Interesting findings about the relationship between PTSD and anger in men and women service members
November 25, 2015
Previous research has found that anger is associated with posttraumatic stress disorder (PTSD) symptom severity in veterans (Elbogen, Wagner, et al., 2010; Novaco & Chemtob, 2002; Taft, Creech, & Kachadourian, 2012) and other trauma-exposed adults (Orth, Cahill, Foa, & Maercker, 2008). A meta-analysis of prior studies conducted with trauma-exposed adults found that the association between anger and PTSD was stronger in populations with traumas related to military experience than in populations with non-military traumas (Orth & Wieland, 2006).
The authors of that meta-analysis suggested two hypotheses why the association between anger and PTSD might be stronger for military populations than non-military populations (Orth & Wieland, 2006). The first hypothesis, which we will label the Differences in Population hypothesis, proposes that people who join the military are different from people who don’t join the military in a way that makes it more likely that they will have a stronger anger response with PTSD. The second hypothesis, which we label the Differences in Trauma hypothesis, proposes that there is something different about deployment-related traumas compared to other types of traumatic events and that makes the anger response stronger among PTSD-affected military populations.
Our study examined these two hypotheses by looking at the PTSD-anger relationship in U.S. Reserve and National Guard service members – including a group of participants who had joined the military and experienced traumas but had not been deployed at the time of our study. Within these data, we had an opportunity to interrogate the two hypotheses by examining whether in an all-military population, the association between anger and PTSD varied depending on whether the traumatic events that gave rise to the PTSD occurred in the context of a deployment or not. We proposed that if the association were found to be consistent regardless of whether the trauma occurred in the context of a deployment or not, this would provide evidence to support the Differences in Population hypothesis. In that case, those who decide to join the military would have a specific pattern of anger response in the context of PTSD, regardless of whether the traumas were sustained as part of a deployment. However, if the association between anger and PTSD were found to be stronger when the trauma occurred in the context of a deployment than when the trauma did not occur during a deployment, we would have evidence to support the Differences in Trauma hypothesis. In that case, those who experience traumas during deployment would have a different pattern of anger response in the context of PTSD from those who experience traumas in a non-deployment context.
What we found surprised us. When we looked at all the participants together, it seemed as though the association between anger and PTSD was consistent regardless of the trauma context, lending support to the Differences in Population hypothesis. However, when we stratified by gender, important differences were revealed. Whereas for men, the association was stronger for deployment-related traumas than for non-deployment traumas, for women, the reverse was true. The group with the strongest association between anger and PTSD was women who had experienced non-deployment traumas. These patterns were maintained when we adjusted for worst traumatic event type, age, education, marital status, and race.
These findings support the Differences in Trauma hypothesis in men, suggesting that for men, there is something about the context of deployment or the types of traumas experienced during deployment that make the association between anger and PTSD stronger. For women, however, this study raises more questions than it answers. What we observed in women is inconsistent with both the Differences in Trauma hypothesis and the Differences in Population hypothesis. There were differences in the PTSD / anger relationship between women whose traumas were deployment-related and those whose traumas were non-deployment related, but those differences were the reverse of what was observed in the prior meta-analysis.
Women make up a significant proportion of military service members these days, and women are now permitted to participate in combat operations (The Women's Memorial, 2011). Yet our understanding of women’s unique experiences before joining the military and in military service is limited, with little research focusing specifically on women’s experiences in the military. The original work establishing the mechanism of effect for anger and PTSD was conducted with male Vietnam-era veterans. Future research should seek to increase our understanding of the potentially distinct social context, psychological processes, and physiological mechanisms at play for women in anger and PTSD.
We recommend that future research on anger and PTSD examine possible differences in these relations by gender, rather than simply adjusting for possible differences. This is the first study we know of to find significant differences in the association between anger and PTSD symptom severity between men and women service members. If these patterns are found to be consistent across study populations, new explanatory hypotheses will need to be developed and reflected in revised clinical guidelines for treatment of men and women with PTSD.
- Why might the association between anger and PTSD symptom severity be stronger for women who experienced traumas before a deployment than for women who experienced deployment traumas?
- Why has previous research treated gender as a confounding variable rather than as a possible modifier in the association between anger and PTSD?
- What future research would you like to pursue to better understand the relations between anger and PTSD in men and women service members?
Worthen, M., Rathod, S. D., Cohen, G., Sampson, L., Ursano, R., Gifford, R., . . . Ahern, J. (2015). Anger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma Context and Gender. Journal of Traumatic Stress, n/a-n/a. doi: 10.1002/jts.22050
Miranda Worthen is an Assistant Professor in the Department of Health Science and Recreation at San Jose State University. Her research focuses on gender and trauma in military populations.
Elbogen, E. B., Wagner, H. R., Fuller, S. R., Calhoun, P. S., Kinneer, P. M., & Beckham, J. C. (2010). Correlates of anger and hostility in Iraq and Afghanistan war veterans. American Journal of Psychiatry, 167, 1051-1058. doi:10.1176/appi.ajp.2010.09050739
Novaco, R. W., & Chemtob, C. M. (2002). Anger and combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 15, 123-132. doi:10.1023/A:1014855924072
Taft, C. T., Creech, S. K., & Kachadourian, L. (2012). Assessment and treatment of posttraumatic anger and aggression: a review. Journal of Rehabilitation Research and Development, 49, 777-788. doi:10.1682/jrrd.2011.09.0156
Orth, U., Cahill, S. P., Foa, E. B., & Maercker, A. (2008). Anger and posttraumatic stress disorder symptoms in crime victims: a longitudinal analysis. Journal of Consulting and Clinical Psychology, 76, 208-218. doi:10.1037/0022-006x.76.2.208
Orth, U., & Wieland, E. (2006). Anger, hostility, and posttraumatic stress disorder in trauma-exposed adults: a meta-analysis. Journal of Consulting and Clinical Psychology, 74, 698-706. doi:10.1037/0022-006x.74.4.698
The Women's Memorial. (2011). Statistics on Women in the Military. Retrieved February 7, 2013, from http://www.womensmemorial.org/PDFs/StatsonWIM.pdf