Depression Combined With PTSD Is A Recipe For Anger Problems

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Post-traumatic stress disorder has been associated with anger and behavior problems, but a new study published by the American Psychological Association shows depression may greatly exacerbate the tendency for veterans with PTSD to lash out in anger.

“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,” said lead author Raymond Novaco, PhD, professor of psychology and social behavior at the University of California, Irvine.

For the study, which was published in the journal Psychological Trauma: Theory Research, Practice and Policy, the researchers reviewed behavioral health data gathered from over 2,000 U.S. soldiers (1,823 men and 254 women) who were deployed to Iraq and Afghanistan and later sought behavioral health services at a military installation.

The team screened participants for PTSD and major depressive disorder, and categorized them in four groups: PTSD-only, MDD-only, PTSD and MDD combined, or neither. Participants were also asked about their anger and whether they were considering harming others.

The researchers found individuals with both PTSD and MDD showed elevated self-rated risk of harm. They also noted that PTSD often paired with depression. Nearly 72 percent of those who tested positive for PTSD were also diagnosed with MDD.

The authors say one reason they were motivated to explore this issue is that anger is largely uninvestigated as a clinical problem among combat veterans and trauma populations.

“PTSD and depression dominate the landscape, but these, of course, are formal psychiatric disorders,” Novaco said. “There is no diagnostic category for anger, nor do I think there should be, so anger slips from research attention.”

The researchers say previous studies focused on both military members and civilians who have experienced trauma indicate anger related to PTSD is more than just a symptom. Anger issues predict PTSD severity, but they can also interfere with PTSD treatment. For example, one 2010 study of more than 18,000 soldiers returning from Iraq showed 40 percent experienced physical bursts of rage, over 30 percent reported threatening someone with physical violence, and over 15 percent reported being involved in physical altercations.

“Anger is a driver of violent behavior but it is responsive to anger-focused psychological treatment,” said Novaco before concluding that soldiers with PTSD, depression, or both should receive treatment focused on anger issues.

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