involves frank discussion of suicide and a suicide attempt.

I've been considering the idea that suicide attempts are underreported. The theory of this is simple, the only way a suicide attempt gets reported is if a person gets medical help for it and admits to it but how many people have attempted suicide and not gotten medical help for it or have denied that it was a suicide attempt? I know one person -- me. I didn't get help for my suicide attempt. My attempt isn't part of the statistics about suicide attempts in bipolar disorder. So are suicide attempts underreported in general?

My Unreported Suicide Attempt

Back in 2010, things were horrendous for me. I was in one of the deepest darkest depressions I had ever been stuck in. I won't take you back there, but suffice it to say, I was being denied access to psychiatric treatment because of processes that were clearly made without care. I knew that if I couldn't get psychiatric treatment then I couldn't get help, and if I couldn't get better, then I couldn't get better, and if I couldn't get better, then what was the point of going on? And one day this weighty reality was just too much for me. Drugs, alcohol and other things were involved in this suicide attempt but for reasons I won't get into, it didn't result in my death. It resulted in me waking up on my kitchen floor.

And I never told anyone about it until I started telling my story to crowds. It's an odd thing to admit to an audience before you sit down and tell your best friend.

Underreporting of Suicide and Suicide Attempts

I am not exactly alone in not reporting my suicide attempt. I've talked to many others who have attempted suicide, survived and then told no one. This isn't what I would recommend, but it's something that really does happen out here in the imperfect, real world.

It is known that suicides themselves are underreported and some scientists have tried to figure out by how much. One study from the United Kingdom estimated that only approximately 47-65 perfect of probable suicides were actually classified as suicides by coroners. It is thought that in the United States, the numbers are similar. In the United States, suicides are thought to be misclassified due to "incomplete data or stigma, particularly in teens and minorities."

Suicide attempts can easily be misclassified for the same reasons: people show up in the Emergency Room after an attempt and due to lack of information, stigma, and patient denial, the incident is not classified as a suicide attempt. This, of course, doesn't even take into account situations like mine where I didn't even end up in an Emergency Room.

The military has conducted surveys both anonymous and not, and have shown that in post-deployment officers, 5.1 percent of people report suicidal ideation when a survey is anonymous whereas during their actual post-deployment health assessment, only 0.9% of people reported suicidal ideation.2 That means that 5.7 times more people report suicidal ideation when it's anonymous. Suicide ideation doesn't equal a suicide attempt, of course, but what we know is that the suicide rate in the veteran population is sky-high and this may be part of the reason. (In 2015, veterans accounted for 14.3 percent of all deaths by suicide in adults [adge 18 and up] in the United States and constituted 8.3 percent of the adult population in the United States.3)

The Implications of Underreported Suicide and Suicide Attempts

There are so many things that happen when a suicide or a suicide attempt is not supported. The first thing that comes to mind is a hindrance to understanding and program funding. For example, current numbers state that about 11 percent of people with bipolar disorder die by suicide while up to half of those with bipolar attempt suicide.4 However, if these numbers are falsely low, it matters in our understanding of the illness and our understanding of how to help people with the illness. Risk management in bipolar is key, but if we don't really understand the risk, how can we manage it?

And yes, funding really matters. If you can show politicians that more of their electorate are dying, they will, theoretically, care more and set aside more money to help those people.

But apart from all of that, you have the human cost. You have the cost to all those who do not get appropriate help after attempting suicide (like me) and the cost to all those families who will never know the truth about their loved one's death. And what I know is that those costs are very, very high.

No single one of us can change these realities. People are always going to be scared of reporting suicidal ideation and suicide attempts. Coroners are always likely to veer away from noting the cause of death as suicide. This is just humanity for you.

But September is National Suicide Awareness Month and now is the time when we need to talk about these things. We need to talk about suicide. We need to talk about suicide attempts. We need to honor those who have died by suicide by making sure that not one more avoidable death happens. Our open and honest conversations about suicide can do that. We can normalize suicidal ideation and, more importantly, normalize getting help for suicidal ideation. We can teach people what to look for when it comes to suicidality. We can know who to turn to if we or someone else needs help. This is our time. This is our moment.

Don't let this moment slip away. Start talking suicide. It will cost you nothing and yet can save everything.

If you feel that you may hurt yourself or someone else, call 9-1-1 immediately.

For more information on suicide, see our suicide information, resources and support section. For additional mental health help, please see our mental health hotline numbers and referral information section.

Sources

  1. Shepard, D., Gurewich, D., et al, "Suicide and Suicidal Attempts in the United States: Costs and Policy Implications." Suicide & Life-Threatening Behavior, October 2015.
  2. Vannoy S., Andrews B., et al, "Under Reporting of Suicide Ideation in US Army Population Screening: An Ongoing Challenge." Suicide & Life-Threatening Behavior, December 2017.
  3. United States Department of Veteran Affairs, "Facts About Veteran Suicide." June 2018.
  4. Soreff, S., Bipolar Disorder. Medscape, May 30, 2019.