Posttraumatic Stress Disorder And The Perpetration Of Domestic Violence
By David S. Riggs, Ph.D.
NCP Clinical Quarterly 7(2): Spring 1997
There is evidence that the impact of trauma and posttraumatic stress disorder (PTSD) extends beyond trauma victims to significantly disrupt their intimate relationships and families (1-4). One area of marital or relationship functioning that should be of particular concern to clinicians working with PTSD veterans is the perpetration of violence toward their intimate partners (2, 5). This paper outlines some of the issues related to domestic violence that are likely to be confronted by clinicians working with traumatized populations, particularly combat veterans. Because it is clear that violence occurs within relationships not legally classified as marriage (e.g., dating, cohabitating), the term domestic violence will be used in this paper to refer to violence between romantic partners.
Veterans with PTSD have less cohesive, less expressive, more conflictual and more violent relationships than veterans without PTSD (2, 3, 6). PTSD in Vietnam veterans is also associated with increased risk for perpetrating domestic violence (2, 5). Further, this finding fits into a broader pattern of evidence that many men in treatment for spouse abuse have previously experienced traumatic events (7, 8). For example, in a sample of incarcerated men, the presence of physical abuse in childhood increased the probability of perpetrating family violence by 500% (7).
Studies of combat veterans suggest that it is not the experience of trauma per se that places men at risk for perpetrating domestic violence but rather the presence of enduring trauma-related symptoms such as PTSD (2, 9). For example, data from a national survey of Vietnam era veterans (the National Vietnam Veterans Readjustment Survey; NVVRS) indicate that 33% of Vietnam veterans with PTSD had assaulted their partners in the previous year as compared to about 15% of veterans without PTSD (2). The average number of aggressive acts perpetrated in the prior year by the veterans with PTSD was 4.86 as compared to 1.32 for veterans without PTSD. Rates of domestic violence may be even higher among treatment seeking veterans. In a study focused on veterans seeking treatment for PTSD, 63% of PTSD veterans had aggressed against their partners in the last year compared to 23% of a non-PTSD sample (9) and the presence of severe PTSD symptoms appears to be related to increased perpetration of domestic violence by combat veterans (5, 10).
The domestic violence reported by PTSD veterans and their partners covers a spectrum of behaviors including verbal aggression (e. g., cursing, criticism), emotional abuse (e. g., controlling behavior) and physical violence (e. g., shoving, hitting, kicking). Typically, the most frequent acts of physical aggression are those considered least likely to produce lasting injury (e. g., pushing, grabbing). However, a significant portion of veterans with PTSD (approximately 12% of the NVVRS sample) report more severe forms of aggression (e. g., hitting with a fist, beating up) in their relationships (2). This rate is likely to be even higher among veterans seeking treatment for PTSD (5).
Understanding The Connection Between PTSD And Domestic Violence
As with other variables associated with domestic violence, it is too simplistic to state that PTSD is the cause of men’s violence toward their intimate partners. Years of research into the problem of domestic violence has made it clear that this phenomenon is multiply determined and is related to many variables. However, the association between PTSD and domestic violence suggests that this disorder should be seen as a marker or risk factor for intimate violence. Therefore, it is important for clinicians to attend to and assess the potential for domestic violence when working with PTSD patients.
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http://www.ncptsd.va.gov/publications/cq/v7/n2/riggs.html
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