Anger and Aggressiveness Linked to Specific PTSD Symptoms in Veterans

A new study sponsored by the National Institute of Mental Health, Department of Veteran Affairs, and the University of North Carolina at Chapel Hill School of Medicine reveals that focusing on particular symptoms of post-traumatic stress disorder (PTSD) may help health officials better treat anger and aggression issues among veterans returning home from the Afghanistan and Iraq wars.

PTSD is a complex anxiety disorder that occurs among individuals who have experienced or witnessed intense trauma or violence. PTSD is commonly associated with military personnel since they are customarily exposed to events or situations of high stress during combat in which severe physical harm is caused or threatened. Although the majority of service members who return from war are not diagnosed with PTSD, those veterans who do experience PTSD exhibit a variety of chronic symptoms including re-experiencing the trauma through flashbacks, dreams, or recurring thoughts; avoiding reminders of their trauma such as social and emotional withdrawal, despondency, and memory loss; and hyperarousal symptoms such as feeling “on edge,” becoming easily startled, suffering from insomnia, and experiencing angry outbursts.

Two particular symptoms related to hyperarousal—anger and aggressiveness—do not occur among all diagnoses of PTSD. The study, led by Eric Elbogen, Ph.D. and his team of researchers from UNC School of Medicine and the VA office, found that specific PTSD symptoms were consistently connected to anger or aggression, while other symptoms did not demonstrate a direct correlation. After interviewing 676 veterans, Elbogen and his team discovered that those who experienced flashbacks and nightmares of their trauma and avoidance issues did not always exhibit anger and aggression.

However, those who experienced hyperarousal symptoms such as irritability, difficulty concentrating, sleep deprivation, being easily startled, and high tension (feeling “on edge” or “on guard”) demonstrated a connection to post-service anger and hostility. The researchers found that those veterans who reported difficulty with anger and aggression were more likely to currently be experiencing hyperarousal symptoms, to have been deployed for more than one year, to have fired a weapon during their service, and to have undergone family violence prior to their service.

Veterans who reported having difficulty controlling their anger were more likely to exhibit hyperarousal symptoms, avoidance issues, have a parent with a criminal history, and to be married. Veterans who exhibited aggressive behavior were more likely to have hyperarousal symptoms, reoccurrences of a traumatic event, a history of mental illness in the family, and a history of childhood abuse. Hyperarousal remained the most common association to anger and aggression issues for all veterans experiencing these symptoms.

Current scientific research has placed much attention on traumatic brain injury and its associations to various psychological disorders, including Alzheimer’s disease, dementia, and PTSD. Elbogen and his team did discover a relationship between a history of traumatic brain injury and difficulty with anger and aggression among veterans, but caution that the relationship was not as evident as the connection between angry and aggressive behavior and hyperarousal symptoms in their study.

By isolating specific symptoms from the multiple categories of PTSD, health officials can better understand returning veterans’ risk of increasing anger and aggressive behavior after having completed their service. A veteran’s transition back into a civilian lifestyle is often a very difficult experience that puts the veteran at risk of further psychological challenges. By addressing specific PTSD factors, the VA and other health professionals can help make this transition more manageable for these vulnerable individuals. Not only does helping veterans who are struggling with psychological disorders make their personal, familial, and occupational lives more controllable, but it also benefits society as a whole due to the veterans’ contributions to the community and economy.

A number of veterans returning from service undergo unsuccessful transitions back into society, and are at risk of increasing psychological disorders, substance abuse disorders, and homelessness. The Department of Veteran’s Affairs considers taking care of U.S. veterans as a community responsibility to honor their service and sacrifice to their country. To learn more about the VA’s resources, research, and services, visit

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