U.S. Army Medical Department, Office of the Surgeon General
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Potentially Life Threatening Thoughts and Behaviors

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Some behaviors and symptoms previously described are not only signs of stress reaction, but can also signal potential suicide risks. Soldiers must be ever vigilant for the signs and signals of a potential threat of suicide given by their fellow Soldiers.

Soldiers contemplating suicide—

  • Believes he or she is in a hopeless situation.
  • Appears depressed, sad, and tearful; may have changes in patterns of sleep and/or appetite.
  • May talk about or actually threaten suicide, or may talk about death and dying in a way that strikes the listener as odd.
  • May show changes in behavior, appearance, or mood.
  • May increase or start drug or alcohol use.
  • May injure self or engage in risky behavior.
  • Abandons planning for the future.
  • May start withdrawing from others, including family and close friends.
  • May give away possessions.
  • May appear apathetic, unmotivated, and indifferent.

The small-unit leader may be the first to identify the "signs" of a potential suicide-risk Soldier. The keys to prevention are to provide aid to persons at suspected risk and follow the acronym AID LIFE—

  • A-Ask: "Are you thinking about hurting yourself?"
  • I-Intervene immediately.
  • D-Do not keep a secret concerning a person at risk.

  • L-Locate help (Leader, peer, BH asset, ER, etc.).
  • I-Inform your chain of command of the situation.
  • F-Find someone to stay with the person. Do not leave the person alone.
  • E-Expedite! Get help immediately. A suicidal person needs the immediate attention of helpers.


Thoughts of homicide and/or injury to others outside of ROE are stress reactions that can be expected during intense combat. Horrific Soldier and civilian deaths may lead Soldiers to feel vengeful and homicidal outside of ROE. Soldiers may verbalize a desire to kill or harm civilians they believe to be aiding the enemy, or toward command they hold responsible for the death of their friends. Vengeful thoughts and pre-misconduct behaviors may occur in individuals or groups of individuals within a unit. Poorly trained and undisciplined Soldiers are at highest risk, but highly cohesive and proud units are also susceptible during times of extreme combat stress.

Early identification of unit and individual risk factors and behaviors that precede misconduct and preventive measures can minimize the risk of homicide or injury to others outside ROE. Soldiers and leaders at every level must be able to identify risk factors and behaviors that may lead to violent and uncontrolled reactions, and employ interventions to prevent misconduct that must be punished.

Unit Risk Factors that may precede homicide or injury to others outside of ROE:

  • Multiple Soldier and civilian deaths, in the same unit, over a short period of time.
  • High op-tempo with little respite between engagements.
  • Rapid turnover of unit leaders.
  • Manpower shortages.
  • Restrictive or confusing ROE: themes of "powerless to fight back".
  • Enemy that is indistinguishable from civilian targets.
  • Perception of lack of support from higher command.
  • Rumors of "Overkill" of legitimate enemy targets e.g.: mutilation of enemy combatant with excessive firepower.

Individual Risk Factors that may precede homicide or injury to others outside of ROE:

  • Soldier with poor social support.
  • Soldier has home-front or unit problems.
  • Soldier known to react impulsively in past.
  • Soldier with history of UCMJ.
  • Individual has suffered a combat loss (friend WIA or KIA).
  • Soldier personally witnessed the injury or death or involved in the medical evacuation of friend/unit member.
  • Loss was particularly gruesome or horrific.

Individual Behaviors that may precede homicide or injury to others outside ROE:

  • Soldier verbalizes thoughts of anger toward/lack of support from higher command.
  • Soldier verbalizes thoughts of indiscriminate revenge.
  • CHANGE in appearance/behavior:
  • Lax military dress/bearing.
  • "On edge".
  • Angry outbursts.
  • Risk taking (intentional near miss in traffic).
  • Morose/isolative.
  • Changes in sleep and appetite.
  • Soldier pushing ROE to the max: e.g.: excessive/indiscriminant/near miss warning shots.
  • Drug or alcohol use.

Leaders are not immune to risk factors or hostile thoughts outside of ROE. They must be alert to and address their own thoughts, feelings and how these may be transmitted to their Soldiers. In addition to self awareness and early recognition of risk factors and behaviors that might indicate future misconduct, small unit leaders and Soldiers of all ranks can intervene to prevent thoughts from becoming behaviors that escalate to uncontrolled violence. Specific interventions include:

  1. Know your Soldier(s) to recognize changes in baseline behavior that seem like more than normal grieving.
  2. Remind Soldier(s) that horrific injury and death occur in combat.
  3. Remind individual/ group before, during and after engagements:
    • You are an American Soldier(s) here to complete a lawful mission.
    • You must behave honorably because it is the right thing to do.
    • To do otherwise dishonors you and your fellow Soldiers (both living and dead).
    • Stepping down to revenge helps the enemy to discredit you and win.
    • The Final Objective is to "Return home with honor."
  4. Remind Soldier(s) that thinking about harming or killing others outside of ROE is a very common reaction to the sadness and anger that are part of combat, but taking action on those thoughts is misconduct that will be punished.
  5. Ask if Soldier(s) is/are thinking about taking revenge outside of ROE.

If leaders suspect that Soldier(s) may act to kill or harm others outside of ROE:

  1. Don't leave Soldier(s) who is dangerous to others alone.
  2. Unless in immediate danger, Soldier(s) should not continue to carry a loaded weapon (or bolt of weapon may be removed).
  3. Don't keep dangerous secrets: locate help immediately (NCO, chaplain, medic, doctor or nurse, Combat Stress Control personnel).
  4. Inform chain of command.

If Soldier(s) return to duty:

  • Obtain advice and ongoing assistance from BH or COSC assets.
  • Consider rotation of individual or small unit (squad) to less intense duties for a period of time.
  • Assign Soldier a Battle Buddy.
  • Frequently check back with the Soldier(s)/remind and get help as above throughout the mission.