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Massa AA, Sippel L, Kirby CM, Melkonian AJ, Back SE, Flanagan JC. Childhood Maltreatment and Use of Aggression among Veterans with Co-occurring PTSD and Alcohol Use Disorder: The Mediating Role of Hostile Cognitions. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2022; 32:574-591. [PMID: 37124837 PMCID: PMC10139741 DOI: 10.1080/10926771.2022.2151961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/03/2022] [Accepted: 11/09/2022] [Indexed: 05/03/2023]
Abstract
History of childhood maltreatment is common among military veterans, particularly those with posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Childhood maltreatment is associated with negative psychosocial outcomes, including use of aggression during adulthood. Prior research has identified maladaptive cognitions as a key mediating variable in the association between early life trauma and aggression. Given the high rates of comorbid PTSD and AUD among veterans and the increased risk of aggression when these conditions co-occur, it is critical to examine malleable intervention targets, such as maladaptive cognitions, for this population. The current secondary analyses examined the mediating role of hostile cognitions on the associations between childhood maltreatment and adulthood aggression in a sample of dually diagnosed veterans. Participants were veterans with co-occurring PTSD and AUD (N = 73) who were enrolled in a larger randomized controlled laboratory trial. Participants completed self-report measures of childhood maltreatment, hostile cognitions, and aggressive behavior. Three models were tested to examine the mediating effect of hostility on the associations between childhood maltreatment, abuse, and neglect on aggression. Results indicated that hostility fully mediated the effect of maltreatment on aggression and partially mediated the effect of childhood abuse on aggression. The effect of childhood neglect on aggression was nonsignificant. Hostile cognitions may be a critical intervention target for veterans with co-occurring PTSD and AUD and history of childhood maltreatment, particularly for those who have experienced higher levels of childhood abuse.
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Affiliation(s)
- Andrea A. Massa
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Lauren Sippel
- National Center for PTSD, U.S. Department of Veterans Affairs, White River Junction, Vermont
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, New Hampshire
| | - Charli M. Kirby
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Alexander J. Melkonian
- East Tennessee State University, Quillen College of Medicine, Department of Family Medicine
| | - Sudie E. Back
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
| | - Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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2
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Patel TA, Dillon KH, Cassiello-Robbins C, Calhoun PS, Beckham JC, Kimbrel NA. Anger, impulsivity and wall/object punching in a sample of U.S. veterans with psychiatric disorders. J Psychiatr Res 2022; 147:269-273. [PMID: 35074743 PMCID: PMC8882153 DOI: 10.1016/j.jpsychires.2022.01.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/16/2021] [Accepted: 01/13/2022] [Indexed: 11/17/2022]
Abstract
Nonsuicidal self-injury (NSSI) has been identified as one of the strongest predictors of suicide attempts. Wall/object punching is a particularly prevalent form of NSSI among male veterans that has been linked to both impulsivity and anger. The objective of the present study was to examine the indirect effect of impulsivity on wall/object punching via anger. Participants included 124 veterans (32 identified as women, 92 identified as men) with at least one psychiatric disorder. A third of the sample met criteria for NSSI disorder (33.1%) with nearly a half of the remaining sample endorsing NSSI. Almost half (41.94%) of the sample endorsed wall/object punching. Consistent with our hypothesis, impulsivity was significantly associated with anger, which was, in turn, significantly associated with wall/object punching. Impulsivity was found to be indirectly related to wall/object punching via anger. These findings underscore the significance of assessing and treating anger among veterans engaging in wall/object punching. Improving our knowledge of anger and impulsivity and their relationship with this particularly prevalent form of NSSI among veterans may lead to a better understanding of suicide risk among veterans and inform future treatments.
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Affiliation(s)
- Tapan A Patel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kirsten H Dillon
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA.
| | - Clair Cassiello-Robbins
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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3
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Zakarian RJ, McDevitt-Murphy ME. Posttraumatic Stress Disorder and Aggression Among Post-9/11 Veterans: The Role of Shame. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022; 185:111267. [PMID: 34840375 PMCID: PMC8612125 DOI: 10.1016/j.paid.2021.111267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Posttraumatic stress disorder (PTSD) is often accompanied by elevated aggression. PTSD and combat exposure alone do not fully explain the reliable finding of heightened aggression among trauma-exposed veterans. Shame may be an important affective feature in this relationship. The present study examined the role of shame from a social hierarchy theoretical perspective in a sample of 52 combat veterans from the post-9/11 era. Correlational analyses indicated moderately strong positive relationships among PTSD, shame, and aggression. Trait shame was found to significantly mediate the relationship between total PTSD severity and physical aggression, but not other forms of aggression. For veterans within the context of a hierarchical military culture, separation from the military and PTSD diagnosis may be very salient markers of social loss and social exclusion. Aggression may operate to reduce the negative affective experience associated with shame and to regain social standing. Findings implicate shame as an important emotional component in the relationship between PTSD and aggression.
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4
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Daruwala SE, Houtsma C, Martin R, Green B, Capron D, Anestis MD. Masculinity's association with the interpersonal theory of suicide among military personnel. Suicide Life Threat Behav 2021; 51:1026-1035. [PMID: 34184317 DOI: 10.1111/sltb.12788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 04/19/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given that the majority of those who die by suicide are male, masculine traits have been examined as a potential link to the development of capability for suicide. However, research has not examined if such traits influence suicidal desire (i.e., thwarted belongingness, perceived burdensomeness). This study examined the influence of stereotypically masculine traits of stoicism, sensation seeking, physical aggression, verbal aggression, and self-reliance on all three components of the Interpersonal Theory of Suicide within a sample of male and female service members. METHODS A total of 953 service members were recruited as part of a larger study. RESULTS Sensation seeking and stoicism were positively associated with capability for suicide. With regard to suicidal desire, self-reliance and verbal aggression were positively associated with both perceived burdensomeness and thwarted belongingness. Stoicism was positively associated with thwarted belongingness. CONCLUSIONS Findings suggest that different masculine traits are associated with the three components of the Interpersonal Theory of Suicide in various ways. Stoicism may be an especially important masculine trait that influences a component of suicidal desire and capability for suicide.
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Affiliation(s)
| | - Claire Houtsma
- University of Southern Mississippi, Hattiesburg, Mississippi, USA.,Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center, New Orleans, Louisiana, USA
| | - Rachel Martin
- University of Southern Mississippi, Hattiesburg, Mississippi, USA.,Canandaigua VA Medical Center, Canandaigua, New York, USA
| | | | - Daniel Capron
- University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Michael D Anestis
- New Jersey Gun Violence Research Center, Piscataway, New Jersey, USA.,Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
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5
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Miles SR, Kent TA, Stanley M, Thompson KE, Sharp C, Niles BL, Young-McCaughan S, Mintz J, Roache JD, Litz BT, Hale WJ, Stanford MS, Keane TM, Peterson AL. Manage Emotions to Reduce Aggression: A Pilot Study of a Brief Treatment to Help Veterans Reduce Impulsive Aggression. J Nerv Ment Dis 2020; 208:897-903. [PMID: 32947454 DOI: 10.1097/nmd.0000000000001229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Veterans with posttraumatic stress disorder (PTSD) report more aggression than civilians with PTSD. Because emotion regulation difficulties mediated the relationship between PTSD symptoms and impulsive aggression in veterans, we developed an intervention to increase emotion regulation skills. This pilot study tested the feasibility and acceptability of a three-session treatment, Manage Emotions to Reduce Aggression (MERA), and examined its effectiveness at reducing aggression and emotion dysregulation. Male combat veterans with PTSD and impulsive aggression completed assessments before and 4 weeks after MERA. Overt Aggression Scale measured frequency of aggression; Difficulties in Emotion Regulation Scale assessed emotion dysregulation. Most veterans (95%) who completed MERA and the posttreatment assessment (n = 20) reported MERA was helpful. Veterans in the intent-to-treat sample demonstrated a significant decrease in their frequency of aggression (Cohen's d = -0.55) and emotion dysregulation (Cohen's d = -0.55). MERA may be an innovative treatment that helps veterans reduce aggression.
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Affiliation(s)
| | | | | | | | - Carla Sharp
- Department of Psychology, University of Houston, Houston, Texas
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6
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Martin RL, Bauer BW, Smith NS, Daruwala SE, Green BA, Anestis MD, Capron DW. Internal Battles: Examining How Anger/Hostility Moderate the Association Between Negative Urgency and Suicidal Desire Variables in Military and Civilian Samples. Suicide Life Threat Behav 2020; 50:805-822. [PMID: 32026518 DOI: 10.1111/sltb.12616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 01/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Suicide is consistently within the top ten leading causes of death in the United States. The suicide rate of National Guard personnel is elevated relative to the general population; however, research suggests that many of the suicide risk factors for military personnel are similar to the suicide risk factors for civilians. We examined whether negative urgency moderated the relationships between anger/hostility and perceived burdensomeness/thwarted belongingness in both a military and civilian samples. METHOD There were two samples in the current study: (1) military personnel (majority national guard) and (2) community members oversampled for suicide attempt history. RESULTS Our hypotheses were partially supported with the interaction of hostility and negative urgency predicting perceived burdensomeness in the military sample. Within civilians, anger interacted with negative urgency to predict perceived burdensomeness. There were nonsignificant findings for analyses predicting thwarted belongingness. Exploratory analyses indicated that in both samples, anger and hostility interacted with negative urgency to predict suicidal ideation. CONCLUSIONS Results suggest that aggressive attributes may contribute to individuals feeling as though they are a burden on others when moderate to high levels of negative urgency are present. Additionally, this study provides foundational support for the differences between suicidal desire and ideation.
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Affiliation(s)
- Rachel L Martin
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Brian W Bauer
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Nicole S Smith
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samantha E Daruwala
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Bradley A Green
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
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7
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Regions of white matter abnormalities in the arcuate fasciculus in veterans with anger and aggression problems. Brain Struct Funct 2019; 225:1401-1411. [PMID: 31883025 PMCID: PMC7271041 DOI: 10.1007/s00429-019-02016-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022]
Abstract
Aggression after military deployment is a common occurrence in veterans. Neurobiological research has shown that aggression is associated with a dysfunction in a network connecting brain regions implicated in threat processing and emotion regulation. However, aggression may also be related to deficits in networks underlying communication and social cognition. The uncinate and arcuate fasciculi are integral to these networks, thus studying potential abnormalities in these white matter connections can further our understanding of anger and aggression problems in military veterans. Here, we use diffusion tensor imaging tractography to investigate white matter microstructural properties of the uncinate fasciculus and the arcuate fasciculus in veterans with and without anger and aggression problems. A control tract, the parahippocampal cingulum was also included in the analyses. More specifically, fractional anisotropy (FA) estimates are derived along the trajectory from all fiber pathways and compared between both groups. No between-group FA differences are observed for the uncinate fasciculus and the cingulum, however parts of the arcuate fasciculus show a significantly lower FA in the group of veterans with aggression and anger problems. Our data suggest that abnormalities in arcuate fasciculus white matter connectivity that are related to self-regulation may play an important role in the etiology of anger and aggression in military veterans.
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8
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Ripley AJ, Clapp JD, Wilkowski BM. PTSD and anger: Evaluation of an indirect effect model in a civilian trauma sample. J Behav Ther Exp Psychiatry 2019; 64:149-157. [PMID: 31035245 DOI: 10.1016/j.jbtep.2019.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 02/03/2019] [Accepted: 02/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Theoretical models propose that PTSD symptoms and subjective anger are indirectly associated through hostile attribution bias, physiological reactivity, and aggressive psycho-motor scripts (Chemtob, Novaco, Hamada, Gross, & Smith, 1997). Originally developed to account for symptoms observed in military personnel, proposed anger mechanisms have received limited attention in civilian populations. The current study looked to evaluate the generalizability of Chemtob et al.'s model in trauma-exposed university students (N = 152). METHODS Trauma exposure and corresponding symptoms were assessed during an initial screening procedure. Hostile attributions and aggressive scripts were examined prior to a laboratory-based anger induction procedure. Physiological reactivity was monitored throughout the provocation task. Ratings of subjective anger and anger recovery were completed following the induction period. Relations of post-trauma symptoms with subjective anger through hypothesized anger processes were examined using bootstrapped estimates of indirect effects. RESULTS A significant indirect effect of PTSD severity on state-level anger was noted for hostile attribution bias (ab = 0.020, 95% CI [0.002, 0.041]) and a marginal effect through aggressive inclinations (ab = 0.015, 95% CI [-0.001, 0.039]). Data failed to provide evidence for physiological reactivity as an intervening variable. Trauma symptoms did not moderate anger recovery following the provocation task. LIMITATIONS Induction of anger in a sub-clinical sample may limit tests of hypothesized effects and the generalizability of the present findings. CONCLUSIONS Results indicate the proposed model may be applicable beyond combat trauma samples and suggest potential anger-related targets for PTSD treatment.
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Affiliation(s)
- Adam J Ripley
- University of Wyoming, Department of Psychology, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Joshua D Clapp
- University of Wyoming, Department of Psychology, 1000 E University Ave, Laramie, WY, 82071, USA.
| | - Benjamin M Wilkowski
- University of Wyoming, Department of Psychology, 1000 E University Ave, Laramie, WY, 82071, USA.
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9
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Korpel POJ, Varkevisser T, Hoppenbrouwers SS, Van Honk J, Geuze E. The Predictive Value of Early-Life Trauma, Psychopathy, and the Testosterone-Cortisol Ratio for Impulsive Aggression Problems in Veterans. CHRONIC STRESS 2019; 3:2470547019871901. [PMID: 32440599 PMCID: PMC7219916 DOI: 10.1177/2470547019871901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/01/2019] [Indexed: 11/18/2022]
Abstract
Background In this study, we examined whether early-life trauma, psychopathy, and the
testosterone/cortisol ratio predicted impulsive aggression problems in
veterans. Method A sample of 49 male veterans with impulsive aggression problems and 51
nonaggressive veterans were included in the study. Logistic regression
analysis was performed with early-life trauma, primary and secondary
psychopathy, and testosterone/cortisol ratio as continuous predictor
variables; impulsive aggression status was entered as a binary outcome
measure. Correlation analyses were conducted to examine pairwise relations
among the predictors. Results Results indicated that early-life trauma and secondary psychopathy, but not
the testosterone/cortisol ratio or primary psychopathy, were significant
predictors of impulsive aggression status. Conclusions The current results indicate that early-life trauma and secondary psychopathy
are risk factors for impulsive aggression problems among veterans. Future
studies are needed to determine the exact causal relations among the
variables examined here.
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Affiliation(s)
- Pauline O J Korpel
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Research and Innovation Center, Dutch Ministry of Defence, Utrecht, the Netherlands
| | - Tim Varkevisser
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Research and Innovation Center, Dutch Ministry of Defence, Utrecht, the Netherlands
| | - Sylco S Hoppenbrouwers
- Thalamus, Centre for Neuropsychiatry and Behavioural Neurology, Wolfheze, the Netherlands
| | - Jack Van Honk
- Utrecht University, Utrecht, the Netherlands.,University of Cape Town, Cape Town, South Africa
| | - Elbert Geuze
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands.,Brain Research and Innovation Center, Dutch Ministry of Defence, Utrecht, the Netherlands
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10
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Bhardwaj V, Angkaw AC, Franceschetti M, Rao R, Baker DG. Direct and indirect relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans. Aggress Behav 2019; 45:417-426. [PMID: 30835866 DOI: 10.1002/ab.21827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/04/2019] [Accepted: 02/21/2019] [Indexed: 12/27/2022]
Abstract
Hostility, anger, and aggression are conceptually related but unique constructs found to occur more often among veterans with posttraumatic stress disorder (PTSD) than among civilians or veterans without PTSD. However, the pathways between PTSD, depression, hostility, anger, and aggression have not been comprehensively characterized. Therefore, drawing on a sample of returning Operation Enduring Freedom/Operation Iraqi Freedom combat veterans ( N = 175; 95% male; mean age 30 years), this study sought to examine the direct and indirect relationships among PTSD, depression, hostility, anger, and four types of aggression: verbal, and physical toward self, others, and objects. Functional modeling of direct effects was done using multiple least-squares regression and bootstrapped mediation analyses were carried out to test indirect effects. Results indicate that PTSD is not the overall direct contributor to different forms of aggression, supporting the mediating role of depression and trait anger. Depression symptoms explain part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward self and trait anger explains part of the relationships between PTSD and verbal aggression, physical aggression toward objects, and physical aggression toward others. Our findings support the importance of assessing for anger, depression, and different types of aggression among veterans presenting for PTSD treatment to develop individualized treatment plans that may benefit from early incorporation of interventions.
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Affiliation(s)
- Vinnu Bhardwaj
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Abigail C. Angkaw
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
| | - Massimo Franceschetti
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Ramesh Rao
- Qualcomm InstituteUniversity of CaliforniaSan Diego CA
- Department of ECEUniversity of CaliforniaSan Diego CA
| | - Dewleen G. Baker
- Veterans Affairs San Diego Healthcare SystemSan Diego CA
- VA Center of Excellence for Stress and Mental HealthSan Diego CA
- Department of PsychiatryUniversity of CaliforniaSan Diego CA
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11
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Cruz AR, Pasion R, Castro Rodrigues A, Zabala C, Ricarte J, Barbosa F. Psychometric properties of the Impulsive/Premeditated Aggression Scale in Portuguese community and forensic samples. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:144-148. [DOI: 10.1590/2237-6089-2018-0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/01/2018] [Indexed: 11/21/2022]
Abstract
Abstract Introduction Aggression can be defined according to impulsive or premeditated features. Impulsivity is defined as an uncontrolled and unplanned form of aggression. On the contrary, premeditation requires planning and is goal-oriented. Objective The purpose of this study was to validate the basic psychometric properties of the Impulsive/Premeditated Aggression Scale (IPAS) into European Portuguese. The scale evaluates aggression according to impulsive and premeditated features, which are considered the predominant forms of aggressive behavior, and can be used in community, forensic and clinical settings. Methods Participants from a community sample (n = 957; 424 male) and incarcerated individuals (n = 115, all male) completed the IPAS. Results Internal consistency and reliability indicated that the scale has good psychometric properties in both samples. Data from a principal component analysis (PCA) demonstrated similarities to previous structures reported in the literature. Conclusions The scale demonstrated to be sensitive to the bimodal classification of aggression in community and forensic samples, indicating its utility in the characterization of aggressive patterns.
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12
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Leonhardt BL, Lysaker PH, Vohs JL, James AV, Davis LW. The experience and expression of anger in posttraumatic stress disorder: the relationship with metacognition. J Ment Health 2018; 27:432-437. [PMID: 29698063 DOI: 10.1080/09638237.2018.1466036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anger experience and expression are a common issue in those experiencing PTSD. However, it remains unclear what variables affect anger and its expression in PTSD. AIMS To explore the relationships of synthetic forms of metacognition and metacognitive beliefs with anger experience and expression in PTSD, independent of the effects hyperarousal and depression symptoms. METHOD Participants were 51 veterans with diagnosed with PTSD. Metacognition was assessed using the Metacognition Assessment Scale-Abbreviated (MAS-A) and the Metacognitions Questionnaire (MCQ). Depression, PTSD symptom severity, and seven domains of anger expression were also assessed. RESULTS Correlations showed after controlling for overall levels of hyperarousal, higher MAS-A total scores were related to lower levels of State Anger, Feeling Angry, Expressing Anger Physically, and Anger Expression in. Lower MCQ scores were related to lower State anger, Expressing anger verbally, and Expressing anger physically. Higher levels of depression were related to higher levels of Trait anger, Expressing anger physically, Anger expression out, and Anger expression in. Multiple regressions suggested that the MAS-A and MCQ predicted unique portions of the variance in anger experience and expression. CONCLUSIONS Metacognitive deficits may affect anger experience and expression in those with PTSD and may be an important treatment target.
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Affiliation(s)
- Bethany L Leonhardt
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,b Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Program , Indianapolis , IN , USA
| | - Paul H Lysaker
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and
| | - Jenifer L Vohs
- a Department of Psychiatry , Indiana School of Medicine , Indianapolis , IN , USA.,b Larue D. Carter Memorial Hospital, Indiana University Psychotic Disorders Program , Indianapolis , IN , USA
| | - Alison V James
- c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and.,d Department of Psychology , Indiana State University , Terre Haute , IN , USA
| | - Louanne W Davis
- c Roudebush Veteran Affairs Medical Center , Indianapolis , IN , USA , and
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13
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Russell MC, Schaubel SR, Figley CR. The Darker Side of Military Mental Healthcare Part Two: Five Harmful Strategies to Manage Its Mental Health Dilemma. PSYCHOLOGICAL INJURY & LAW 2018. [DOI: 10.1007/s12207-017-9311-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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van de Kamp MM, Emck C, Cuijpers P, Beek PJ. A psychomotor diagnostic instrument for patients with post-traumatic stress disorder. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2018. [DOI: 10.1080/17432979.2017.1420692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Claudia Emck
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Peter J. Beek
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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15
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The Impact of Aggression on the Relationship Between Betrayal and Belongingness Among U.S. Military Personnel. MILITARY PSYCHOLOGY 2017. [DOI: 10.1037/mil0000160] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Muhtz C, Wittekind C, Godemann K, Von Alm C, Jelinek L, Yassouridis A, Kellner M. Mental Health in Offspring of Traumatized Refugees with and without Post-traumatic Stress Disorder. Stress Health 2016; 32:367-373. [PMID: 25556841 DOI: 10.1002/smi.2630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 11/23/2014] [Accepted: 11/24/2014] [Indexed: 11/08/2022]
Abstract
Intergenerational transmission of psychological trauma and the impact of parental post-traumatic stress disorder (PTSD) on offspring are controversially discussed. We studied 50 offspring (36 women and 14 men, mean age 42.1 years) of refugees who were severely traumatized as children at the end of World War II. From these, 25 of the refugees currently suffered from chronic PTSD, and 25 had no PTSD. Parental PTSD status did not significantly influence mental health [as per the Symptom Checklist (SCL)-90-R] or quality of life (assessed by the 36-item Short-form Health Survey) in their children. In the entire sample, frequency of talking with the mother about the flight correlated with phobic anxiety (r = 0.67, p = 0.03). Interestingly, the stated burden of having a parent with a history of flight significantly (p < 0.05) correlated with almost all subscales of the SCL-90-R. These results in a non-clinical sample do not support a specific role of parental PTSD in intergenerational trauma transmission. Our other remarkable, but preliminary, results need to be studied in larger samples using more subtle interaction or schema analyses. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Christoph Muhtz
- Department of Psychosomatic Medicine, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg-Eilbek, Hamburg, Germany. .,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Charlotte Wittekind
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Godemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Von Alm
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Michael Kellner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Miles SR, Menefee DS, Wanner J, Teten Tharp A, Kent TA. The Relationship Between Emotion Dysregulation and Impulsive Aggression in Veterans With Posttraumatic Stress Disorder Symptoms. JOURNAL OF INTERPERSONAL VIOLENCE 2016; 31:1795-1816. [PMID: 25681165 DOI: 10.1177/0886260515570746] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
While Veterans in general are no more dangerous than the civilian population, Veterans with posttraumatic stress disorder (PTSD) have stronger associations with anger and hostility and certain forms of aggression, such as intimate partner violence, than civilians with PTSD. This is alarming because up to 21% of Veterans seeking Veterans Affairs (VA) health care are diagnosed with PTSD. Emotion regulation difficulties (emotion dysregulation) are also related to increased PTSD symptom severity and may play a role in aggressive behavior. Because the predominant form of aggression in PTSD appears to be the impulsive subtype, the authors sought to clarify the relationship between PTSD, emotion dysregulation, and impulsive aggression. We examined how emotion dysregulation influenced impulsive aggression in a Veteran sample (N = 479) seeking treatment for trauma sequelae. All Veterans completed measures that assessed demographic information, emotion dysregulation, aggression frequency and subtype, and PTSD symptoms. Men generally reported more aggression than women. The emotion dysregulation, aggression, and PTSD measures were significantly correlated. Two cross-sectional mediation models showed emotion dysregulation fully accounted for the relationship between PTSD and impulsive aggression (indirect path for men: b = .07, SE = .026, bias-correct and accelerated confidence interval [BCa CI] = [0.02, 0.13]; indirect path for women: b = .08, SE = .022, BCa CI = [0.05, 0.13]). PTSD can increase negative emotions yet does not always lead to aggressive behaviors. The ability to regulate emotions may be pivotal to inhibiting aggression in those with PTSD. PTSD interventions may benefit from augmentation with emotion regulation skills training.
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Affiliation(s)
- Shannon R Miles
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Houston, TX, USA
| | - Deleene S Menefee
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Houston, TX, USA
| | - Jill Wanner
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andra Teten Tharp
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Thomas A Kent
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA South Central Mental Illness, Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Houston, TX, USA Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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Royal B. A hopeful tale from the wonderland of psychosis. NPJ SCHIZOPHRENIA 2015; 1:15015. [PMID: 27336031 PMCID: PMC4849445 DOI: 10.1038/npjschz.2015.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 02/18/2015] [Accepted: 02/20/2015] [Indexed: 11/09/2022]
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Romans L, Fresán A, Sentíes H, Sarmiento E, Berlanga C, Robles-García R, Tovilla-Zarate CA. Validation of the Impulsive/Premeditated Aggression Scale in Mexican psychiatric patients. Nord J Psychiatry 2015; 69:397-402. [PMID: 25541859 DOI: 10.3109/08039488.2014.994033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Aggression has been linked to several psychiatric disorders. None of the available instruments validated in Mexico is able to classify aggression as impulsive or premeditated. The Impulsive/Premeditated Aggression Scale (IPAS) is a self-report instrument designed to characterize aggressiveness as predominately impulsive or premeditated. OBJECTIVE The aim of the study was to determine the validity and reliability of the IPAS in a sample of Mexican psychiatric patients. METHOD A total of 163 patients diagnosed with affective, anxiety or psychotic disorder were included. A principal-component factor analysis was performed to obtain construct validity of the IPAS impulsive and premeditated aggression subscales; convergent validity as well as internal consistency of subscales were also determined. RESULTS The rotated matrix accounted for 33.4% of the variance. Significant values were obtained for convergent validity and reliability of the IPAS subscales. CONCLUSION The IPAS is an adequate instrument, which might be used to differentiate the type of aggressive behavior in Mexican psychiatric patients.
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Affiliation(s)
- Laura Romans
- Laura Romans, Servicios de Atención Psiquiátrica. Secretaría de Salud . Mexico City , Mexico
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Generational Wartime Behavioral Health Crises: Part One of a Preliminary Analysis. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9224-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Posttraumatic stress disorder (PTSD) now sits within the newly created "Trauma- and Stressor-Related Disorders" section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM-5). Through the refinement and expansion of diagnostic criteria, the DSM-5 version better clarifies the broad and pervasive effects of trauma on functioning, as well as the impact of development on trauma reactions. Aggressive and dissociative symptoms are more thoroughly characterized, reflecting increasing evidence that reactions to trauma often reach beyond the domains of fear and anxiety (these latter domains were emphasized in DSM-IV). These revised criteria are supported by decades of preclinical and clinical research quantifying traumatic stress-induced changes in neurobiological and behavioral function. Several features of the DSM-5 PTSD criteria are similarly and consistently represented in preclinical animal models and humans following exposure to extreme stress. In rodent models, for example, increases in anxiety-like, helplessness, or aggressive behavior, along with disruptions in circadian/neurovegetative function, are typically induced by severe, inescapable, and uncontrollable stress. These abnormalities are prominent features of PTSD and can help us in understanding the pathophysiology of this and other stress-associated psychiatric disorders. In this article we examine some of the changes to the diagnostic criteria of PTSD in the context of trauma-related neurobiological dysfunction, and discuss implications for how preclinical data can be useful in current and future clinical conceptualizations of trauma and trauma-related psychiatric disorders.
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Worthen M, Rathod SD, Cohen G, Sampson L, Ursano R, Gifford R, Fullerton C, Galea S, Ahern J. Anger problems and posttraumatic stress disorder in male and female National Guard and Reserve Service members. J Psychiatr Res 2014; 55:52-8. [PMID: 24755257 PMCID: PMC4084757 DOI: 10.1016/j.jpsychires.2014.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 03/27/2014] [Accepted: 04/03/2014] [Indexed: 11/25/2022]
Abstract
Anger is a common problem among veterans and has been associated with posttraumatic stress disorder (PTSD). This study aimed to improve understanding of how anger and PTSD co-occur by examining gender differences and differences by whether the triggering traumatic event is deployment-related vs. civilian-related in current service members. A representative cohort of Reserve and National Guard service personnel (n = 1293) were interviewed to assess for deployment- or civilian-related traumas, PTSD, and anger. The prevalence of self-reported anger problems was estimated among male (n = 1036) and female (n = 257) service members. Log Poisson regression models with robust standard errors were used to estimate the associations of problems with anger with PTSD and PTSD symptom severity for men and women. Self-reported anger problems were common among male (53.0%) and female (51.3%) service members. Adjusted prevalence ratios (PR) showed associations between anger and PTSD connected to both civilian- and deployment-related traumas (PR were 1.77 (95% CI 1.52-2.05) and 1.85 (95% CI 1.62-2.12), respectively). PTSD symptom severity was also associated with anger. This study was cross-sectional and so a causal relationship between PTSD and anger cannot be established. Problems with anger are common among male and female current Guard and Reserve members. These findings suggest that anger treatment should be made available to current service members and that clinicians should assess anger problems irrespective of gender. Future research should examine the effectiveness of anger treatment protocols by gender.
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Affiliation(s)
| | | | | | | | - Robert Ursano
- Uniformed Services University of the Health Sciences
| | | | | | - Sandro Galea
- Columbia University Mailman School of Public Health
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Stappenbeck CA, Hellmuth JC, Simpson T, Jakupcak M. The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2014; 6:65-72. [PMID: 25225593 DOI: 10.1037/a0031468] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aggression among combat veterans is of great concern. Although some studies have found an association between combat exposure and aggressive behavior following deployment, others conclude that aggression is more strongly associated with symptoms of posttraumatic stress disorder (PTSD), and that alcohol misuse may influence this association. Many of these studies have assessed aggression as a single construct, whereas the current study explored both nonphysical aggression only and physical aggression in a sample of Iraq and Afghanistan war veterans (N = 337; 91% male). We found that alcohol problems interacted with PTSD symptom severity to predict nonphysical aggression only. At low levels of PTSD symptoms, veterans with alcohol problems were more likely to perpetrate nonphysical aggression only, as compared with no aggression, than veterans without an alcohol problem. There was no difference in the likelihood of nonphysical aggression only between those with and without alcohol problems at high levels of PTSD symptoms. The likelihood of nonphysical aggression only, as compared with no aggression, was also greater among younger veterans. Greater combat exposure and PTSD symptom severity were associated with an increased likelihood of perpetrating physical aggression, as compared with no aggression. Ethnic minority status and younger age were also associated with physical aggression, as compared with no aggression. Findings suggest that a more detailed assessment of veterans' aggressive behavior, as well as their alcohol problems and PTSD symptoms, by researchers and clinicians is needed in order to determine how best to intervene.
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Affiliation(s)
| | | | - Tracy Simpson
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Matthew Jakupcak
- VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and University of Washington
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Stevens D, Wilcox HC, MacKinnon DF, Mondimore FM, Schweizer B, Jancic D, Coryell WH, Weissman MM, Levinson DF, Potash JB. Posttraumatic stress disorder increases risk for suicide attempt in adults with recurrent major depression. Depress Anxiety 2013; 30:940-6. [PMID: 23893768 PMCID: PMC4026925 DOI: 10.1002/da.22160] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/27/2013] [Accepted: 06/01/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Genetics of Recurrent Early-Onset Depression study (GenRED II) data were used to examine the relationship between posttraumatic stress disorder (PTSD) and attempted suicide in a population of 1,433 individuals with recurrent early-onset major depressive disorder (MDD). We tested the hypothesis that PTSD resulting from assaultive trauma increases risk for attempted suicide among individuals with recurrent MDD. METHODS Data on lifetime trauma exposures and clinical symptoms were collected using the Diagnostic Interview for Genetic Studies version 3.0 and best estimate diagnoses of MDD, PTSD, and other DSM-IV Axis I disorders were reported with best estimated age of onset. RESULTS The lifetime prevalence of suicide attempt in this sample was 28%. Lifetime PTSD was diagnosed in 205 (14.3%) participants. We used discrete time-survival analyses to take into account timing in the PTSD-suicide attempt relationship while adjusting for demographic variables (gender, race, age, and education level) and comorbid diagnoses prior to trauma exposure. PTSD was an independent predictor of subsequent suicide attempt (HR = 2.5, 95% CI: 1.6, 3.8; P < .0001). Neither assaultive nor nonassaultive trauma without PTSD significantly predicted subsequent suicide attempt after Bonferroni correction. The association between PTSD and subsequent suicide attempt was driven by traumatic events involving assaultive violence (HR = 1.7, 95% CI: 1.3, 2.2; P< .0001). CONCLUSIONS Among those with recurrent MDD, PTSD appears to be a vulnerability marker of maladaptive responses to traumatic events and an independent risk factor for attempted suicide. Additional studies examining differences between those with and without PTSD on biological measures might shed light on this potential vulnerability.
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Affiliation(s)
- Daniel Stevens
- Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Holly C. Wilcox
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dean F. MacKinnon
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Francis M. Mondimore
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barbara Schweizer
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dunya Jancic
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
| | | | - Myrna M. Weissman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York. New York State Psychiatric Institute, New York, New York
| | - Douglas F. Levinson
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, California
| | - James B. Potash
- Department of Psychiatry, University of Iowa, Iowa City, Iowa
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25
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Influence of Depression on State and Trait Anger in Veterans with Posttraumatic Stress Disorder. COGNITIVE THERAPY AND RESEARCH 2013. [DOI: 10.1007/s10608-012-9506-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Military veterans represent a unique, heterogeneous population with suicide prevalence rates, risk factors and preventative management needs that differ from those of the rest of community. Veterans worldwide receive high proportions of their healthcare from community providers, and sensitivity to these distinct needs is required for optimized care. An overview of the recent prevalence-study literature, with a focus upon statistical design, is presented in order to provide a critical orientation within this field with high levels of popular media attention. Attention to psychiatric comorbidity, subthreshold symptomology, select signature disorders of contemporary conflicts (namely, post-traumatic stress disorder and traumatic brain injury), and veteran life narratives before, within and beyond military service will guide our review of risk factor assessment and management strategies. This critical review of the literature provides an overview of this active field of neuropsychiatric research with a select focus upon these topics of special interest.
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Affiliation(s)
- Timothy R Rice
- Department of Psychiatry, The Mount Sinai School of Medicine, 1425 Madison Avenue, Box 1230, New York, NY 10029, USA.
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Kulkarni M, Porter KE, Rauch SAM. Anger, dissociation, and PTSD among male veterans entering into PTSD treatment. J Anxiety Disord 2012; 26:271-8. [PMID: 22245698 DOI: 10.1016/j.janxdis.2011.12.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 12/01/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
Prior research suggests that dissociation and anger are risk factors for the development of posttraumatic stress disorder (PTSD). Research found that trauma survivors with higher levels of anger also report more severe PTSD overall. Studies also support a relationship between PTSD severity and dissociation. Only one prior study of sexual assault survivors by Feeny, Zoellner, and Foa (2000) examined the relationships among dissociation, anger, and PTSD. While Veterans have been found to report high levels of anger and dissociation, the relationship between these factors and PTSD has not been examined among Veterans. This paper examines the relationship among anger, dissociation, and PTSD in treatment-seeking Veterans who presented for evaluation at the PTSD Clinic in the VA Ann Arbor Healthcare System during a four year period. Anger and dissociation predicted PTSD, hyperarousal, and avoidance/numbing severity while dissociation predicted intrusive severity. The implications of these results for clinical practice are discussed.
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Affiliation(s)
- Madhur Kulkarni
- VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, USA.
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Yen JY, Yen CF, Wu HY, Huang CJ, Ko CH. Hostility in the real world and online: the effect of internet addiction, depression, and online activity. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2011; 14:649-55. [PMID: 21476897 DOI: 10.1089/cyber.2010.0393] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hostility online has not been evaluated by an empirical investigation. This study aims to evaluate (a) the difference between hostility in the real world and that online and (b) whether the difference is associated with Internet addiction, depression, or online activities. A total of 2,348 college students (1,124 males and 1,224 females) were recruited and completed the Chen Internet Addiction Scale, the Center for Epidemiological Studies' Depression Scale, and the questionnaire for online activity. Further, the Buss-Durkee Hostility Inventory-Chinese version-short form was utilized to evaluate hostility in both real and virtual worlds. The results demonstrated that the levels of all four dimensions of hostility were lower when getting online than those in the real world. Subjects with Internet addiction had higher hostility both in the real world and online as do subjects with depression. Further, college students with Internet addiction had increased expressive hostility behavior and those with depression had decreased hostility cognition, hostility affection, and suppressive hostility behavior when getting online. Lastly, the buffering effect of the Internet on hostility was attenuated among subjects paying the most online time in chatting, and those using the Internet mainly for online gaming had higher expressive hostility behavior not only in the real world but also online. These results suggest that attention should be paid to interventions concerning aggressive behavior among subjects with Internet addiction or online gaming and chatting. On the other hand, depressed college students would be less hostile after entering the Internet. It is suggested that the Internet would be one possible interactive media to provide intervention for depression.
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Affiliation(s)
- Ju-Yu Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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