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Journal of Traumatic Stress, Vol. 20, No. 6, December 2007, pp. 945–954 (
Anger, Hostility, and Aggression Among Iraq and
Afghanistan War Veterans Reporting PTSD and
Subthreshold PTSD
Matthew Jakupcak
VA Puget Sound Health Care System, Seattle, WA
Daniel Conybeare and Lori Phelps
VA Puget Sound Health Care System and Mental Illness Research, Education, and Clinical
Center, Seattle, WA
Stephen Hunt
VA Puget Sound Health Care System, Seattle, WA
Hollie A. Holmes
VA Puget Sound Health Care System and Mental Illness Research, Education, and Clinical
Center, Seattle, WA
Bradford Felker
VA Puget Sound Health Care System, Seattle, WA
Michele Klevens and Miles E. McFall
VA Puget Sound Health Care System and Mental Illness Research, Education, and Clinical
Center, Seattle, WA
Iraq and Afghanistan War veterans were grouped by level of posttraumatic stress disorder (PTSD)
symptomatology and compared on self-report measures of trait anger, hostility, and aggression. Veterans
who screened positive for PTSD reported significantly greater anger and hostility than those in the
subthreshold-PTSD and non-PTSD groups. Veterans in the subthreshold-PTSD group reported significantly greater anger and hostility than those in the non-PTSD group. The PTSD and subthreshold-PTSD
groups did not differ with respect to aggression, though both groups were significantly more likely to have
endorsed aggression than the non-PTSD group. These findings suggest that providers should screen for
anger and aggression among Iraq and Afghanistan War veterans who exhibit symptoms of PTSD and
incorporate relevant anger treatments into early intervention strategies.
A recent meta-analysis revealed a strong relationship
between PTSD and anger and PTSD and hostility among
trauma-exposed adults (Orth & Wieland, 2006). Larger
effect sizes were associated with combat exposure (compared to other traumatic events) and a greater period of
time since trauma exposure. Among Vietnam veterans,
Correspondence concerning this article should be addressed to: Matthew Jakupcak (S116-MHC), Deployment Health Clinic, Seattle VA Medical Center, 1660 South Columbian Way,
Seattle, WA 98108. E-mail: [email protected]
C 2007 International Society for Traumatic Stress Studies. Published online in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/jts.20258
945
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research has consistently found that levels of anger and
hostility are greater among veterans with PTSD compared to veterans without PTSD (e.g., Beckham, Feldman,
Kirby, Hertzberg, & Moore, 1997; Castillo, Fallon, Baca,
Conforti, & Qualls, 2001; Frueh, Henning, Pellegrin, &
Chobot, 1997; Kubany, Gino, Denny, & Torigoe, 1994),
even after accounting for combat exposure, substance
abuse, or comorbid mental health disorders (Chemtob,
Hamada, Roitblat, & Muraoka, 1994; Lasko, Gurvtis,
Kuhne, Orr, & Pitman, 1994; Novaco & Chemtob, 2002).
Although anger is a diagnostic criterion for PTSD, research indicates that the relationship between anger and
PTSD is not an artifact of measurement overlap. Posttraumatic stress disorder symptom severity has been significantly correlated with multiple measures of anger after anger items were removed from the PTSD measures
(Lasko et al., 1994; Novaco & Chemtob, 2002). In a study
with combat veterans, severity of anger symptoms at intake did not covary with changes in PTSD symptoms following treatment, unlike baseline measures of anxiety, depression, and substance use (Forbes, Creamer, Hawthorne,
Allen, & McHugh, 2003). These findings prompted the
researchers to suggest that anger is independent from,
albeit related to, PTSD. The consistent relationship between anger and PTSD may exist because anger functions
to facilitate emotional disengagement (Foa, Skeketee, &
Rothbaum, 1989; Jaycox & Foa, 1996) and therefore may
play a role in the formation and maintenance of PTSD. Indeed, higher initial anger levels predict later PTSD severity
(Andrews, Brewin, Rose, & Kirk, 2000; Feeny, Zoellner,
& Foa, 2000; Koenen, Stellman, Stellman, & Sommer,
2003; Riggs, Dancu, Gershuny, Greenberg, & Foa, 1992)
and poorer treatment outcome (Foa, Riggs, Massie, &
Yarczower, 1995; Forbes et al., 2003; Pitman et al., 1991;
Riggs et al., 1992; Taylor et al., 2001).
In addition to documenting the relationship between
PTSD and anger and between PTSD and hostility, numerous studies have found that veterans with PTSD are
more likely to commit aggressive acts than veterans without
PTSD or the general public (e.g., Beckham et al., 1997;
Kulka et al., 1990; Lasko et al., 1994; McFall, Fontana,
Raskind, & Rosenheck, 1999). In one study, Vietnam
combat veterans with PTSD reported an average of 20
acts of violence in the past year compared to less than 1
act reported by combat veterans without PTSD (Beckham
et al., 1997). In another study, veterans receiving inpatient
PTSD treatment were approximately 7 times more likely
than non-PTSD veterans receiving inpatient psychiatric
care to have committed aggression in the 4 months prior
to treatment (McFall et al., 1999). There is also evidence
that veterans with PTSD are more prone than veterans
without PTSD to express hostility and physical aggression
within their intimate relationships (Carroll, Rueger, Foy,
& Donahoe, 1985; Glenn et al., 2002; Jordan et al., 1992).
Overall, there is strong agreement among veterans, spouses,
and clinicians that anger and aggressive behavior are major
concerns in the families of veterans with PTSD (Biddle,
Elliott, Creamer, Forbes, & Devilly, 2002; Calhoun et al.,
2002; Jordan et al., 1992).
Despite the consistent relationships found between
PTSD and anger, PTSD and hostility, and PTSD and
aggression, much of the extant research has focused on the
experiences of Vietnam combat veterans assessed decades
after their military service. With a growing number of
combat veterans returning from deployments in Iraq and
Afghanistan, additional research is needed to determine
whether these relationships exist among this new cohort.
Recent findings suggest high rates of post-deployment
mental health disorders, including symptoms of PTSD
experienced by approximately 10% to 20% of returning
servicemen and service women (Hoge et al., 2004; Hoge,
Terhakopian, Castro, Messer, & Engel, 2007; Vasterling
et al., 2006), along with significant PTSD-related impairment in occupational functioning (Hoge et al., 2007).
Furthermore, many Iraq and Afghanistan veterans may
be suffering from subthreshold levels of PTSD. Previous
research has found that subthreshold levels of PTSD are associated with significant impairment (Mylle & Maes, 2004;
Stein, Walker, Hazen, & Forde, 1997; Weiss et al., 1992;
Zlotnick, Franklin, & Zimmerman, 2002) and may predict delayed onset PTSD (Carty, O’Donnell, & Creamer,
2006). Subthreshold levels of PTSD found in veterans
have been shown to be associated with physical and mental
health impairment, as well as limitations in occupational
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Anger and Aggression in Iraq and Afghanistan Veterans
and interpersonal functioning (Grubaugh et al., 2005;
Kulka et al., 1990; Schnurr, Friedman, & Rosenberg, 1993;
Weiss et al., 1992).
The current study sought to compare anger, hostility,
and aggression, based on level of PTSD symptomatology,
among treatment-seeking Iraq and Afghanistan War veterans. A retrospective review was conducted of self-report responses to clinical intake questionnaires assessing problematic alcohol use, combat exposure, PTSD, anger, hostility,
and aggression. It was predicted that veterans who screened
positive for PTSD would report significantly greater trait
anger and hostility, and be more likely to have reported aggressive behavior than veterans reporting subthreshold and
nonclinical levels of PTSD. It was also predicted that the
veterans reporting subthreshold PTSD symptoms would
report greater trait anger and hostility, and be more likely
to have reported aggressive behavior than the non-PTSD
group.
METHOD
Participants
The sample for this retrospective review study was comprised of consecutive Iraq and Afghanistan War combat veterans (N = 117), who presented with a variety of concerns
to the Deployment Health Clinic of the VA Puget Sound
Health Care System between May 2004 and June 2005.
The University of Washington Human Subjects Division
and the Veterans Administration Research and Development Committee approved the protocol for this study.
Veterans who denied any combat exposure (n = 6) or who
were missing responses to study variables (n = 6) were not
included in the study.
The Deployment Health Clinic is structured to screen
for and provide both physical and mental healthcare services to Iraq and Afghanistan War veterans within a primary
care setting. Because the nature of the referral to the clinic
was not assessed by the intake questionnaires, the reasons
for seeking treatment are not available.
Most of the participants were men (97%) and White
(71%), with a mean age of 32.7 (SD = 8.5) and 14.0
947
(SD = 2.3) years of education. Nearly one half of participants were married (49.6%), 34.8% single, and 13.0% divorced. Approximately one quarter (23.4%) of the sample
reported a household income of $50,000 or more, 40.5%
between $25,000 and $50,000, and 34% below $25,000.
The majority (78.1%) reported serving in the Army or the
National Guard, and 69.8% reported they were on reserve
status when called to duty.
Measures
Combat exposure was assessed using the 10 items from
Laufer’s Combat Exposure Scale (Laufer, Gallops, & FreyWouters, 1984) and 17 non-redundant items from the
Desert Storm Trauma Questionnaire (see Southwick et al.,
1993). On both surveys, respondents indicate (yes or no)
whether they were exposed to a number of stressful combatrelated events (e.g., witnessed injury or death, experienced
sniper fire), and a summary score is calculated by summing
the number of items positively endorsed. The Laufer Combat Exposure Scale has demonstrated good psychometric
properties (Gallops, Laufer, & Yeager, 1981). Although no
published psychometrics were found for the Desert Storm
Trauma Questionnaire, the measure has been used to assess
trauma in Gulf War I veterans and has previously demonstrated positive associations with PTSD symptom severity
(Southwick et al., 1993). In the current study, internal
consistency for the 27 items was good (α = .84).
Problem drinking was assessed using the Patient History Questionnaire (PHQ; Spitzer, Kroenke, & Williams,
1999), a self-report measure based on the clinicianadministered Primary Care Evaluation of Mental Disorders (PRIME-MD; Spitzer et al., 1994). The PHQ includes five items that assess symptoms of alcohol abuse
by asking respondents to indicate whether they have engaged in problematic behavior (e.g., drove an automobile
while intoxicated) or experienced negative outcomes associated with alcohol consumption (e.g., failed to complete
daily responsibilities due to alcohol use). Prior research
suggests that the PHQ has good psychometric properties
and is an effective screening measure for psychiatric conditions (Spitzer et al., 1999). In the current study, internal
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
948
Jakupcak et al.
consistency for the five PHQ alcohol items was adequate
(α = .59; see Nunnally, 1967).
Posttraumatic stress disorder symptoms were assessed
using the PTSD Checklist Military Version (PCL-M;
Weathers, Litz, Herman, Huska, & Keane, 1993), a 17item self-report instrument that asks respondents to rate
the degree to which they have been bothered by symptoms
of PTSD as defined by the Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (DSM-IV ; American
Psychiatric Association, 1994) within the last month on a
5-point scale from 1 (not at all) to 5 (extremely). The instrument has demonstrated good psychometric properties
(Weathers et al., 1993), and previous research supports the
screening classification of PTSD in a combat veteran population using a global cut-off score of 50 or greater (Forbes,
Creamer, & Biddle, 2001). The PCL-M scores ranging
from 35 to 49 were classified as subthreshold PTSD; those
who scored <35 were classified as non-PTSD (i.e., bothered no more than a little bit on any of the items). In
the current study, internal consistency for the PCL-M was
excellent (α = .97).
Anger was assessed using the Trait-Anger Scale (T-Anger
Scale; Spielberger, Jacobs, Russel, & Crane, 1983), a 10item subscale of the State-Trait Anger Expression Inventory
(Spielberger, 1988) that assesses an individual’s disposition
to experience anger. Respondents rate the degree to which
they react in an angry fashion from 1 (almost never) to
4 (almost always), and responses are summed for a global
score. The T-Anger Scale has been shown to have good
psychometric properties and there is good support for the
measure’s construct validity (Spielberger et al., 1983). In
the current study, internal consistency for the T-Anger
Scale was good (α = .90).
Hostility was assessed using the hostility subscale of the
Brief Symptom Inventory (BSI; Derogatis & Melisaratos,
1983), which asks respondents rate the degree to which
they engage in five hostile reactions on a 5-point scale from
0 (not at all) to 4 (extremely). Individual item scores are
averaged for a global score. Overall, the BSI has demonstrated good psychometric properties, and there is good
support for the construct validity of the measure, including the hostility subscale (Derogatis, 1993). In the current
study, internal consistency for the subscale was good (α =
.88).
Aggression was measured using four items that have
been adapted from the National Vietnam Adjustment
Study (see McFall et al., 1999). Respondents indicate
whether they have engaged in behaviors including destroying property, threatening the use of violence (with and
without a weapon), or physically assaulting another person. In the current study, internal consistency for the four
items was adequate (α = .65).
RESULTS
Preliminary Analyses
Based on PCL-M scores, 47 veterans screened positive for
PTSD (M = 63.9, SD = 8.0), 21 were classified as subthreshold PTSD (M = 42.7, SD = 4.6), and 49 were
classified as non-PTSD (M = 24.0, SD = 5.1). Scores
on measures of combat exposure, trait anger, and hostility were linearly and normally distributed. Mean combat
exposure scores for the PTSD, subthreshold-PTSD, and
non-PTSD groups were 13.4 (SD = 5.8), 13.0 (SD =
5.1), and 8.9 (SD = 5.5), respectively. Problem drinking and the summed aggression variables were significantly
positively skewed. Efforts to transform the distributions
of these variables were unsuccessful and therefore both
measures were treated as dichotomous variables (yes = 1,
no = 0; see Tabachnick & Fidell, 2001), based on whether
veterans endorsed at least one item on each measure. Over
one half of the veterans in the PTSD-group (53.2%) and
the subthreshold-PTSD group (52.4%) endorsed at least
one act of aggression in the past 4 months, compared to
20.4% in the non-PTSD group; the modal number of
aggressive acts for those who screened positive for aggression was one. Frequencies for specific aggressive acts are
presented in Table 1.
Combat exposure, problem drinking, and demographic
variables (age, race, education, and income) were examined
as potential covariates by computing their associations with
anger, hostility, and aggression. Age was significantly negatively associated with the dichotomous aggression variable,
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Anger and Aggression in Iraq and Afghanistan Veterans
949
Table 1. Number of Veterans Reporting Specific Aggressive Acts
PTSD
(n = 47)
Destroyed property
Threatened physical violence (no weapon)
Threatened someone with a weapon
Had a physical fight with someone
Subthreshold PTSD
(n = 21)
Non-PTSD
(n = 49)
n
%
n
%
n
%
9
12
1
8
19.1
25.5
2.1
17.0
5
8
3
2
23.8
38.1
14.3
9.5
3
5
2
2
6.1
10.2
4.1
4.1
Note. PTSD = Posttraumatic stress disorder.
r = −.19, p < .05, but was not significantly related to trait
anger, r = −.13, ns, or hostility, r = .08, ns. No other significant associations emerged between demographic variables and anger, hostility, and aggression. Combat exposure was significantly positively associated with trait anger,
r = .20, p < .05, and hostility, r = .18, p < .05, but was
not significantly related to aggression, r = .14, ns. Problem drinking was significantly positively associated with
trait anger, r = .27, p < .01, hostility, r = .25, p <
.01, and aggression, χ 2 (1, N = 117) = 5.85, p < .05.
Only covariates significantly associated with the respective
outcome variables were retained for further analyses (see
Tabachnick & Fidell, 2001).
Primary Analyses
The results of an analysis of covariance (ANCOVA) indicated that, after accounting for combat exposure and
problem drinking, the PTSD group variable significantly
predicted differences in trait anger, F (2, 112) = 20.05,
p < .01, η2 = .26. Results of planned t-test analyses indicated that the PTSD-group reported significantly
greater trait anger (M = 23.9, SD = 5.9) than both the
subthreshold-PTSD group (M = 19.1, SD = 6.6), t(66) =
2.72, p < .01, and the non-PTSD group (M = 15.1, SD =
4.6), t(94) = 7.61, p < .01. In addition, the subthresholdPTSD group reported significantly greater trait anger than
the non-PTSD group, t(68) = 2.90, p < .01.
The results of a second ANCOVA indicated that, after
accounting for combat exposure and problem drinking, the
PTSD group variable significantly predicted differences in
hostility, F (2, 112) = 42.80, p < .01, η2 = .43. Results
of planned t-test analyses indicated that the PTSD-group
reported significantly greater hostility (M = 2.4, SD = .9)
than both the subthreshold-PTSD group (M = 1.6, SD
= 1), t (66) = 3.24, p < .01, and the non-PTSD group
(M = .07, SD = .07), t (94) = 10.34, p < .01. In addition, the subthreshold-PTSD group reported significantly
greater hostility than the non-PTSD group, t (68) = 4.61,
p < .01.
A binomial logistic regression predicting aggression (yes
or no) was conducted in which age and problem drinking were entered into the model as covariates at Step 1
and the PTSD group variable was entered into Step 2.
There was a significant main effect for PTSD group. As
shown in Table 2, veterans in the PTSD-group were more
likely than the veterans in the non-PTSD group to have
reported aggression. Veterans in the subthreshold-PTSD
group were also more likely than the veterans in the nonPTSD group to have reported aggression. There was no
significant difference in aggression comparing the PTSD
and subthreshold-PTSD groups. To verify that findings
from the ANCOVA and logistical regression were not artifacts of the PCL-M anger-related item, all analyses were
rerun after omitting that item from the PTSD symptom
severity variable; the significance and magnitude of the
results did not change.
DISCUSSION
Results from the current study confirm the hypothesis that
symptoms of PTSD are associated with anger, hostility,
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
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Jakupcak et al.
Table 2. Results of a Binomial Logistic Regression of PTSD Group on Aggression (yes/no) Controlling
for Age and Problem Drinking (N = 117)
Step 1
Step 2
Variable
Wald
df
Exp(B)
95% CI
Age
Problem drinking
Age
Problem drinking
PTSD group
1. PTSD vs. non-PTSD
2. PTSD vs. Subthreshold
3. Subthreshold vs. non-PTSD
2.33
4.53*
2.02
3.72*
1
1
1
1
0.96
0.38
0.95
0.50
.92–1.0
.15–.93
.19–1.3
.91–1.0
8.81**
<1
7.12**
1
1
1
4.17
1.17
4.89
1.6–10.7
.40–3.5
1.5–15.7
Note. PTSD = Posttraumatic stress disorder.
* p < .05. ** p < .01
and aggression among Iraq and Afghanistan War veterans. Veterans who screened positive for PTSD reported
greater trait anger and hostility and were more likely to have
endorsed recent aggression than veterans who screened negative for PTSD. Likewise, veterans reporting subthresholdPSTD symptoms indicated greater trait anger and hostility and were more likely to endorse recent aggression than
the non-PTSD veterans. Although the PTSD-group reported significantly greater trait anger and hostility than
the subthreshold-PTSD group, they were not more likely to
report aggression. The nature of the results did not change
after eliminating the anger item from the PTSD measure,
thus replicating previous findings (e.g., Lasko et al., 1994;
Novaco & Chemtob, 2002). This further supports the notion that the relationship between anger and PTSD is not
a methodological artifact.
These results contribute to the research examining the
relationship between PTSD and anger among combat
veterans in two important ways. First, the strong associations between PTSD and anger, hostility, and aggression have been consistently demonstrated among Vietnam
combat veterans, although assessment of these factors was
conducted decades following military service (Beckham,
Moore, & Reynolds, 2000). The current study suggests
that anger, hostility, and aggression associated with symptoms of PTSD are present in Iraq and Afghanistan War veterans within the first few years after returning from combat
duty and that these associations are significant even after
accounting for other factors such as combat exposure and
problem drinking. As such, early intervention may be particularly important in this population given that rates and
severity of PTSD may increase over time (Gray, Bolton,
& Litz, 2004; Southwick et al., 1995; Wolfe, Erickson,
Sharkansky, King, & King, 1999), along with the strength
of the relationship between PTSD and anger (Orth &
Wieland, 2006).
Second, this study confirms previous research indicating that subthreshold-PTSD is associated with clinically
significant impairment among treatment-seeking Vietnam
veterans (Grubagh et al., 2005) and community members
from an epidemiological sample (Stein et al., 1997). In the
current study, veterans with subthreshold levels of PTSD
symptoms had greater anger and hostility than veterans
without PTSD and were just as likely to have endorsed aggression as were veterans who screened positive for PTSD.
Although rates of PTSD among soldiers serving in the Iraq
and Afghanistan Wars have been estimated to range from
10% to 20% (Hoge et al., 2004; Vasterling et al., 2006), an
additional percentage of returning soldiers are likely experiencing subthreshold levels of PTSD symptoms, which may
contribute to difficulties with anger and aggression. Clinicians may underestimate the impairment associated with
subthreshold levels of symptoms and subthreshold-PTSD
veterans may be less likely to seek mental health services
than those with PTSD (Grubaugh et al., 2005). This has
important implications for the Department of Veterans
Affairs and community health care providers, underscoring the need to screen for symptoms of PTSD in settings
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
Anger and Aggression in Iraq and Afghanistan Veterans
such as primary care clinics (Ramaswamy et al., 2005)
and to encourage the use of appropriate mental health
services.
Results from the current study should be considered in
light of certain limitations. First, given the nature of the
clinic from which the sample was drawn, we cannot infer
whether veterans experiencing PTSD symptoms initially
presented for medical concerns or were seeking treatment
for mental health issues. This makes it difficult to choose
relevant norms for comparing levels of self-reported PTSD,
anger, hostility, and aggression. For example, trait anger
scores among the PTSD and subthreshold-PTSD groups
in the current study were lower than those reported by
Vietnam combat veterans receiving outpatient PTSD treatment (Lasko et al., 1994), and rates of aggression among
the PTSD and subthreshold-PTSD groups were lower than
those reported by Vietnam combat veterans seeking inpatient PTSD treatment (McFall et al., 1999). However, direct comparisons between the current sample and previous
samples are problematic without knowing why the current
sample presented to the clinic. Second, the current study
relied on self-report methodology to assess level of PTSD
symptoms, although there are more detailed ways in which
to assess subthreshold levels of PTSD (see Mylle & Maes,
2004). In addition, although the PCL-M has demonstrated
good sensitivity and specificity for detecting PTSD based
on structured clinical interviews (Forbes et al., 2001), other
factors that may influence self-report of symptom severity
were not assessed and therefore may have influenced results.
For example, efforts to seek disability and compensation
for PTSD were not considered, although these factors have
been associated with inflated reports of symptom severity
among veterans (Gold & Frueh, 1999). In addition, medical factors that may impact anger or aggression were not
assessed, such as traumatic brain injury, the incidence of
which is estimated to be prominent during military service in Iraq (Warden, 2006). Finally, the cross-sectional
design of the current study makes it problematic to infer
causality among the relationships between anger, hostility,
aggression, and PTSD.
Prior research also has concluded that anger is an important symptom to address among Vietnam veterans with
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PTSD (Frueh et al., 1997; Koenen et al., 2003; McFall
et al., 1999). The results of the current study suggest that
introducing anger management skills should also be a priority in treating Iraq and Afghanistan War veterans with
symptoms of PTSD. There is preliminary support for a
brief four-session cognitive–behavioral anger management
intervention among active duty military personnel, although attrition rates as high as 50% were noted (Linkh &
Sonnek, 2003). In addition, anger management skills training has been found to improve anger control among Vietnam combat veterans with PTSD (see Chemtob, Novaco,
Hamada, & Gross, 1997). Future research should investigate the effectiveness of these approaches with this new
population of veterans, along with potential differential
treatment outcome based on level of PTSD symptomatology. Research also should be devoted to examining
possible factors that predict whether veterans will be at
risk for experiencing subthreshold versus diagnostic levels
of PTSD symptoms following combat. Level of combat
exposure did not distinguish between veterans reporting
subthreshold-PTSD and PTSD in the current study; however, other factors may include pre-existing trauma exposure (see Donovan, Padin-Rivera, Dowd, & Blake, 1996)
or intelligence level (see Macklin et al., 1998).
It would also be helpful to examine whether results from
the current study apply to female and minority veterans.
One prior study examined the relationship between PTSD
and hostility among female veterans and found that those
with PTSD reported significantly higher levels of hostility
than those without PTSD (Butterfield, Forneris, Feldman,
& Beckham, 2000), but more attention to this population
is needed as an increasing number of women are serving
in combat-related roles in the military. In addition, several
studies have indicated that minority veterans experience
a more negative course of PTSD than do White veterans (Koenen et al., 2003; Kulka et al., 1990), although
racial differences specific to PTSD-related anger have not
been explored. Prospective research using structured assessment interviews and larger, more diverse samples of Iraq
and Afghanistan War veterans is needed to replicate these
findings and to explore interactive effects that might exist
between PTSD and other factors.
Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.
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Jakupcak et al.
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