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PTSD and Anger in Veterans of the Wars in Iraq and Afghanistan

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Updated November 05, 2008

High levels of anger in veterans of the Iraq and Afghanistan Wars have been observed. In fact, as the conflicts in Iraq and Afghanistan are ongoing, and we are constantly learning more and more about the impact of these wars on military service men and women. One point that has been clear is that Iraq and Afghanistan War veterans are at risk for a number of mental health problems.

Studies have consistently shown that veterans of the Iraq and Afghanistan War are exhibiting high rates of PTSD, depression, and substance use disorders. However, there is some evidence that Iraq and Afghanistan War veterans may also have difficulties with anger.

Anger Problems in Iraq and Afghanistan War Veterans

A group of researchers at the Seattle VA Medical Center looked at rates of PTSD and anger problems among a group of 117 Iraq and Afghanistan War veterans.

Similar to other reports, the veterans they looked at exhibited high rates of PTSD. In fact, around 40% had PTSD and an additional 18% almost had a PTSD diagnosis, or what is often referred to as subthreshold PTSD (that is, they were struggling with some severe symptoms of PTSD but not quite enough symptoms to meet criteria for a full PTSD diagnosis).

In addition, over half of the veterans with PTSD indicated that they had been aggressive in the past 4 months, such as threatening physical violence, destroying property, and having a physical fight with someone. Veterans with almost a PTSD diagnosis reported just about the same amount of aggressive behavior as the veterans with PTSD.

There appears to definitely be a connection between the experience of PTSD symptoms and aggressive behavior among Iraq and Afghanistan War veterans. Veterans with PTSD and with almost a PTSD diagnosis were much more likely to be aggressive than those veterans without PTSD.

Individuals with PTSD may have intense and unpredictable emotional experiences, and anger and aggressive behavior may ways of establishing a sense of control. Anger may also be a way of trying to express or release tension connected to uncomfortable emotions often associated with PTSD, such as shame and guilt.

Dealing with Anger

Individuals with PTSD may be more likely to have problems controlling anger, and this study shows that problems with anger may occur soon after returning from combat.

Anger can be a very difficult emotion to deal with and can lead to a number of legal and interpersonal problems, such as domestic violence. In fact, individuals with PTSD are particularly at risk for the perpetration of relationship violence.

However, you can do a number of things to better manage anger. First, addressing symptoms of PTSD through therapy may also help reduce feelings of anger. Many treatments for PTSD even incorporate anger management skills. Learning more effective ways of coping with stress may also be helpful in managing anger and aggressive behavior. Some coping skills that may be particularly helpful are deep breathing, mindfulness, taking "time-outs," and identifying the short- and long-term negative and positive consequences of different behaviors.

The National Center for PTSD also provides some excellent information on the relationship between PTSD and anger, as well as a number of suggestions on how to better manage anger and aggressive behavior.

Sources:

Erbes, C., Westermeyer, J., Engdahl, B., & Johnsen, E. (2007). Posttraumatic stress disorder and service utilization in a sample of service members from Iraq and Afghanistan. Military Medicine, 172, 359-363.

Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I., & Koffman, R.L. (2004). Combat duty in Iraq and Afghanistan: mental health problems and barriers to care. New England Journal of Medicine, 351, 13-22.

Jakupcak, M., Conybeare, D., Phelps, L., Hunt, S., Holmes, H.A., Felker, B., Klevens, M., & McFall, M.E. (2007). Anger, hostility, and aggression among Iraq and Afghanistan War veterans reporting PTSD and subthreshold PTSD. Journal of Traumatic Stress, 20, 945-954.

Tull, M.T., Jakupcak, M., Paulson, A., & Gratz, K.L. (2007). The role of emotional inexpressivity and experiential avoidance in the relationship between posttraumatic stress disorder symptom severity and aggressive behavior among men exposed to interpersonal violence. Anxiety, Stress, and Coping: An International Journal, 20, 337-351.

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