Aggressive Behavior Among Military Veterans in Substance Use Disorder Treatment: The Roles of Posttraumatic Stress and Impulsivity

• Predictors of aggressive behavior were examined among patients in SUD treatment.
• PTSD symptoms and impulsivity explained aggressive behavior at treatment entry.
• Impulsivity mediated the relation between trauma symptoms and aggressive behavior.
• Clinicians are encouraged to consider a standard assessment of impulsivity.
• Interventions that target impulsivity as a trans-diagnostic process may be appropriate.

This study examined posttraumatic stress disorder (PTSD) symptom severity and impulsivity as predictors of aggressive behavior among 133 male military veterans entering substance abuse treatment who endorsed difficulty controlling anger in the past year. At treatment intake, participants completed measures assessing PTSD symptom severity, impulsivity and aggressive behavior. Perpetration of aggressive behavior was reassessed 4 months later. Results from multivariate models indicated that PTSD symptom severity and impulsivity explained unique variance in aggressive behavior at intake but not follow-up. Mediation models indicated that the association between PTSD symptom severity and aggressive behavior was accounted for by impulsivity. The identification of impulsivity as a key mediator between trauma symptoms and aggressive behavior has significant clinical and research implications. Based on these findings, clinicians are encouraged to consider a standard assessment of impulsivity and the selection of interventions that target impulsivity as a trans-diagnostic process among at-risk client populations.