Disentangling the Link Between Posttraumatic Stress Disorder and Violent Behavior: Findings From a Nationally Representative Sample
Objective: Although research using combat veteran samples has demonstrated an association between posttraumatic stress disorder (PTSD) and violence toward others, there has been relatively little research examining this relationship among individuals with no combat history. Method: Data representative of the United States population collected from the two wave National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analyzed to determine the risk factors for violent behavior of individuals reporting no history of active military combat (N = 33,215). Results: In χ2 analyses, participants meeting criteria for lifetime PTSD at Wave 1 reported higher rates of violence between Waves 1 and 2 compared with participants without a history of PTSD (7 vs. 3%). An increase in anger after trauma and use of alcohol to cope with PTSD symptoms were stronger predictors of physically aggressive or violent acts than a lifetime diagnosis of PTSD without anger. When controlling for these and other covariates, PTSD alone no longer significantly predicted any subtype of physical aggression or violence toward others. Conclusions: Results suggest that although PTSD is related to violent behavior, specific sequelae of trauma (specifically, increased anger and self-medicating with alcohol) are more critical than diagnosis per se in predicting violent behavior in the general population. Clinical implications and future research directions are discussed.