Veterans who suffer from both post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) tend to experience significantly higher rates of anger, compared to those with only one or no disorder, according to a new study published in the journal Psychological Trauma: Theory Research, Practice and Policy.
One reason the researchers chose to focus on anger is that it is given insufficient attention as a clinical problem among combat veterans and trauma populations in general.
“PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders,” he said. “There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention,” said lead author Raymond Novaco, Ph.D., professor of psychology and social behavior at the University of California, Irvine.
“Our study findings should draw attention to anger as a major treatment need when military service members screen positive for PTSD or for depression, and especially when they screen positive for both.”
For the study, researchers looked at the behavioral health data of 2,077 U.S. soldiers (1,823 men and 254 women) who were deployed to Iraq and Afghanistan and who later sought behavioral health services at a large military installation.
The participants were screened for PTSD and major depressive disorder (MDD) and placed in one of four groups: PTSD-only, MDD-only, PTSD and MDD combined, or neither. The researchers also measured the veterans’ anger and whether they said they were considering harming others.
Anger and self-rated risk of harm were both significantly higher in the group with both PTSD and MDD compared to the other three groups. The researchers also found that PTSD was commonly paired with depression. Approximately 72 percent of veterans who screened positive for PTSD also screened positive for MDD.
Earlier studies conducted with both military members and civilians who have experienced trauma have shown anger in the context of PTSD to be far more than a symptom; it can predict PTSD severity and also interfere with PTSD treatment.
A 2010 study of more than 18,000 soldiers returning from Iraq found that about 40 percent had physical bursts of anger, more than 30 percent threatened someone with physical violence and over 15 percent got into a physical fight.
“Anger is a driver of violent behavior but it is responsive to anger-focused psychological treatment,” said Novaco, adding that this is one reason why soldiers presenting with PTSD, depression or, most important, both should receive treatment focusing on anger.
Novaco added that a variety of studies have been published on the effectiveness of cognitive behavior therapy for anger treatment, including anger treatment completed with combat veterans.