PTSD When the Past Doesn\'t

PTSD

WHEN the PAST DOESN'T DIE

Post-Traumatic Stress Disorder

Introduction number of studies and other researches have yielded findings that many or most combat or war veterans who return home from the battlefield develop Post-traumatic Stress Disorder or PTSD. The disorder consists in reliving the memories of war, which a veteran re-enacts. Because of the nature of warfare and the veteran's own indoctrination to aggression, he also develops aggressive or violent behavior towards the members of his household and even outsiders at uncertain moments or episodes.

Military troops, due to militaries' lack of infrastructure, are at risk of having long-term psychological and social effects of PTSD.

Review of Literature

Doyle, L. (2007). Suicide Rates in U.S. Army Highest in 26 Years. The (London) Independent: Independent Newspapers UK Limited

Doyle writes about a military report on the rate of suicides among American soldiers fighting in Iraq and Afghanistan as reaching its highest in 26 years. Many of these soldiers were said to have exhibited symptoms of post-traumatic stress disorder or PTSD, specifically repeated flashbacks of combat experiences. They belonged to an "overstretched" U.S. Army, which was sent back to action more than in the past. According to the report, there were 99 confirmed suicides for 2006 as compared to 88 the year before it and 102 in 1991. Of this number, 28 were sent to Iraq and Afghanistan and twice as many were women sent to fight in the wars as those not sent. Causes were identified as "occupational" or "operational," destroyed relationships, legal and financial.

Army statistics showed 17.3 suicides per 100,000 soldiers in 2006. Thirty of the 99 confirmed were in war zones. More than 1.5 million U.S. troops have fought in Iraq and Afghanistan since 2001. There have been complaints from them about being "overstretched." A series of studies preceded these suicides, which showed an increase in mental health problems among them. The studies found a lack of adequate mental-health provision for the soldiers. Approximately 35% of them sought some type of mental-health treatment a year from their return home. The Army sent medical teams to them while at war to monitor their health, morale and related conditions. But returning soldiers were deprived of proper or adequate families. The Army, however, said they provided training programs, especially on suicide prevention, and added 25% more psychiatrist and other mental-health professionals to its ranks. It also said that it taught all soldiers how to recognize mental-health problems among themselves and to seek help when these occurred.

Elia, L. (2007). Staunching Veterans' Unseen Wound: Post-Traumatic Stress Disorder. Market Wire. Retrieved March 29, 2008 at http://findarticles.com/p/articles/pwwi/ls_200711/ai_n21097808

The author notes the findings of a 2004 study published at the England Journal of Medicine about 15-17% of returning soldiers from Iraq as likely to develop PTSD. The Department of Veterans Affairs had said that 25% of soldiers fighting in Afghanistan and Iraq were diagnosed as suffering from PTSD and other mental-health problems. It also said that these afflicted veterans seeking treatment increased by 70% within a year from June 30. The Veterans Administration likewise acknowledged almost 50,000 PTSD cases in the military personnel. Washington acknowledged only 30,000 wounded.

Elia emphasizes mental health as the second largest category of illness for U.S. veterans who fought in Iraq and Afghanistan and sought treatment. It is second only to orthopedic problems, but has been increasing at a faster rate than orthopedic cases. These cases occur just when the Veterans Affairs Department has been incurring budget shortage.

Yen, H. (2007). Repeated Deployments Called Serious Mental Health Risks. Deseret News (Salt Lake City): Deseret News Publishing Company

The Defense Department's Task Force on Mental Health said that repeated deployments of troops to Iraq and Afghanistan increased their risk of developing mental health problems. It reported that more than a third of these troops and veterans were already diagnosed with traumatic brain injury and post-traumatic stress disorder. With current shortages in money for health care and staffing and the escalating war in Iraq, these affected soldiers would tend to increase in number. It also said that the current system for psychological health care would not be able to meet the current and increasing needs.

The Task Force sought more money and a radical shift in the focus of treatment to prevention and screening from waiting for afflicted soldiers to voluntarily seek treatment. Soldiers were not too encouraged to come out on their own. They were subjected to ridicule or else their entire career would suffer if they admitted they had PTSD.

The Task Force found that 38% of soldiers and 31% of marines suffered from psychological problems, such as traumatic brain injury and post-traumatic stress disorder, after they returned from the fight. The incidence was much higher in the National Guard at 49%. Repeated deployments would raise the figure higher. Furthermore, the Task Force discovered from its visits at 38 military bases that most of these soldiers would not even seek the care and treatment they needed. Soldiers who have returned from battle did not have the provision. Mental-health programs have been limited to active-duty military personnel. Members of the family were excluded and forced to look for civilian health care providers, which were also few, inappropriate and small. The Government Accountability Office recently found that only 22% of returning troops from Iraq and Afghanistan, who showed symptoms of PTSD, were referred by Pentagon health care providers for mental health assessment.

Business Editors (2007). Therapy Battles War-Related Mental Health Conditions.. Business Wire: Gale Group

Families of soldiers returning from active duty have been struggling against the side effects of war at an alarming rate. They need not wait for their turn at military mental-health systems. They could consult with mental-health experts for their war-related mental-health conditions, such as PTSD. The National Center for PTSD initially estimated that 18% of those fighting in Iraq and 11% in Afghanistan would develop PTSD. Their families could help by recognizing and understanding the symptoms of the disorder. These are flashbacks or reliving traumatic events at war, nightmares, sleep disturbances, anger and irritability, fear and anxiety, shame or guilt, suicidal thoughts, great and deep sadness and grief, relationship problems, and extreme alcohol or drug use.

Psychotherapy can help the veterans. There are treatment programs, which can alleviate these symptoms. Marriage and family therapists can assess, diagnose and treat these sufferers.

Speckman, S. (2006). Program Aims to Help Vets "Reintegrate.." Deseret

News (Salt Lake City): Deseret News Publishing Company

Roughly a third of military troops returning home from battle in Iraq and Afghanistan were diagnosed with PTSD. Divorce rates have increased for this reason. These were the chief findings of a study conducted by the Utah Department of Human Services. A bill, HB 407, passed by legislators in Utah would help these soldiers "reintegrate" into civilian and family life on their return from battle. The bill would benefit primary returning reservists on duty for up to two years to tackle transitional issues involved in their return. The Utah Division of Veterans' Affairs wanted these soldiers and their families to know that there was help for them and that they were not alone in their problem or situation. The State's 161,000 veterans could gain information on benefits and services, such as family counseling, right from the internet. The bill attracted roughly $210,000 State contribution to fund the internet initiative and radio spots to cover counseling costs for the veterans.

Buncombe, a. (2005). Virtual Reality "War" Helps Treat Troops Traumatized by Combat. The (London) Independent: Independent Newspapers UK Limited

Buncombe writes about virtual reality video games and how they can help treat traumatized soldiers who return home from battle. The Pentagon spent $4 million for these games, which present combat situations in Iraq, to effect treatment. Military doctors use them to determine and measure the soldiers' reaction to the combat situation through their heartbeat, blood pressure, rate of breathing and skin temperature. The doctors could use the information in better diagnosing PTSD and coming up with better treatment.

Monitoring their reactions could enable the soldiers to acquire greater control over their own behavior in certain situations.

According to a published account at the New England Journal of Medicine, close to 17% of all soldiers returning from Iraq admitted to or reported some type of mental illness, which was combat-related. Broken marriages, car accidents, dissension and drug or alcohol abuse had risen along. The soldiers also reported about experiences and frustration in non-combat situation. The visual presentations are accompanied by sounds of American military helicopters, sniper fire and mortar rounds.

Kozaric-Kovacic, D and Boroveci, a (2005). Prevalence of Psychotic Co-Morbidity in Combat-Related Post-Traumatic Stress Disorder. Military Medicine: Association of Military Surgeons in the United States study of 680 men diagnosed with combat stress and PTSD as compared with 289 with combat experience and still in active military service. It found that 15% of war veterans had chronic PTSD and 45% had PTD with co-morbid conditions. About 17% of those with PTSD also had psychotic disorders. Approximately 17% of them had major depressive disorder. The study also revealed that 9% of those still in active military service developed psychiatric disorders. It concluded that many of them displayed psychotic symptoms other than flashbacks and dissociative symptoms. These symptoms are essential parts of PTSD.

Most of the war veterans investigated exhibited psychotic symptoms of either depressive or schizophrenia. O the PTSD patients, 9% also suffered from major depressive disorder with psychotic features, while 11% had psychotic disorders. Many of them showed psychotic symptoms other than flashbacks and dissociative symptoms. Psychotic symptoms are essential parts of PTSD and relates to the trauma.

Personality disorders were found to be critical in developing PTSD after combat trauma. Alcohol dependence was often found in these afflicted soldiers. it, thus, presented as a risk factor to developing alcohol dependence after combat trauma. PTSD soldiers without personality disorders, on the other hand, confronted the risk of developing co-morbid depressive disorder and psychotic symptoms. This study suggested that psychotic symptoms differ from flashbacks and symbolically and strongly connect to the trauma. The findings also underscored the existence of complex PTSD. This type covers symptoms, which include changes in affect regulation, consciousness, perception of self and the offender, relationships, and one's set of meanings.

Lapp, K. et al. (2005). Lifetime Sexual and Physical Victimization Among Male Veterans and Combat-Related Post-Traumatic Stress Disorder. Military Medicine: Association of Military Surgeons of the United States study conducted by the authors found that the majority or 96% of the cohorts of veteran men with combat-related Post-traumatic Stress Disorder experienced a form of sexual or physical victimization at some point of their lifetimes. The experiences were highest during childhood at 69%, adulthood at 93% and in recent periods, such as the past year. These were in the form of sexual assault, which was common in childhood at 41% and 20% in adulthood, and physical assault, which was common in all life phases. They experienced physical assault in childhood at 60%, 93% in adulthood, and 44% in the past year. The specific types of abuse in childhood were hitting, choking, intentional burning, threatening with weapons, and sexual violations. Evidence also suggested that combat veterans with PTSD were more likely than those without to display aggressive behavior. They would get involved in physical brawls related to PTSD symptoms they experienced. Patterns of victimization could play a role in perpetuating the cycle of abuse. Almost half of all the surveyed veteran men said they experienced some form of assault in the past year alone. A similar study, on the other hand, strongly correlated child physical or sexual abuse and recent victimization. Recent assault was seen as potentially entailing ongoing physical and emotional danger, which could affect the course and severity of combat-related PTSD.

Leider, C. (2004). Deployment Takes Toll in Troops, Kin. The (Colorado Springs) Gazette: ProQuest Information and Learning Company

The Pikes Peak Mental Health extended treatment to 5,000 returning soldiers and their families and noted an increase in their number. The solders exhibited minor depression, difficulty re-integrating into society and their usual day-to-day living and developing PTSD. Pikes Peak Mental Health maintains an 18-bed mental health unit. The management said that most inpatients are diagnosed with less severe conditions, such as minor depression.

Most soldiers need help to readjust to life at home. Most of them return to wives who have already become independent or unfaithful or a financial problem presents itself. Some people change and the soldier may just discover that he has become a stranger in his own home.

Eisen, S.A., et al. (2004). Lifetime and 12-Month Prevalence of Psychiatric Disorders 8.169 Male Vietnam War Era Veterans. Military Medicine: Association of Military Surgeons of the United States

Eisen discusses the findings of a study on the prevalence of psychiatric disorders among Vietnam War veterans conducted by the National institute of Mental Health Diagnostic on 8,169 respondents. They served in the military during the 1965-75 Vietnam War era. It found that roughly 72% of them had a lifetime history and a 12-month history of at least one psychiatric disorder. The disorders were alcohol abuse or dependence at 54% lifetime and 17% 12-month; smoking at 48% lifetime and 22% 12-month; and PTSD at 10% lifetime and 4.5% 12-month. The study concluded that psychiatric disorders were prevalent among more than 8 million Vietnam War era veterans. This conclusion would strengthen the call and challenge to prevent, identify and treat these illnesses among American veterans.

Gerlock, a.A. (2004). Domestic Violence and Post-Traumatic Stress Disorder for Participants of a Domestic Violence Rehabilitation Program. Military Medicine: Association of Military Surgeons of the United States

Gerlock describes the 62 male participants of a domestic violence program meant to keep them active within the program. Completers and non-completers were compared, based on the relationship established between PTSD and the severity of domestic violence. Forty-seven of them were veterans, 14 of them in active status. More than half of them or 55% were Caucasian, 29% were African-American, 6% Latino, 5% Asian-American, 3% Native American and 2% mixed races. Their age range was 20 to 62 years, with a median of 38.81 years. Completers were less than 35, gave higher self-ratings in relationship mutuality, less stress and post-traumatic stress and regularly court-monitored.

Non-completers tended to confront higher rates of repeated violence of up to a year more than completers. Those who commit domestic violence preferred to complete shorter programs. But shorter programs did not deal with the full range of abusive behaviors and thus were insufficient to impact these behaviors. Longer programs require them to travel for longer periods from work, hence approximately 2/3 of them dropped out from the programs.

In establishing the connection between PTSD from childhood and domestic violence in adulthood, the study correlated a child's witnessing domestic violence, PTSD and the severity and frequency of domestic violence in adult life. The strong concern of researchers behind this study was the relationship between the batterers' PTSD levels, the abuses they committed and their non-completion of the rehabilitation programs.

American Family Physician (2003). What You Should Know About Post-Traumatic Stress Disorder. American Academy of Family Physicians: Gale Group

The magazine says that PTSD can develop from a traumatic experience. It may be a severe car accident, a natural disaster, military combat or a crime, such as rape. Although not everyone develops it after a traumatic event, those who do could feel alone or guilty that they survived while others did not. The anxiety could last for months or years. PTSD can be detected by the doctor if the consulting patient has clear nightmares, flashbacks and bad memories. The patient would not stop thinking about the event or events and cause him fear and panic in each recall. He would also have an upset stomach or a headache during the recall. He would avoid thoughts, feelings, persons and places connecting or reminding him of the event. He may find it difficult sleeping or remaining asleep. He may be irritable and prone to anger or fail to pay attention or concentrate.

For treatment, doctors prescribe a medicine for depression or anxiety. The patient is instructed to sleep at certain hours consistently. Consulting with a mental health professional may also be advised. Therapy is usually hourly sessions held weekly or monthly. If the treatment is adequate and followed consistently, PTSD symptoms should disappear within a few months. But the treatment takes long. In the meantime, patients can cooperate with the treatment by taking their medicines at prescribed durations; sleeping at the same time each night at a dark and quiet place with a comfortable temperature; refraining from food two hours before sleeping; exercising regularly; and eating a balanced diet.

MacDonald, M (2003). Evaluation of Stress Debriefing Interventions with Military Populations. Military Medicine: Association of Military Surgeons of the United States

The author discusses formal interventions used to mitigate the psychological impact of traumatic experiences in members of the military. Two of such interventions developed and implemented were the Critical Incident Stress Debriefing and Process Debriefing.

A study conducted on British soldiers who fought at the Gulf War under the Army War Graves Service found that only 25% of them sought help for their symptoms. Soldiers often believed that their symptoms were an inevitable consequence and part of their work. They felt that being strong and "tough" meant not seeking psychological help. Avoiding reminders of their trauma meant avoiding the help needed by those who suffered from the trauma. Current informal peer debriefings conducted during pre-deployment training appeared to have limited effects. There could be better results if these were conducted by trained peers with the same experiences. The recipients of the debriefings might also feel more comfortable revealing very personal emotions with a colleague than with outsiders in formal debriefings.

The study contended that many soldiers preferred the opportunity to express personal feelings of anger and guilt and recognize that these would be a normal emotional response to trauma. A study on the effects of stress training and the two formal interventions mentioned earlier was conducted on "peace-keeping" troops, which fought in the Bosnian War. The research found that only 7.4% of the debriefed soldiers reported strong conflict and distress, compared with 25% in the non-debriefed group. The scores were viewed as low, considering the high level of trauma among the soldiers.

Exposure to trauma is a frank reality to military personnel, especially during combat and humanitarian missions. Current methods used excluded soldiers exposed to the trauma and would negate randomization. The control group would then be personally chosen and produce questionable results. It was, therefore, suggested that the debriefings be conducted after several incidents. Despite its popularity and appeal, Critical Incident Stress Debriefing or CISD has not demonstrated to reduce PTSD in military cases. Available data on its value has remained anecdotal and utilized only a few randomized control trials.

Begic, D. (2001). Aggressive Behavior in Combat Veterans with Post-traumatic Stress Disorder. Military Medicine: Association of Military Surgeons of the United States

Drazen's study on the violent behavior of 116 combat veterans revealed that aggression was a very frequent symptom among them. It was also the main reason for their seeking help. It was typically the victim of the war veteran's aggressive behavior who insisted on securing and starting treatment, often including psychiatric treatment. Quite often, the cause was PTSD. The types of aggression can be combined, with one type replacing another in the course of time. One type is auto-destructive behavior, such as suicide, and another is hetero-aggressive behavior, such as physical and verbal aggression. In 2/3 of the respondents, aggression appeared more than a year after exposure to traumatic experiences in war on the average. The aggression mostly lasted 10 months before the start of treatment. The frequency was greater in those belonging to lower socio-economic status, lower educational level, with previous maltreatment and earlier manifestations of aggressiveness. Aggressiveness in war veterans was recognized as a serious problem in the individual and for the health sector.

Turkington, Carol a. (1999) Post-traumatic Stress Disorder. Encyclopedia of Medicine: Gale Encyclopedia of Medicine. Retrieved on March 29, 2008 at http://www.findarticles.com/p/articles/mi_q2601/is_0011/ai_260100/100

Turkington writes that Post-traumatic Stress Disorder or PTSD is a debilitating condition affecting those exposed to a major traumatic event. It is characterized by upsetting memories or thoughts of the distress, a "blunting' of emotions, intense arousal, and at time, personality changes. It was also called "shell shock" or battle fatigue. But it is most well-known as the problem of war veterans returning from the battlefield. It is a response to the traumatic event, characterized by anxiety.

Nelson, Briana S. (1996) Understanding and Treating Post-traumatic Stress Disorder Symptoms in Female Partners of Veterans with PTSD. Journal of Marital and Family Therapy: American Association for Marriage and Family Therapy

Nelson reports that victims of traumatic events can be severely affected by PTSD but those close to him are also greatly influenced by his behavior changes, by adjustment problems and other symptoms of PTSD, experienced by the victim. The indirect influence of traumatic events on those close to the victim is referred to as secondary traumatization. Secondary traumatization can produce PTSD symptoms among these close persons, especially female partners. Problems associated with physical and emotional abuse, personal traumatic events, family-of-origin experiences and personal attributes. Female partners comprise a population, which has been disregarded in current studies on PTSD but deserves notice. Professionals are more and more becoming aware of the possible systemic effects of PTSD on these persons within the close range of war victims of war trauma. They too deserve appropriate treatment.

Statement of the Problem

Dire experiences in the battlefield create wounds and disturbing memories, which a returning war veteran brings back home with him. Many of these memories remain unresolved and recur as torments to the veteran. Studies show that symptoms of PTSD usually begin three months after the trauma. From their onset, these symptoms may present themselves for six months or longer. Some of these symptoms become chronic or remain untreated. In most cases of PTSD, the veteran relives and re-enacts the horror of their war experience in the form of domestic violence. This paper intends to draw evidence from previous studies on the relationship between PTSD and domestic violence.

Method and Research Instruments

This paper uses the descriptive and normative method of research in recording, describing, interpreting, analyzing and comparing the data gathered from four previous studies on PTSD and domestic violence. These previous studies utilized interviews of inpatients with severe mental illness, surveys and an analysis of violent behavior in 116 combat veterans..

Discussion and Conclusion

PTSD can grow out of a traumatic experience, such as military combat (American Family Physician 2003). Not every soldier develops it but when he does, he can feel quite alone or guilty about surviving while others did not. The experience can continue for months or years. A doctor can detect PTSD through a consulting patient's symptoms, such as nightmares, flashbacks and painful memories. The event is obsessive and produces fear and panic with each recall. The recall may also be accompanied by an upset stomach or a headache. He avoids thoughts, feelings, persons or places associated with the event. He finds sleep difficult. He is often angry, irritable and unable to pay attention or concentrate. PTSD is treated with medicines for depression or anxiety, consulting with a mental health professional and following doctor's instructions regarding taking medications. Treatment takes long but symptoms are expected to disappear when instructions are followed completely and consistently. These instructions include details on sleep, eating before sleep, exercise and a balanced diet (American Family Physician)..

Post-traumatic Stress Disorder is common among war veterans returning home from the battlefield and bringing these painful memories. Among the most troubling symptoms are flashbacks, often triggered by sounds, smells, feelings or images (Turkington 1999). Through these, the veteran relives the entire experience and completely loses touch with current reality. He goes through it again for minutes or even hours, believing that it is happening all over again. In addition to flashbacks, his "intrusive" symptoms can include sleep disorders, nightmares, and intense distress. "Avoidance" symptoms include avoiding the feeling, inability to remember the event, inability to experience the emotion and a sense of a shortened future. He also experiences increased arousal, sleeping problems, hyper-alertness, memory and concentration problems, moodiness, and - violence. Children with PTSD often develop learning disabilities and memory or attention problems. They become more dependent, anxious or self-abusive. Treatment deemed most helpful for PTSD consists of medication combined with supportive and cognitive-behavioral therapies. Medications can include anxiety-reducing medications and antidepressants, like fluoxetine. Sleep problems can be managed with anti-anxiety drugs, such as alprazolam, although their long-term use can develop adverse side effects, such as increased anger. Support and cognitive behavioral therapy will aim at reducing negative thought patterns and self-talk, change specific actions and thoughts through relaxation training and breathing techniques. Effectiveness of the treatment depends on the extent of the trauma and the person's personality and genetic make-up. Records show that sufferers who received appropriate medication, emotional support, and counseling achieved a significant level of improvement. However, prolonged exposure to severe, such as sexual abuse or other trauma, can leave permanent psychological scars (Turkington).

2004 study published in the England Journal of Medicine found that 15-17% of returning soldiers from Iraq were likely to develop PTSD (Elia 2007). Their number increased 70% within a year. The Veterans Administration acknowledged that there were almost 50,000 of such cases as against Washington's recognition of only 30,000 wounded soldiers in Iraq. Mental health was the second largest category of illness for these veterans and growing at a faster rate than the first largest category of orthopedic illnesses. This happened when the VA was encountering fund shortage (Elia).

A convincingly significant occurrence of aggression was observed among combat veterans with PTSD in comparison with those without PTSD (Begic 2001). Violent behavior has often been observed in war victims. Their educational level, low socio-economic status, maltreatment experience in childhood and previous types of violent behavior are factors to its development. Studies show that the lower the educational level or intelligence quotient, the greater the frequency of PTSD symptoms. Those who were exposed to previous mistreatment also tended to develop symptoms of PTSD, among them aggression or violence. It was often in the form of sexual or physical mistreatment in childhood. An investigation revealed that 26% of those with PTSD were previously subjected to mistreatment, as compared to only 10.8% without such previous mistreatment. The intensity of aggressive and other PTSD symptoms depends on the nature and extent of previous traumas. But violent behavior is the most frequent symptom of combat veterans with PTSD at almost 7 times more often than with veterans without PTSD. It is the most frequent reason for seeking help. Studies found that 37.1% of veterans consulted a psychiatrist for aggressive behavior on their own, by the police or upon the persuasion of a close person. In more than half of the studies veterans, violent behavior started more than a year after the veterans' return from war (Begic).

Other veterans entertained thoughts of suicide by an overdose of tablets, taking alcohol and pills, cutting their forearm veins or jumping from a high place (Begic 2001). The thought of suicide lodged in them for as long as a month to 8 months. The thought was often a result of a quarrel with their spouse, divorce, difficult economic situation, the suicide of someone they knew, and some other extreme difficulty. If he takes it out on others, he engages most frequently on hetero-aggression in the form of verbal, physical, sexual, traffic and aggression with the use of weapons. The aggression is either verbal or physical or both. Verbal aggression can be in the form of shouting or yelling, triggered during a conversation with known or unknown people. Physical aggression involves the use of physical force on living beings or objects, often under the influence of alcohol. Both types of aggression are repeatable. Among their consequences are light physical injuries, scratches, contusions, and hematomas. Certain issues accompany the physical aggression displayed by returning war veterans with PTSD. These are the legal regulations and sanctions for such a behavior; the frequent wish of the assailant to hide his act; and the victim does not report the incident promptly. The most frequent victims of these veterans' violence or aggression are the former or current spouse, a young child or an unknown person at 90% of those studied (Begic 2001). In most cases, the aggression was done repeatedly and aimed at the victim or victims of the first attack. The attack could be towards an animal or an object. Sexual aggression was another form. The veteran could display this form of aggression on his wife. He can be extremely demanding or promiscuous. Other forms of aggression were fast driving, disregarding traffic rules, signs and signals and driving under the influence of liquor (Begic).

A study was conducted on 62 male participants of a domestic violence program meant to keep them active within the program (Gerlock 2004). The purpose was to discover how PTSD related to the severity of domestic violence. The participants were mainly Caucasian, aged 20-62. Those who completed the program were younger than 35 with higher self-ratings of relationship mutuality, less stress and post-traumatic stress and were regularly court-monitored. The non-completers, on the other hand, had higher risks of repeated domestic violence than completers. Non-completers preferred shorter programs as longer ones required more travel time from their work. As a consequence, 2/3 of them dropped from the program. The study found that a child who witnessed domestic violence was more prone to PTSD and to severe and frequent domestic violence as an adult. The connection between higher PTSD levels, domestic abuses and their failure to complete the program was the chief concern of the study.

A female partner is a woman who is currently involved in a long-term ongoing adult relationship with a war veteran (Nelson 1996), particularly one with PTSD. The female partners of war veterans with PTSD who exhibit domestic violence may have different symptoms and circumstances, but there are also many, which they hold in common. They share common roles, which are caretaking, gender roles, survivor skills and psychological symptoms. The household of a typical violent or aggressive returning war veteran with PTSD is disorderly. The uncertainty prevailing among the members of that household triggers the veteran's PTSD symptoms. He is often convinced that he is helpless to these symptoms and their effects and the family members feel the blame for the flare-up. The four specific areas of interpersonal problems within the households, relating to PTSD, are coping with the veteran's PTSD symptoms, the female partner's unmet needs, violence, and emotional abuse. In a war, a veteran learns that expressing feelings other than hostility and aggression is a weakness and costs lives. He learns how to cope and survive combat through anger. This is why he uses it when he feels helpless and weak. This is why the frequency of expressions of hostility and physical aggression is greater in those experiencing PTSD than in those not experiencing it. This conclusion may explain the commonly hostile or angry emotional climate of many PTSD veterans' family systems (Nelson).