Personality Assessment Inventory internalizing and externalizing structure in veterans with posttraumatic stress disorder: Associations with aggression

Abstract

Posttraumatic stress disorder (PTSD) is associated with aggressive behavior in veterans, and difficulty controlling aggressive urges has been identified as a primary postdeployment readjustment concern. Yet only a fraction of veterans with PTSD commit violent acts. The goals of this study were to (1) examine the higher-order factor structure of Personality Assessment Inventory (PAI) scales in a sample of U.S. military veterans seeking treatment for PTSD; and (2) to evaluate the incremental validity of higher-order latent factors of the PAI over PTSD symptom severity in modeling aggression. The study sample included male U.S. Vietnam (n = 433) and Iraq/Afghanistan (n = 165) veterans who were seeking treatment for PTSD at an outpatient Veterans Affairs (VA) clinic. Measures included the Clinician Administered PTSD Scale, the PAI, and the Conflict Tactics Scale. The sample was randomly split into two equal subsamples (n's = 299) to allow for cross-validation of statistically derived factors. Parallel analysis, variable clustering analysis, and confirmatory factor analyses were used to evaluate the factor structure, and regression was used to examine the association of factor scores with self-reports of aggression over the past year. Three factors were identified: internalizing, externalizing, and substance abuse. Externalizing explained unique variance in aggression beyond PTSD symptom severity and demographic factors, while internalizing and substance abuse did not. Service era was unrelated to reports of aggression. The constructs of internalizing versus externalizing dimensions of PTSD may have utility in identifying characteristics of combat veterans in the greatest need of treatment to help manage aggressive urges.

The Utility of the Personality Assessment Inventory in the Assessment of Posttraumatic Stress Disorder in OEF/OIF/OND Veterans

“…Convergent and discriminant validity has been established with various psychometric instruments relating to constructs assessed by all the scales (Morey, 1996). Subsequent research has confirmed good internal consistency in samples of veterans with PTSD (Van Voorhees et al, 2014), extratest validity in inpatient substance abuse settings (Hopwood, Baker, & Morey, 2008), convergent validity in a federal inmate sample (Patry & Magaletta, 2014), and reliability and consistent factor structure in a neuropsychological sample (Busse, Whiteside, Waters, Hellings, & Ji, 2014). The internal consistency in the present sample ranged from moderate to strong for all scales (α = .69 to α = .95).…”

“…As in other veteran samples, the full AGG scale T score for the PTSD group was in the moderate-high range (≥ 65T). Calhoun et al, 2010;Crawford, Calhoun, Braxton, & Beckham, 2007;Mozley et al, 2005;Van Voorhees et al, 2014), whereas civilian samples have consistently shown mean scores below 60T for PTSD groups. This differential elevation in the AGG scale between veteran and nonveteran samples suggests that this PAI scale may have clinical utility in detecting concomitant difficulties with aggression among individuals with PTSD, which is important in light of research indicating that anger and aggression are frequent problems experienced by veterans with PTSD (Calhoun et al, 2002).…”

“…Calhoun et al (2010) examined a sample of veterans of Vietnam, Korea, World War II, Iraq, and Afghanistan, and Van Voorhees et al (2014) examined a sample of veterans of Vietnam, Iraq, and Afghanistan. Both these studies found clinically significant elevations on the SOM, ANX, ARD, DEP, and SCZ scales.…”

Nonsuicidal self-injury and interpersonal violence in U.S. veterans seeking help for posttraumatic stress disorder

“…Additionally, a total measure of the count of violent acts (i.e., minor and severe violence) committed in the past year was scored by assigning the mid-points of the latter four response categories and summing the items (Straus, 1979). Following previous research using the CTS with veterans (Crawford et al, 2007; Jordan et al, 1992; Van Voorhees et al, 2014), high violence was defined as 13 or more violent acts in the past year. Internal consistency of these scoring methods is adequate [alpha .79-.83; (Straus, 1979, 1990)].…”

Understanding the molecular mechanisms of aggression in BALB/c and TPH2-deficient mice

“…We found significant correlations between number of attacks in the resident-intruder test and relative gene expression of TNF (p=0.0065, r=0.478), IL-1β (p=0.0003, r=0.608), GSK-3β (p<0.0001, r=0.692), IL6 (p=0.0059, r=0.483) and number of Ki67-positive cells (p=0.047, r=-0.327, Fig.9.A-E). neurodegenerative (Levenson et al, 2014) conditions, as well as depression (Knox et al, 2000) and stress-related disorders (Van Voorhees et al,2014). Aggressive behaviour during major depression is associated with an enhanced risk of suicide (Gvion & Apter, 2011).…”