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38 Law & Hum. Behav. 1 (2014)

handle is hein.journals/lwhmbv38 and id is 1 raw text is: Law and Human Behavior
2014. Vol. 38. No. 1. 1-9

© 2013 American Psychological Association
0147-7307/14/$12.00  DOI: 10.1037/1hb0000035

PTSD Symptoms and Family Versus Stranger Violence in Iraq and
Afghanistan Veterans

Connor P. Sullivan
University of North Carolina at Chapel Hill

Eric B. Elbogen
University of North Carolina at Chapel Hill and Veterans
Affairs Mid-Atlantic Mental Illness Research, Education, and
Clinical Center, Durham, North Carolina

As a diagnosis, posttraumatic stress disorder (PTSD) has been associated with violence committed by veterans
in many studies; however, a potential link to specific PTSD symptoms has received relatively less attention.
This paper examines the relationship between PTSD symptoms and different types of violent behavior in Iraq
and Afghanistan veterans. Participants were randomly sampled from a roster of all separated U.S. military
service members or national guard/reservists who served after September 11, 2001. Data were collected at
baseline and 1-year follow-up from a national sample of N = 1,090 veterans, from 50 states and all military
branches. Of these veterans, 13% reported aggression toward a family member and 9% toward a stranger
during the 1-year study period. Anger symptoms at baseline predicted higher odds of family violence at
follow-up, both severe (OR = 1.30, CI [1.13, 1.48], p < .0001) and any (OR = 1.28, CI [1.19, 1.37], p <
.0001). PTSD flashback symptoms at baseline predicted higher odds of stranger violence at follow-up, both
severe (OR = 1.26, CI [1.11, 1.42], p < .0001) and any (OR = 1.16, CI [1.05, 1.28], p = .0029). Analyses
revealed that males were more likely to engage in stranger violence, whereas females were more likely to
endorse aggression in the family context. The results provide limited support to the hypothesis that PTSD
flashbacks in veterans are linked to violence. The differing multivariate models illustrate distinct veteran
characteristics associated with specific types of violence.
Keywords: PTSD, veteran, violence, symptomology

Past research has shown that posttraumatic stress disorder (PTSD)
is linked to aggression toward others among veterans (McFall, Fon-
tana, Raskind, & Rosenheck, 1999; Savarese, Suvak, King, & King,
2001; Taft, Vogt, Marshall, Panuzio, & Niles, 2007). In one study,
veterans with PTSD reported 13-22 acts of general violence/aggres-
sion in the preceding year compared to 0-3 violent acts among
veterans without PTSD (Beckham, Feldman, Kirby, Hertzberg, &
Moore, 1997). Preliminary research has also suggested that PTSD is
linked to violence in the current cohort of Iraq and Afghanistan War
veterans (Finley, Baker, Pugh, & Peterson, 2010; Hellmuth, Stappen-
beck, Hoerster, & Jakupcak, 2012; Jakupcak et al., 2007), even among
veterans in the United Kingdom and elsewhere (Galovski & Lyons,
2004; Macmanus et al., 2011).
This article was published Online First May 6, 2013.
Connor P. Sullivan, Department of Psychiatry, University of North
Carolina-Chapel Hill School of Medicine; Eric B. Elbogen, Department of
Psychiatry, University of North Carolina-Chapel Hill School of Medicine,
and Veterans Affairs Mid- Atlantic Mental Illness Research, Education,
and Clinical Center, Durham, North Carolina.
The research was supported by National Institute of Mental Health Grant
R01MH080988; the Mid-Atlantic Mental Illness Research, Education, and
Clinical Center; the Office of Research and Development Clinical Science;
and the Department of Veterans Affairs. We would like to extend our
sincere thanks to the participants who volunteered for this study.
Correspondence concerning this article should be addressed to Eric B.
Elbogen, University of North Carolina-Chapel Hill School of Medicine,
Forensic Psychiatry Program and Clinic, Department of Psychiatry, CB
7167, Chapel Hill, NC 27599. E-mail: eric.elbogen@unc.edu

Recently, PTSD has also gained attention in the legal sphere, which
has noted an increasing rate of arrests, mental health problems, and
the theoretical link between the two in veteran populations (Caine,
2009; Cavanaugh, 2011; McGrane, 2011). The need for veteran
specialty courts has been addressed in multiple law reviews (Caine,
2009; Cavanaugh, 2011; McGrane, 2011), in particular because of
issues veterans have with PTSD (Caine, 2009; Cavanaugh, 2011;
McGrane, 2011). However, these courts in general are not intended
for violent offenders (Caine, 2009). Clearly, as there has been a
potential link between veterans with PTSD and criminal behavior
(Caine, 2009; Cavanaugh, 2011; McGrane, 2011), there should also
be some amount of services provided to violent offenders. PTSD has
been noted as a mental disorder that can change the amount of
culpability the defendant faces, especially in the case of combat
veterans (Caine, 2009; McGrane, 2011; Walls, 2011). Some veterans
charged with a capital crime may go undiagnosed until a mental
health screening is given at the time of the court case (McGrane,
PTSD is a complex disorder, requiring a minimum of one
symptom of intrusive recollection, three avoidance/numbing
symptoms, and two hyperarousal symptoms (Diagnostic and Sta-
tistical Manual of Mental Disorders, 4th ed., text rev., American
Psychiatric Association, 2000). With respect to violence, much of
the literature examines the effects of the PTSD diagnosis as a
whole. Some studies have gone so far as to examine violence as a
function of PTSD symptom clusters, showing that hyperarousal
symptom cluster in particular is positively related to aggression
(Makin-Byrd, Bonn-Miller, Drescher, & Timko, 2012; Savarese
et al., 2001; Taft, Street, Marshall, Dowdall, & Riggs, 2007). Still,

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