The Spring/Summer 2008 issue of the American Psychological Associations' Section VII newsletter contains an interesting article on the "postdeployment homicide" statistics of combat veterans, that basically follows up on the study published in the New York Times in January of 2008, which we blogged about, here, while expanding on it and doing additional research. The findings are quite worth reading.
(The study's authors are Kyle Burchett, David Ferreira and Glenn Sullivan, all from the Virginia Military Institute.)
They write:
A relationship between criminal behavior and Posttraumatic Stress Disorder in combat veterans has been hypothesized almost since the inclusion of PTSD in DSM-III (e.g. Wilson & Zigelbaum, 1983). Some researchers (e.g. Chemtob, Novaco, Hamada, Gross, & Smith, 1997) have posited that combat veterans may be more prone to entering a cognitive, behavioral, and physiological “survival mode” when confronted with threats in civilian environments, and may be more likely to respond to perceived threats with overwhelming aggression. Multiple studies, beginning with the National Vietnam Veterans Readjustment Study (NVVRS; Kulka et al., 1990), have shown dramatically higher rates of violence among combat veterans with PTSD compared to combat veterans without PTSD. Beckham and colleagues (Beckham, Feldman, Kirby, Hertzberg, & Moore, 1997), for example, found rates of 22 violent acts in the past year for help-seeking combat veterans with PTSD, versus 0.2 violent acts for combat veterans without PTSD. One implication of the extant research is that combat exposure
In January 2008 the New York Times published a list of 121 U.S. veterans who had been charged with homicide after returning from deployments in Iraq or Afghanistan (Sontag & Alvarez, 2008). This list, and the series of articles that followed it, provoked strong reactions from some veterans’ advocates. Many expressed concern that the nation’s most recent veterans were being portrayed as “ticking time bombs” who pose a risk to civilian society. The authors of the present article examined the 121 homicide cases presented in the Times’ study from a clinical perspective, with the intent of clarifying the association between combat exposure and postdeployment violence in the dataset.
In addition to the information on each case available on the Times’ website, we gathered corroborative data from independent media outlets -- most commonly online versions of newspapers serving the localities where the crimes had occurred. In more than 80% of the cases, we gathered significantly more information about the perpetrator than was available in the original Times article. In fewer than 10% of the cases, we were unable to find any additional information about the case and relied solely on the account provided by the Times.
All but one of the 121 offenders were male (99.2%). The majority of the offenders (53.7%) were between 18 and 24 years old, and 85% were under age 30. Of the cases in which race/ethnicity was known, Caucasians represented the majority (54.4%), followed by Hispanics (23.5%) and African-Americans (22.1%). The most represented service branches were Army (62.8%) and Marine Corps (30.6%). Over 90% of the charged offenders had served in Iraq, and 10.7% had served in Afghanistan; two of the 121 has served in both countries. Eleven offenders (9.1%) had deployed overseas twice during the current hostilities and five (4.1%) had deployed three times.
The homicide victims included strangers (35.2%), friends/acquaintances (23.0%), spouses/girlfriends (18.8%), children (8.3%), and Other/Unknown (14.7%). As in the general population, handguns were the most frequently employed murder weapon. The most common criminal charge was first-degree (i.e. willful and premeditated) murder (55.7%). At the time of this study (April 2008), nearly 30% of the cases were still pending (i.e. th veterans had been charged but not convicted). Seven of the veterans on the Times’ list (5.8%) had been acquitted of the homicide charges against them. None of the veterans received a Not Guilty by Reason of Insanity acquittal, although considerations related to combat-exposure and self-defense appear to have influenced prosecutors in at least one case (e.g. Matthew Sepi). More than one-fifth of the cases (20.5%) involved vehicular manslaughter or homicide. All but one of these vehicular cases were primarily substance-related – the prototypical homicide victim in these cases was the passenger in a vehicle driven by an intoxicated veteran.
We reviewed the compiled case material for evidence of combat exposure. In the vast majority of cases (92%), some evidence of combat exposure was provided in media accounts of the criminal proceedings. In 40% of the cases, combat exposure appeared certain: news reports included details regarding combat decorations, injuries sustained by the accused in battle, or testimony by commanding officers or multiple fellow unit members regarding IEDs, mortar attacks, clearing buildings, etc. In an additional 52% of the cases, combat exposure appeared probable: friends or family members of the accused veteran referred to combat exposure, the veteran’s unit was known to have engaged in combat during the veteran’s deployment, the area in which the veteran operated (e.g. Fallujah) was known for intense combat, etc.
We also evaluated the case files for evidence of psychiatric symptoms. Due to the nature of our data, we could not achieve anything resembling a formal diagnosis, but we reliably detected significant psychiatric symptoms related to PTSD, Antisocial Personality Disorder, Substance Abuse, or psychosis in 114 of the 121 cases (94.2%). Only four (3.5%) of the veterans demonstrated psychotic symptoms.
Significant symptoms related to PTSD were reported in 85 of the 121 cases we examined (70.2%). Family members, friends, judges, defense attorneys (and even prosecutors) referred to veterans’ nightmares, insomnia, intrusive thoughts, survivor guilt, hyperarousal, hypervigiliance, intense anger, depressed mood, and suicidal ideation. In general, we searched for evidence that the veteran had returned from combat somehow “changed” or disturbed. Approximately 34% of the veterans in this sample demonstrated PTSD symptoms only, an additional 19% exhibited PTSD and comorbid Substance Abuse, and almost 17% appeared to display symptoms of both PTSD and Antisocial Personality Disorder.
We identified 39 cases that appeared to involve significant symptoms associated with Antisocial Perrsonality Disorder (ASPD; 32.2%). Evidence for ASPD included committing violence for material gain (e.g. killing a spouse for the insurance money), killing during the commission of a felony (e.g. shooting a gas station attendant during the course of a robbery), evidence of substantial criminal activity prior to the instant offense, callous disregard for others, lack of remorse, etc. In general, we searched for evidence of pre-deployment antisocial behavior or instrumental (versus expressive) aggression. Almost 17% of the veterans in this sample (n=19) demonstrated ASPD symptoms only, an equal number exhibited comorbid ASPD and PTSD, and one displayed comorbid ASPD and Substance Abuse.
Finally, each judge rated the strength of the association between the violent act reported in each case and the combat experiences of the accused veteran. We used a seven-point scale in which “1” indicated no relationship and “7” indicated the strongest possible linkage (i.e. the crime would not have been committed “but for” the combat exposure). The mean rating for the entire sample was 5.2 (standard deviation = 1.9). Over 50% of the sample was rated “6” or higher and less than 5% received ratings of “0.” This approach requires further validation but a similar procedure may prove useful in assessing public attitudes toward hypothetical criminal cases in which combat-related PTSD is presented as a mitigating factor.
The prevalence of PTSD symptoms in this sample of combat veterans charged with homicide (70.2%) is much greater than has been found in other samples of returning veterans. This finding appears to be consistent with prior research that suggests that PTSD mediates the frequency and severity of violent behavior among combat veterans. However, it is also extremely important to note that a substantial minority of veterans in this sample (n=20; 16.5%) exhibited no symptoms of PTSD and appeared rather to demonstrate behaviors associated with habitual criminality. Criminal cases involving recent veterans, like those of Vietnam veterans before them, are likely to be marked by either legitimate claims of diminished culpability or cynical attempts to malinger the effects of trauma.
Social support is a strong protective factor against PTSD. To date, the over 1.4 million American soldiers that have been deployed to Iraq or Afghanistan have received generally positive reactions to their homecoming.
Unfortunately, this public support is not guaranteed and might be negatively affected by misinterpretation of news reports regarding violent combat veterans. Should public support for veterans deteriorate for any reason, an already immense public health problem could become even less manageable. It would be terrible for the public to conclude erroneously that returning veterans are inherently dangerous. This is why the Veterans of Foreign Wars and other veterans’ advocacy groups have taken pains to point out that the murders in the Times’ dataset yield an estimated 8.6/100,000 homicide rate in the veteran population, which they contrast to the 29.3/100,000 rate among American men aged 18 to 24.
References
Beckham, J.C., Feldman, M.E., Kirby, A.C., Hertzberg, M.A., & Moore, S.D. (1997). Interpersonal violence and its correlates in Vietnam veterans with chronic Posttraumatic Stress Disorder.
Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Cognitive-behavioral treatment for severe anger in post-traumatic stress disorder. Journal of Consulting and Clinical Psychology, 62, 827-832.
Kulka, R. A., Schlenger, W. E., Fairbank, J. A., Hough, R. L., Jordan, B. K., Marmar, C. R., et al. (1990). Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.
Sontag, D., & Alvarez, L. (2008). Across America, deadly echoes of foreign battles. Retrieved January 15, 2008, from http://www.nytimes.com/2008/01/13/us/13vets.html
Wilson, J.P., & Zigelbaum, S.D. (1983). The Vietnam veteran on trial: The relation of Post-Traumatic Stresss Disorder to criminal behavior. Behavioral Sciences and the Law, 1(3), 69-83.
Editor's note: Thanks to psychology graduate student, Melanie Goodman, for pointing out this article!
