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Publication Briefs

PTSD Symptom Severity Predicts Aggression after Treatment

There is consistent cross-sectional evidence that PTSD symptoms are associated with aggression, but there is little information on whether the association between aggression and PTSD severity is maintained after completing treatment. This study examined whether PTSD symptoms after treatment are related to aggression at post-treatment and 4-month follow-up in a sample of patients completing residential PTSD treatment. Investigators identified 175 male Veterans who were admitted to a VA residential PTSD treatment program between 2000 and 2007; 74 Veterans from this group also completed study measures at 4-month follow-up. Veterans admitted to this treatment program had a diagnosis of PTSD with severe symptoms; exclusion criteria included current psychotic symptoms, substance use within 15 days of treatment, and medical conditions that might interfere with or prevent psychological treatment (e.g., inability to move independently). For this study, investigators measured: demographics, PTSD severity, and aggression at pre-treatment, post-treatment, and 4-month follow-up. They also examined whether PTSD symptom cluster (e.g., re-experiencing symptoms, avoidance/numbing symptoms, hyper-arousal) severity differentially influenced aggression at post-treatment and 4-month follow-up.


  • Post-treatment PTSD severity predicted aggression at the end of treatment and 4 months after treatment. Patients who experienced greater PTSD symptom severity at the end of treatment were more likely to be aggressive after treatment completion, regardless of their aggression history before treatment.
  • Results suggest that severity of each PTSD symptom cluster is associated with aggression four months after treatment completion.
  • Post-treatment PTSD severity accounted for an additional 14% of the variance in 4-month follow-up aggression, whereas hyper-arousal symptom severity accounted for an additional 17% of the variance in 4-month follow-up aggression. Of the PTSD symptom clusters, hyper-arousal had the largest correlation with concurrent aggression before and after treatment.
  • The authors suggest that this research could inform the development of aggression prevention and intervention efforts, as well as the development of clinical recommendations for post-treatment safety for patients with PTSD.


  • This sample consisted of approximately half the patient population treated in this PTSD treatment program during this time period, and follow-up data were available only for a subset of patients.
  • The aggression measure was brief and did not provide rich information regarding the nature of the interpersonal aggression — nor the relationship between the perpetrator and victim.

This project was supported by VA's Office of Academic Affiliations and HSR&D (RCS 00-001, IIR 07-264), as well as by a CSR&D Career Development Award to Dr. Bonn-Miller. Drs. Bonn-Miller and Timko are part of HSR&D's Center for Health Care Evaluation, Palo Alto, CA.

PubMed Logo Makin-Byrd K, Bonn-Miller M, Drescher K, and Timko C. Post-Traumatic Stress Disorder Symptom Severity Predicts Aggression after Treatment. Journal of Anxiety Disorders March 2012;26(2):337-342.

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