Posttraumatic Stress Disorder and Male-Perpetrated Intimate Partner Violence
Authors: Kathryn M. Bell
Journal: JAMA (2009)

ALTHOUGH THE RELATIONSHIP BETWEEN POSTTRAUmatic stress disorder (PTSD) and aggression is generally well established within the literature, research investigating the relationship between PTSD and male-perpetrated intimate partner violence (IPV) has only begun to emerge. Preliminary findings suggest a link between trauma exposure, PTSD symptomatology, and maleperpetrated IPV, which may have important clinical implications for batterer intervention programs. To the extent that IPV associated with PTSD has an etiology distinct from non–PTSD-related IPV, prevention and intervention programs may need to be tailored to address the potentially unique IPV risk factors among men with PTSD. Because of the lack of research on the association of PTSD and IPV perpetrated by women, this Commentary will focus on male-perpetrated IPV. Most US studies examining the relationship between PTSD and male-perpetrated IPV have been conducted with male veterans. Findings from these studies indicate that male veterans with greater PTSD symptomatology often self-report higher levels of anger, hostility, aggressiveness, anger reactivity, and IPV perpetration than veterans without significant PTSD symptomatology. The association between PTSD and IPV perpetration has also been found among civilian men. Rosenbaum and Leisring found that civilian male batterers referred to a group batterers treatment program who met diagnostic criteria for PTSD based on the PTSD Checklist-Civilian Version self-reported greater generalized aggressivity and significantly higher rates of IPV perpetration on the Conflict Tactics Scale than civilian male batterers without PTSD. In a study examining IPV rates within a nonclinical civilian male sample recruited from a college campus, Jakupcak and Tull reported similar findings, with higher self-reported rates of IPV perpetration, trait and internal anger, and hostility found among civilian men with PTSD symptomatology compared with civilian men without PTSD symptoms. Prior research investigating the relationship between PTSD and aggression has often included PTSD as a single construct. However, findings from a 3-wave longitudinal study examining the course of PTSD symptoms over a 12-month period in young adults who experienced community violence highlight the importance of considering how the 3 PTSD symptom clusters differentially change over time, influence other PTSD symptoms, and affect behavior, including aggression. Although debate exists as to the nature and number of factors, PTSD is currently characterized by 3 distinct symptom clusters consisting of (1) reexperiencing symptoms (eg, nightmares, flashbacks); (2) avoidance symptoms (eg, avoidance of trauma-related stimuli); and (3) hyperarousal symptoms (eg, hypervigilance, exaggerated startle response). These 3 symptom clusters have been examined as they relate to aggressive behavior. Overall, hyperarousal symptoms appear to play an especially prominent role in the initiation of aggressive behavior. For example, in a study examining the association between aggression and each of the 3 PTSD symptom clusters among male Vietnam veterans participating in a larger multisite psychophysiological project on PTSD, Taft et al found hyperarousal symptoms to have the strongest positive relationship with aggressive behavior in comparison with the other 2 PTSD symptom clusters. Additionally, the authors found that hyperarousal symptoms were both directly related to aggression and indirectly associated with aggression through alcohol problems, as measured by the CAGE questionnaire for assessing alcoholism. Conversely, findings from the same study show that reexperiencing symptoms may not directly influence aggressive behavior, but may indirectly affect aggression via their positive relationship on physiological reactivity (ie, heart rate and skin conductance) to trauma cues and negative affect on alcohol problems. Mixed findings exist regarding the role of PTSD avoidance symptoms and subsequent aggressive behavior. A study comparing male Vietnam veterans seeking inpatient PTSD treatment with a mixed diagnostic group of male inpatient Vietnam veterans without PTSD found a positive relationship between avoidance/numbing symptoms and aggression when assessing PTSD symptom clusters using the brief Mississippi Scale for Combat-Related PTSD. However, additional evidence from the study by Taft et al suggests a potential negative association between avoidance/numbing