The Link Between PTSD and Interpersonal Violence

Psychological and Social Research: Review, Evaluation and Design

Abstract

Post-traumatic stress disorder (PTSD) was a serious mental health condition that affected veterans from all conflict eras and many, due to witnessing such extreme violence and suffering with the symptoms of PTSD, turned to commit interpersonal violence (IPV). This review concentrated on providing evidence to prove that there was a significant link between PTSD and IPV. A systematic search was conducted using three databases for academic journals and an overall total of 10 papers were reviewed and discussed. There appeared to be a link between PTSD and IPV based on the papers reviewed but there was limited research on females and no research on homosexual relationships; reasons for this were mentioned. To prevent the perpetration of IPV; interventions should be looked at to help the veterans understand PTSD and how it could be linked to IPV.

A Systematic Review on Veterans’ PTSD and Intimate Partner Violence as a consequence of war Definition and prevalence of PTSD

Jones and Wessely (2009) stated that being exposed to a war related situation increased the risk of being diagnosed with post-traumatic stress disorder (PTSD) (as cited in Sundin, Fear, Iversen, Rona and Wessely, p.367). PTSD was originally known as “shell shock” during the first world war (Loughran, 2012) and continued to be called this until the end of the Vietnam war. In 1980, the mental illness that many veterans suffered with was finally given an official name (Brown, 2017) PTSD, this led it to being added to the third edition of the DSM and was finally recognised as a serious mental health condition (Van Der Kolk, 2007). According to the current edition of the DSM (DSM-V), a few of the symptoms associated with PTSD are: intrusive memories, recurrent distressing dreams and flashbacks, as well as depression and anxiety (Comer, 2015). The highest rates of PTSD were found in post-conflict settings (Atwali, Stein, Koenen, and McLaughlin, 2015), which could be explained by the older populations, who were either inadvertently or advertently involved in a war (Burri and Maercker, 2014), such as World War 2. Concentrating on a study conducted on UK military, only 4.8% of Iraqi veterans were found to have or be experiencing PTSD symptoms (Iversen et al, 2009). The percentage was small due to the stigma associated with PTSD, some of the troops might have chosen not to come forward and declare that they were suffering with symptoms of the condition (Buchanan, Kemppainen, Smith, MacKain, Wilson-Cox, 2011). In comparison to the UK, a study conducted in the USA found that 18% of troops returning from Iraq suffered with PTSD symptoms (Hoge, Castro, Messer, McGurk, Cotting and Koffman, 2004). A more recent study found that 23% of veterans who were involved in both Operations Iraqi Freedom and Enduring Freedom (OIF/OEF), were believed to be experiencing symptoms of PTSD (Fulton, Calhoun, Wagner, Schry, Hair, Feeling…Beckham, 2015). The percentage could be explained by the difficulty in obtaining treatment and care in westernised countries, including both the UK and USA (Langston, Gould and Greenberg, 2007).

Self-Perception theory

Veterans who experienced war zones and combat-deployment often suffered with PTSD as already discussed. The key issue here was whether their own self-perception was altered after experiencing a traumatic event. Self-perception theory involved an individual learning about their own emotions and attitudes by observing their own behaviour, much like they did with others (Baumeister and Bushman, 2011). People who suffered with PTSD including veterans, often suffered with changes in their self-perception. Veterans with PTSD often felt feelings of guilt and shame (Singer, 2004), as well as experiencing self-blame and isolation (Regehr and Roberts, 2010). It was important that they understood the meaning of a traumatic event and had schemas in place to re-correct their perceptions (Lee, Scragg and Turner, 2001).

Definition and prevalence of IPV

There were several terms that could be used to define intimate partner violence (IPV) such as; partner abuse, spouse abuse (Aronson, Perkins and Olson, 2014) or domestic violence (Garcia-Moreno, Jansen, Ellsberg, Heise and Watts, 2005). IPV was defined as:

“IPV is a pattern of coercive behaviours that can result in physical injury, psychological abuse, sexual assault and social isolation…three types of violence that constitute IPV: psychological/emotional abuse, physical and sexual abuse.” (Daigle, Scherer, Fisher and Azini, 2016, as cited in Cuevas and Rennison, p.374).

Regarding the rates of IPV many studies found that more violent IPV was committed by military samples in comparison to civilian samples (Rentz, Martin, Gibbs, Clinton-Sherrod, Hardison and Marshall, 2006; Aronson et al., 2014). It was also discovered that both genders appeared to commit similar acts of IPV at the same rates. However, men were more inclined to commit both physical and sexual abuse compared to women; whereas, both genders committed emotional abuse at the same rates. A study conducted by LaMotte, Taft, Scott and Eckhardt (2015) found that out of their sample of 63 veterans 27.7% had committed physical abuse on their partner at least once. These studies help confirm the notion that IPV was more likely to be committed by military personnel.

Frustration-Aggression theory and the coming of the General Aggression Model

This provided a theoretical framework for IPV and it postulated that an individual who was frustrated could experience many ways to respond to the feeling, however, the normal response was anger or aggression (Mitchell and Vanya, 2009; as cited in Mitchell and Anglin, p.41) especially in males, as this was a prominent masculine trait (Klein, 2008). The impact of aggression on relationships often led to a negative effect (Bookwala, Frieze and Grote, 1994). Although the frustration-aggression theory provided a starting point for why IPV occurred, the general aggression model (GAM) was more expansive and provided a conceptual framework that included the frustration-aggression theory (DeWall and Anderson, 2001). There were a number of situations that increased the likelihood of aggression, such as: mental exhaustion. When this occurred, they were less likely to control their levels of aggression, more so if they felt provoked or were experiencing communication problems, as said by Medeiros and Straus (2007, as cited in Hamels and Nicholls, pp. 77-78). Those who experienced PTSD often felt mentally drained. During a relationship altercation those experiencing PTSD attacked their partner because they misperceived the level of threat (Bell and Orcutt, 2009) and due to them experiencing this mental exhaustion. It was discovered that PTSD had a role in the development of a chronic fatigue like illness in veterans (Kang, Natelson, Mahan, Lee and Murphy, 2003).

Attachment theory

To begin with attachment theory was initially created to understand children’s attachments; it now included attachments for adults regarding their relationships with others. There were 4 attachment styles or patterns to which adults could be categorised: secure attachment, preoccupied, dismissive and fearful-avoidant (Gibson and Gibson, 2016).

Attachments have been researched in the area of PTSD and IPV to see if there was a relationship between the type of attachment and how that affected PTSD development and committing of IPV. According to Scott and Babcock (2010) experiencing a high dependency and anxiety attachment (preoccupied) strengthened the relationship between PTSD and IPV as it made emotional connections more difficult (Knox and Schacht, 2015). Whereas, having low dependency and anxiety attachments (dismissive) decreased the rates of IPV and PTSD (Scott and Babcock, 2010). These results implied that a preoccupied attachment style led to high PTSD and IPV rates and having a dismissive attachment was associated with rejecting intimate relationships and experiencing less symptoms of PTSD. As many veterans experienced elevated levels of PTSD and committed IPV then their attachment style would be more related to the preoccupied attachment, based on this study.

The importance of this review

A review of PTSD and IPV was important to establish whether there was a link, as many studies found conflicting results. There appeared to be a lack of homosexual relationships involved in this research area, as there was discriminating attitudes towards them (Sinclair, 2009), so it would be interesting to see if they were included in more recent research.

Regarding the research conducted on veterans and PTSD, this review would be considering samples from deployment in Iraq. The review itself would provide clinicians with what to look out for regarding the treatment of PTSD and the committing of IPV, as well as providing the veterans with a better understanding of the implications of war. PTSD and IPV have only been researched relatively recently (Bell and Orcutt, 2009; Sullivan and Elbogen, 2014; Finley, Baker, Pugh and Peterson, 2010) and there was a lack of research that solely concentrated on the veterans from the OIF/ OEF eras (Aronson et al., 2014; LaMotte,Taft, Weatherill, Scott and Eckhardt, 2014). Due to the length of the Iraq war and due to advanced research more studies could now be conducted on the effects of combat deployment and IPV (Link and Palinkas, 2013).

Method - Literature search

To begin the initial search, it was decided that the Discover@Bolton, Ebsco and Proquest Central should be used as they included articles within their databases that were both scholarly and peer-reviewed, both considered as important for this systematic search. It was decided that 2006-2017 would be the years looked at.

The scope of the review originally concentrated on Cognitive Behavioural Therapy (CBT) and PTSD using the search terms: cognitive behavioural therapy, cognitive behaviour therapy, post-traumatic stress disorder, post traumatic stress disorder and posttraumatic stress disorder. After finding 76,242 articles on one website (Ebsco) and only managing to narrow that down to 8527, it was concluded that this search was too broad. That was when IPV was considered alongside PTSD regarding Iraqi war veterans which yielded a much better search. There was a variety of abbreviations that could be used, as established in the original search. It was important to concentrate on only a few so the search would be more narrow and specific. The search criteria finally used was: PTSD, IPV and Iraqi war veterans and the years remained the same as in the first search. Due to the difficulties in the initial search 70 articles was given as a cut-off point. Studies conducted in the UK or USA were used as they were both involved in the Iraq war and it was thought that anything before 2006 would be outdated and not as relevant as more modern research. Only English papers were looked at due to a language barrier which did not affect the final search as all of them were in English. A specific sample size was not required for this review as long as the participants were veterans from the OEF/OIF eras.

Both Discover@bolton and Ebsco found 65 relevant articles and Proquest Central found 15; of these articles, 10, 5 and 7 titles contained the relevant key words; 4, 1 and 2 titles were considered irrelevant and were removed. That left 6, 2 and 5 relevant titles for the reading stage of the search. However, 1 was removed via abstract and 2 were removed due to duplication. This left an overall count of 10 papers for review (see Figure 1).

All results found via using the terms: PTSD, IPV and Iraqi war veterans; years 2006-2017
	Proquest central	Discover@bolton	EBSCO
Overall papers	15	65	65
Relevant key words	7	10	5
Irrelevant titles	2	4	1
Relevant titles	5	6	2
Removed via abstract	1	0	0
Removed due to duplication	0	2	0
Total from each website	4	4	2
Overall total used	10

Figure 1 shows the search strategy used to find the relevant papers for this review

Discussion: Findings of the papers, strengths and limitations

Based on the papers reviewed there was an overwhelming majority that supported a relationship between PTSD and the committing of IPV in veterans which included both physical and mental abuse (Klaw, Demers and Da Silva, 2016; Teten, Schumacher, Taft, Stanley, Kent, Bailey…White, 2010; Sullivan and Elbogen, 2014; Finley et al., 2010; Miles, Menefee, Wanner, Teten-Sharp and Kent, 2016; Rabenhorst, McCarthy, Thomsen, Milner, Travis, Foster and Copeland, 2013; LaMotte, Taft, Weatherill, Scott and Eckhardt, 2016; Kar and O’Leary, 2013). The papers that were kept for this review will now be discussed in terms of their findings (for more information on the papers please see the matrix table in Appendix A).

To begin with, Finley et al (2010) interviewed OEF/OIF veterans and their partners on their history of deployment (if relevant), their experiences and likelihood of violence in the home. The transcripts suggested there was a relationship between committing violence in their home and suffering from PTSD. There were a number of strengths for the methodology of the study; instead of just concentrating on male veterans they included females as well, however, using random selection the transcripts were all relevant to male veterans only, as the sample of female veterans was so small. When conducting the interviews both veterans and their spouses were interviewed separately so neither could have an impact on what the other was saying, making the results more reliable. As well as this, no cues were given about violence which meant responses were more natural and allowed for the interviewee to discuss what they wanted rather than being pushed for information. In comparison, Teten et al (2010) had PTSD and non-PTSD diagnosed veterans complete self-report measures on levels of desirability and conflict scales. Regarding their findings, it helped back up the claims made by Finley et al (2010) as those with PTSD were significantly more likely to report psychologically abusing their partner, which was a form of IPV. Before they conducted this study, Teten et al (2010) ensured that all participants were in the right frame of mind to participate and provided incentives, such as information on mental health organisations. By doing this, they were providing help for the veterans and showing them that they were not alone, as many people with PTSD suffer in silence due to the stigmatisation associated with this disorder (Buchanan et al., 2011). Although, the desirability scale was used to see about the levels of honesty when reporting socially undesirable behaviours, the OEF/OIF veterans had higher scores so wanted to appear more favourable. The results given on the other self-report measures may be affected by this participant bias which could have been accounted for but it was never stated if this was the case.

Kar et al (2013) had OEF/OIF male veterans from a medical centre complete several questionnaires relating to: conflict, PTSD symptomology and personal assessment of relationships. The results suggested that PTSD symptoms predicted a form of IPV which was physical aggression, meaning that PTSD and committing IPV were interlinked. Kar et al (2013) provided support for the attachment theory as it backed up the claim made by Knox and Schacht (2015) as they argued that those with poorer emotional coping styles had more difficulty dealing with a traumatic event. However, the sample failed to account for female veterans or homosexual relationships and some of the data was removed as relationships ended. They failed to include why these relationships broke down and whether it was connected to IPV, if it was due to IPV, they could have included this in their study. In support of the findings Rabenhorst et al (2013) reviewed 9511 incidents that involved both forms of IPV from a United States Airforce database. Although they never included PTSD symptomology, they found that moderate to severe levels of abuse occurred after being involved in the Iraq war (OEF/OIF) which would be prominent for the development of PTSD (Atwali et al., 2015). Again, like many of the studies mentioned they failed to include females or homosexual relationships and they only considered men who were married and not those in a long-term relationship. However, due to the large sample size the results were more generalisable but as they only accounted for the US air force they could not be generalised to other military outlets. As they used a database where spouse abuse was recorded, some people might have not wanted to come forward and so the amount of data available could therefore be affected.

Sullivan et al (2014) completed a 1-year follow up study using a sample from the national post-deployment adjustment survey. The original sample contained 950 veterans followed by 866 1 year later. The first study found that experiencing a vast amount of combat exposure increased the likelihood of severe family aggression and outbursts of anger was linked to PTSD. At the 1-year follow up those experiencing high combat exposure were more inclined to commit any form of violence or aggression not just severe family aggression as previously thought. The idea of anger causing any form of aggression or violence remained the same. They argued that the symptoms led to detaching oneself from reality and that “reexperiencing symptoms that leads to violence is associated with this dissociation.” (p.02). This provided further evidence that supported the GAM as the reexperiencing of symptoms could be viewed as the misperceived threat (Bell and Orcutt, 2009) or traumatic reminders (LaMotte et al., 2016). Both the sample size and methodology increased the generalisability of this study as there was a large demographic including, more than one military outlet (see Appendix A), female veterans and it accounted for those who had no computer as they sent copies of the questionnaires by mail as well as email. In contrast to these findings by Sullivan et al (2014) and the previous papers discussed, LaMotte et al (2014) included the veterans’ partners in their sample. The questionnaires were administered over the telephone and the partners were asked if they had privacy, to ensure that the veterans were not present. Although the findings suggested that the partners committed more violence than the veterans, there was an explanation as to why. When completing the questionnaires there was no authentic way of knowing if the partner was in fact alone, so the veteran had the opportunity to prompt what she was saying; meaning the abuser had satisfaction due to having control over their partners life (Knox and Schacht, 2015). To appear socially desirable, the veteran could have made her admit to violence that she did not commit or had committed in self-defence, as some females in violent relationships did this to protect themselves (Medeiros and Straus, 2007, as cited in Hamels and Nicholls, p.60.) which would explain the results obtained. Considering this, there appeared to be a major flaw in LaMotte et al’s (2014) study as it could not be said for sure that the partners answered truthfully.

To support the idea of PTSD and IPV; Kelley, Stambaugh, Milletich, Veprinsky and Snell (2015) conducted a study on navy members who were deployed in either OEF or OIF. They found a significant interaction between deployment and relationship satisfaction. They failed to account for PTSD but as the sample had experienced deployment in Iraq, PTSD cannot be ruled out, as previously mentioned. Regarding relationships and deployments, the number of deployments experienced effected the rate of IPV which increased as the relationship satisfaction decreased. The sample size (see Appendix A) included females and the participants race/ethnicity so the sample was comparable. They used deception techniques in their procedure as they did not inform the participants that they were assessing the levels of partner violence. It can have damaging effects on the well-being of an individual, especially with people who experienced PTSD as they already felt guilty and shameful (Regehr and Roberts, 2010) because of their symptoms. This study never stated if the participants had PTSD, so it cannot be said for sure that the use of deception had detrimental effects. Bringing in PTSD symptomology, Miles et al (2016) discovered a relationship between controlling emotions and PTSD and suggested that veterans in a treatment programme who could not control their emotions were more associated with impulsive aggression, which ultimately led to a decrease in relationship satisfaction (Bookwala et al., 1994). It was important to have the frustration-aggression theory and the GAM according to Miles et al (2016) as it helped with understanding aggression in those with PTSD. Having this information would allow for predictions and preventions regarding aggressive outbursts. They had a wide sample that included females as well as males meaning that the results could be generalised to both genders. They failed to include people suffering with PTSD outside of the treatment program (see Appendix A) which would have provided a comparison. Regarding the self-report on the level of anger or aggression, participants could have had a different understanding for each term, to reduce the chance of this, definitions of each should have been given or the researchers should have had them explain the outburst to ensure it came under the right form- aggression or anger.

The final papers to review included LaMotte et al (2016) which looked at male OEF or OIF veterans from a health centre and placed them in simulated scenarios that were either trauma or non-trauma related. They found that those in the trauma scenario had a stronger link between PTSD severity and physical aggression articulations. Experiencing PTSD could increase the likelihood of not so severe forms of IPV; such as verbal aggression but adding traumatic reminders led to more severe IPV, being physical aggression. The sample size was small and failed to include female veterans as most of the papers discussed did. Both demand characteristics and experimenter bias might have impacted the results due to the study taking place in a laboratory setting. However, this study would be easier to replicate than a study based in a natural setting and allows for stronger control over the variables, which meant that a strong cause and effect relationship would be guaranteed. To support the results found by LaMotte et al (2016) and the other papers discussed, Klaw et al (2016) studied 166 college war veterans from universities or colleges in California. The results showed that committing physical IPA correlated with anger and psychological distress (there were other factors but they were irrelevant for this review) and there was a relationship between psychological distress and anger. For veterans who were either distressed or angry believed that physical fighting was acceptable. To provide evidence of this claim LaMotte et al (2014) discovered that experiencing severe PTSD was associated with less reporting of physical aggression. The sample of college veterans was sufficient but failed to include those who had no access to a computer, they may have gained extra participants if they handed out the surveys on the campus.

Conclusions

Bringing all the necessary papers together it can be said there was a lack of research around homosexual relationships, as previously mentioned because of the stigmatisation associated with homosexuality in the military, as discussing homosexual behaviours could jeopardize a career (Sinclair, 2009). The same could be said for females as although a couple of the papers mentioned female samples the emphasis appeared to be on male veterans. It was thought that hypermasculinity played a huge role regarding the perpetration of IPV in the samples discussed (Klaw et al., 2016) which explained why there were more males, as having hypermasculinity was associated with IPV in heterosexual relationships (Klein., 2008).

The review answered the question of whether there was a link between PTSD in veterans and the likelihood of committing IPV. Most of the papers already stated found there was a link between the two. In some sense as the research concentrated on the Iraq war and as both the UK and US forces were involved, they would have experienced similar if not the same situations. As the papers were conducted in the United States there were similar cultural influences, so the papers would be beneficial for the UK military. The relevance of this review on veterans was extremely beneficial, as it would help them understand the implications and effects being involved in conflict could cause. Conducting more mixed-methods or qualitative research in the future would provide more thorough research into this area. Also, it would be important to provide interventions in relation to both PTSD and IPV to prevent the perpetration of IPV in future veterans.

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Sullivan, C.P., & Elbogen, E.B. (2014). PTSD symptoms and family vs. stranger violence in Iraq and Afghanistan veterans. Law human behaviour. 38(1). 1-9. DOI: 10.1037/ihb0000035.

Teten, A.L., Schumaker, J.A., Taft, C.T., Stanley, M.A., Kent, T.A., Bailey, S.B., Dunn, N.J., & White, D.L. (2010). Intimate partner aggression perpetrated and sustained by male Afghanistan, Iraq and Vietnam veterans with and without posttraumatic stress disorder. Journal of interpersonal violence. 25(9), 1612-1630. DOI:10.1177/0886260509354583.

Van Der Kolk, B. A. (2007). The history of trauma in psychiatry. In Freidman, M.A., Keane, T.M., & Resick, P.A. (1^st ed.), Handbook of PTSD (p.30). New York: Guildford Press.

Reference	Year	Purpose	Life style addressed (key terms used)	Methods- Questionnaires/assessments, procedure	Sampling	No. of participants	Results
Finely, E.P., Baker, M., Pugh, M.J., & Peterson, A. (2010). Patterns and perceptions of intimate partner violence committed by returning veterans with post-traumatic stress disorder. Journal of Family Violence. 24(8). 737-743. DOI: 10.1007/s10896-010-9331-7	2010	To examine spontaneous descriptions of IPV occurring between PTSD- diagnosed male OIF/OEF veterans and their partners that arose during a study of families with combat PTSD.	Partner violence, veterans, PTSD, patterns of abuse, trauma	Interviews- life history, deployment and post-deployment experiences   Transcripts- descriptions of violence in the home, concerns about potential violence, explanations of why violence occurred	Local colleges, universities, patients receiving outpatient care at a South Texas VA clinic	50 male OIF/OEF veterans and 16 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) family members   Randomly selected 19 male OIF/OEF veterans and 11 spouses	Case studies suggest there may be distinct patterns of violence committed by PTSD-diagnosed veterans within the home.

Appendix A

Matrix Table

Teten, A.L., Schumaker, J.A., Taft, C.T., Stanley, M.A., Kent, T.A., Bailey, S.B., Dunn, N.J., & White, D.L. (2010). Intimate partner aggression perpetrated and sustained by male Afghanistan, Iraq and Vietnam veterans with and without posttraumatic stress disorder. Journal of interpersonal violence. 25(9), 1612-1630. DOI:10.1177/0886260509354583

2010

To examine the nature and frequency of self-reported partner aggression perpetrated by male OEF/OIF veterans with and without PTSD as compared to male Vietnam veterans with PTSD   To explore veterans’ reports of the violence hey experienced from their female partner

Posttraumatic stress disorder, intimate partner aggression, domestic violence, veterans

Veterans Affairs medical centre, recruited by phone,   Completed several self-report measures and were given $20 as reimbursement for the time they took to complete the questionnaires as well as a list of community and VA resources: mental health treatment options, parenting classes, family therapy, domestic violence shelters and community support groups Crowne Marlowe desirability scale, conflict tactics scale-revised

Male Vietnam or OEF/OIF veterans, who had completed a routine diagnostic screening for PTSD,   As a safety precaution all participants were approved to participate by their clinician

94 consented to participate, 59 were OEF/OIF veterans- 27 diagnosis of PTSD, 35 Vietnam veterans- 31 diagnosis of PTSD, 8 veterans were removed leaving a sample size of 86

OEF/OIF veterans with PTSD were significantly more likely to report psychologically abusing their partner than those OEF/OIF veterans without PTSD   The two OEF/OIF groups have comparable scores on the Crowne Marlowe desirability scale (where higher scores represent want to appear more favourable) but OEF/OIF veterans with PTSD had significantly higher scores on the CMDS than Vietnam veterans with PTSD

Kar, H.L., & O’Leary, D.K. (2013). Emotional intimacy mediates the relationship between posttraumatic stress disorder and intimate partner violence perpetration in OEF/OIF/OND veterans. Violence and Victims. 28(5). 790-803. http://dx.doi.org/10.1891/0886-6708.VV-D-12-00080

2013

To assess both overall relationship satisfaction as well as the specific construct of emotional intimacy to evaluate whether emotional intimacy is a more robust mediator of the PTSD-IPV relationship than is relationship satisfaction

Aggression, path analysis, couples, mental health

One in-person study session at the Northport VAMC- explained the study, obtained consent, administered questionnaires, paid $25   Revised conflict tactics scale, Posttraumatic stress disorder checklist-military, personal assessment of intimacy in relationships, dyadic adjustment scale

Northport veterans’ affairs medical centre

110 male OEF/OIF veterans

PTSD symptomology predicted emotional intimacy, relationship satisfaction and physical aggression, preliminary results suggest that emotional intimacy may be more important in understanding the relationship between PTSD and IPV, relationship satisfaction and emotional intimacy were predictive of partner aggression, emotional intimacy had a unique relationship with partner aggression, predeployment IPV predicted postdeployment IPV

Rabenhorst, M.M., McCarthy, R.J., Thomsen, C.J., & Milner, J.S (2013) spouse abuse among United States air force personnel who deployed in support of operation Iraqi freedom/operation enduring freedom. Journal of Family Psychology. 27(5). 754-761. DOI: 10.1037/a0034283

2013

To investigate the potential differences in rates of spouse abuse perpetration or changes in rates of abuse perpetration predeployment and postdeployment as a function of deployer gender

Combat deployment, spouse abuse, intimate partner violence, OEF/OIF

Used a United States Airforce (USAF) database to conduct their study contained information about USAF deployments   USAF family advocacy system of records (FASOR)- information about each incident of spouse maltreatment

deployment database provided by the clinical informatics branch

Deployments represented 261,644 individual airmen, after removing people that haven’t been married, there were 270,383 combat related deployments completed by 156,926 individuals   FASOR- 16,117 substantiated spouse abuse incidents, 9,575 perpetrated by an active duty member, sexual and neglect were removed leaving 9,511 incidents of physical/emotional abuse or both

Men perpetrated moderate/severe abuse with higher rate post-deployment, despite overall rates of spouse abuse being higher among enlisted deployers than officers-spouse abuse decreased post deployment only for enlisted personnel, rate of spouse abuse perpetrated by enlisted deployers was lower post-deployment than pre-deployment- higher than the rate perpetrated by officers, those who had only one deployment/shortest total deployment durations exhibited greater increases in spouse abuse perpetration post-deployment

Sullivan, C.P., & Elbogen, E.B. (2014). PTSD symptoms and family vs. stranger violence in Iraq and Afghanistan veterans. Law human behaviour. 38(1). 1-9. DOI: 10.1037/ihb0000035

2014

To explore whether the theoretical linkages to violence implied in the cluster-based results are confirmed in the actual symptoms

PTSD, veteran, violence, symptomology

Sent an introductory letter about the survey, 4 days later- sent an invitation by mail, containing commemorative postage stamps as an incentive, instructions on how to complete a 35 min confidential web-based survey, 16 days later- potential participants were sent postcards thanking them for completing the survey/reminding them to do so, 2 weeks after- those who had not taken the survey received the paper version with a paid return envelope, 2 months after the paper version had been sent- final letter was sent out in order to encourage participation and said that the survey would close the following week   Alcohol use disorder identification test, deployment risk and resilience inventory, Davidson trauma scale 1-year follow-up- participants who completed the first survey received the same letters, incentives, reminders, reimbursements Conflict tactics scale was used

Survey sample was from the current national post-deployment adjustment survey, completed at 1-year follow-up as well

A random selection of over 1 million us separated veterans, 3,000 names randomly selected, decreased to 1388 with 438 having incorrect addresses- 950   1-year follow-up- 1090 completed the same survey at 1-year follow-up and was adjusted to 866

The largest effect of high combat exposure was found in severe family aggression, increasing the odds of being severely violent by almost four times, anger linked to PTSD and increased the odds of any aggression or violence, high combat also increased the odds of any aggression or violence at follow-up compared to those who did not have high combat exposure, anger symptoms predicted higher odds of both severe and general aggression at follow-up measurements

LaMotte, A.D., Taft, C.T., Weatherill, R.P., Scott, J.P., & Eckhardt, C.I. (2014). Examining intimate partner aggression assessment among returning veterans and their partners. Psychological Assessment. 26(1). 8-15. http://dx.doi.org/10.1037/a0034579

2014

To compare the overall levels of physical and psychological IPA perpetrated by OIF/OEF combat veterans and their partners, report rates of inter-partner concordance on veteran- and partner- perpetrated IPA, examine relationship satisfaction and PTSD symptoms as correlates of intimate partner concordance

Intimate partner aggression, concordance, veterans, OEF/OIF

Male veterans contacted first about participating and during the initial assessment were asked if their partners could be contacted, a trained research assistant contacted the partners to administer the questionnaires and made sure they had adequate privacy   Revised conflict tactics scale, QMI, PTSD checklist

Recruited from the Greater Boston area- flyers posted through the veterans’ affairs centre, Boston healthcare system and associated outpatient clinics, subject recruitment database of veterans who had consented to be notified about research studies with the national centre of PTSD, mass mailings using a roster of OEF/OIF veterans from the defence manpower data centre, shared with the VA

245 were interested, 153 were removed due to not meeting the criteria, left with 92- 27 were exclude as data was not provided by their partner, Final sample- 65 male OIF/OEF combat veterans and their partners

Partners of the OIF/OEF veterans perpetrated more partner violence than the veterans, higher mean for partners physical IPA perpetration than for veterans’ perpetration, significant differences found for veterans’ reports and combined reports, low to moderate levels of agreement between veterans and their partners on perpetrating physical/psychological IPA, agreement on the veterans’ physical IPA was lower than the agreement on the partners’ physical IPA

Kelley, M.L., Stambaugh, L., Milletich, R.J., Veprinsky, A., & Snell, A.K. (2015). Number of deployments, relationship satisfaction and perpetration of partner violence among US navy members. Journal of family psychology. 29(4), 635-641. http://dx.doi.org/10.1037/fam0000101

2015

To examine associations between the number of deployments, relationship satisfaction, and the reports of the perpetration of IPV among US navy members anticipating deployment

Deployment, relationship satisfaction, partner violence, navy members

Invited to participate via individual email invitations, told about the study by the captain on the ship, received an online survey link where they consented to participate, emailed a $10 online e-card for participating   Perpetration of physical partner violence, relationship assessment scale, items assessing deployment,

Navy members assigned to an Arleigh Burke-class destroyer,

295 contacted, 108 completed the questionnaires, due to missing data the final sample size was 72

There was a statistically significant interaction between number of deployments and relationship satisfaction, the effect that the number of deployments has on perpetration of IPV diminishes as relationship satisfaction increases

Miles, S.R., Menefee, D.S., Wanner, J., Tharp, A.T., &Kent, T.A. (2015). The relationship between emotion dysregulation and impulsive aggression in veterans with posttraumatic stress disorder symptoms. Journal of interpersonal violence. 31(10). 1795-1816. DOI: 10.1177/0886260515570746

2015

Examines if emotion dysregulation found in veterans with PTSD symptoms relates to impulsive and premeditated aggression

Emotion regulation, aggression, posttraumatic stress disorder, veterans

Admitted to a treatment program and a trauma speciality psychologist assess for lifetime prevalence of PTSD, completed a clinical interview and a self-report assessment within 48 hrs, included in the study if they consented to the research proposal, completed all measure of interest   Difficulties in emotion regulation scale, PTSD checklist- stressor specific version impulsive/premeditated aggression scale, clinician administered PTSD scale

Veterans seeking inpatient trauma-related treatment at a large VA medical centre

Original sample size- 625, due to not consenting and completing all the measure the sample size was now 479

There was a significant relationship between emotion dysregulation and PTSD variables, Impulsive Aggression (IA) significantly correlated with PTSD total symptoms, suggested that it was the failure to regulate emotions that was related to IA in this sample of veterans, emotion regulation is the likely difference between having PTSD and acting aggressively while having PTSD

LaMotte, A.D., Taft, C.T., Weatherill, R.P., Scott, J.P., & Eckhardt, C.I. (2016). Posttraumatic stress disorder symptoms, traumatic reminders and partner aggressive tendencies among veterans. Journal of Family Violence. 31(4). 461-466. DOI: 10.1007/s10896-015-9776-9

2016

To investigate whether laboratory exposure to trauma cues potentiated the relationship between veterans’ PTSD symptoms and IPA articulations elicited during an anger-induction task

Veteran, PTSD, intimate partner violence, aggression, traumatic reminder

Completed two laboratory sessions at the study site, first session- informed consent, screening for drugs/alcohol abuse, mental illness that would preclude valid participation, checking of PTSD symptoms,   Second session- articulated thoughts in simulated situations (ATSS) both trauma cued and non-trauma cued conditions, 3 different scenarios to listen to, had to imagine personal involvement, 30 sec. pause participants asked to verbally report their immediate feelings/thoughts, first scenario- neutral, second scenario- themes of sexual jealousy, third scenario- spousal criticism, participants completed self-report measures of anger and other emotions 3 times throughout the procedure The clinician administered PTSD scale, state trait anxiety expression inventory, emotion rating form, ATSS IPA articulation

Recruited from the Greater Boston area- flyers posted through the veterans’ affairs centre, Boston healthcare system and associated outpatient clinics, subject recruitment database of veterans who had consented to be contacted, mass mailings using a roster of veterans living in Massachusetts

82 male OEF/OIF veterans

There was a significantly stronger association between PTSD severity and physical IPA articulations made after a trauma cue, trauma cue did not appear to influence the relationship between PTSD symptom severity and verbal IPA articulations, verbal IPA articulations were more frequently used, PTSD symptoms may generally increase the likelihood of lower-threshold forms of IPA- verbal aggression, exposure to traumatic reminders may play a role in instigating forms of IPA that have a higher threshold- physical aggression

Klaw, E.L., Demers, A.L., & Da Silva, N. (2016). Predicting risk factors for intimate partner violence among post 9/11 college student veterans. Journal of interpersonal violence. 31(4). 572-594, DOI:10.1177/0886260514556102

2016

To understand specific factors that predict aggression in the intimate partner relationships of post 9/11 student veterans

Veterans, college students, relationships, domestic violence, partner violence

College student veterans- flyers, email, Criagslist advertisements, anonymous electronic survey- informed consent, second website to enter a draw for 1 of 6 apple iPods   Brief symptom inventory, alcohol use disorders identification test, drug abuse screening test, hypermasculinity index, social support, relationship assessment scale, conflict tactics scale, domestic violence myth acceptance, dimensions of anger reactions- revised

Veterans from California state universities and community colleges

230 agreed to participate, 166 met the criteria

Perpetrating violence against a partner was correlated with psychological distress, alcohol abuse, anger, hypermasculinity and domestic violence myth endorsement, rates of IPV may be explained by the negative relationship identified between social support and psychological distress, there is a strong positive relationship between psychological distress and anger, veterans that were distressed or angry are more likely to condone physical fighting and risk taking and endorse hyper-masculine attitudes. More social support available the less distress and likelihood that he would use verbalisations in his intimate relationships, high levels of psychological distress and hyper-masculine attitudes are significant predictors of anger and psychological aggression