title: The Effects of Alcohol Problems, PTSD, and Combat Exposure on Nonphysical and Physical Aggression Among Iraq and Afghanistan War Veterans.
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.
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, Seattle, Washington.
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Stappenbeck
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, Seattle, Washington.
authors.forename: Julianne C
authors.initials: JC
authors.lastname: Hellmuth
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and Department of Psychiatry and Behavioral Sciences, University of Washington.
authors.forename: Tracy
authors.initials: T
authors.lastname: Simpson
authors.affiliation: VA Puget Sound Health Care System, Seattle Division, Seattle, Washington, and University of Washington.
authors.forename: Matthew
authors.initials: M
authors.lastname: Jakupcak
keywords: Iraq and Afghanistan war veterans; PTSD; aggression; alcohol problems; combat exposure