Preliminary Investigation of the Roles of Military Background and Posttraumatic Stress Symptoms in Frequency and Recidivism of Intimate Partner Violence Perpetration Among Court-Referred Men

Abstract

Significant rates of intimate partner violence (IPV) perpetration have been identified among men with military backgrounds. Research indicates posttraumatic stress symptoms place military men at increased risk for IPV perpetration, but may be negatively associated with IPV among nonmilitary samples. However, no previous studies have directly compared court-referred IPV offenders with and without military experience, which may have clinical implications if posttraumatic stress symptoms are differentially associated with IPV perpetration across these two samples. Twenty court-referred IPV offenders with military background were demographically matched with 40 court-referred IPV offenders without military background. As anticipated, self- and partner-report of physically assaultive acts and injurious acts during baseline assessment showed significantly greater physical assault and injury perpetrated by offenders with military background. However, 1-year follow-up data on convictions indicated a significantly lower rate of recidivism among offenders with military background than among nonmilitary offenders. As hypothesized, symptoms of posttraumatic stress at intake showed a significant positive correlation with IPV perpetration among offenders with military background; however, this relationship showed a negative correlation among offenders without military background. Clinical implications are discussed including treatment avenues, such as Veterans Courts and other incarceration diversion programs, which may be particularly appropriate for offenders with military backgrounds.

Keywords

military veteran intimate partner violence perpetration recidivism posttraumatic stress

Intimate partner violence (IPV) perpetration is a serious social problem among men with military background, including veterans and active duty service members, with overall prevalence rates ranging from 13.5% to 58% (Marshall, Panuzio, & Taft, 2005). Although research suggests that rates of IPV perpetration are higher among military samples than those found in the general population (Heyman & Neidig, 1999; Jones, 2012; Rentz et al., 2006), only three previous studies have directly compared the occurrence of IPV perpetration in military and civilian couples (Cronin, 1995; Griffin & Morgan, 1988; Heyman & Neidig, 1999). First, Griffin and Morgan (1988) surveyed treatment-seeking couples in military and civilian treatment clinics in the same community, finding higher rates of IPV perpetration among military couples compared with civilian couples. Cronin (1995) interviewed dependent children of military families and civilian federal employees stationed in Europe, finding a significantly higher rate of reported parental violence among military families than civilian families. Finally, Heyman and Neidig (1999) compared epidemiological samples of military and civilian couples, finding greater rates of moderate and severe violence among military couples than among civilian couples.

IPV Perpetration and Posttraumatic Stress Symptoms

One possible explanation for the higher rates of IPV perpetration found among military samples is that higher rates of mental health problems place them at risk for IPV perpetration. In fact, the prevalence of IPV perpetration rises drastically among male veterans seeking mental health treatment (Teten et al., 2010; Teten, Sherman, & Han, 2009). Specifically, veterans have higher rates of posttraumatic stress disorder than the general population (Jordan et al., 1992; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), which is a risk factor for IPV perpetration among veterans (Sherman, Sautter, Jackson, Lyons, & Han, 2006; Taft, Schumm, Marshall, Panuzio, & Holtzworth-Monroe, 2008; Teten et al., 2010). In fact, posttraumatic stress symptoms have been shown to partially explain the link between trauma exposure and IPV perpetration among military members (Taft et al., 2008). Given the positive association between IPV perpetration and posttraumatic stress symptoms among veterans, coupled with higher rates of posttraumatic stress symptoms in this demographic, IPV perpetration may be a particularly problematic issue. Evidence shows that veterans with posttraumatic stress disorder perpetrate IPV at rates 2 to 3 times the national average (Byrne & Riggs, 1996; Jordan et al., 1992; Sherman et al., 2006; Taft et al., 2005) suggesting that addressing posttraumatic stress symptoms may be important in the treatment of IPV perpetration, particularly among veterans.

Veterans who commit IPV may be similar to IPV offenders in the general public who have higher rates of trauma exposure, such as witnessing violence (Henning, Jones, & Holdford, 2003). For example, intimately violent men report more traumatic childhood experiences than nonviolent men, and exposure to childhood trauma is a significant predictor for the perpetration of IPV in adulthood (Delsol & Margolin, 2004). Although many studies have evaluated the role of posttraumatic stress and IPV perpetration among military samples, most studies investigating this role among general IPV offenders focus solely on trauma exposure, with few studies evaluating the influence of posttraumatic stress symptoms on IPV perpetration (Delsol & Margolin, 2004; Hotaling & Sugarman, 1986). Of those that have, the data indicate that while posttraumatic stress symptoms place military members at risk for IPV perpetration, nonmilitary offenders with significant posttraumatic stress symptoms commit less IPV than court-referred men without significant posttraumatic stress symptoms (e.g., Hoyt, Wray, Wiggins, Gerstle, & Maclean, 2012; Tweed & Dutton, 1998). For example, Tweed and Dutton (1998) found that men they termed as instrumental batterers used violence more often and were elevated on measures of narcissism and antisocial features. In contrast, “impulsive batterers” engaged in moderate, more reactive violence and were elevated on measures of posttraumatic stress. One recent study further examining the differential role of trauma exposure and posttraumatic stress symptoms among court-referred offenders found that while trauma exposure rates are high among IPV offenders, partner violent men with clinical symptoms of posttraumatic stress reported lower levels of perpetrated physical assault and injury on the Conflict Tactics Scale–Revised (CTS-2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) than both IPV offenders with a trauma history but subclinical symptoms of posttraumatic stress and those without a trauma history (Hoyt et al., 2012). These findings suggest that while there are substantial rates of trauma among general IPV offenders, posttraumatic stress symptoms may be negatively associated with IPV perpetration among men who have not served in the military.

Understanding the factors, like posttraumatic stress, that contribute to IPV perpetration among culturally distinct groups is important, especially because evidence suggests that posttraumatic stress symptoms may be differentially associated with IPV perpetration across military and nonmilitary samples. A better understanding of the relationship of these factors is critical, as recipients of most therapeutic interventions fare no better than those who simply receive arrest, probation, or community service, with an average 33% recidivism rate within 6 months (Babcock, Green, & Robie, 2004; Stover, Meadows, & Kaufman, 2009). Likewise, among a military sample of Navy couples identified for male-perpetrated IPV, a randomized control trial of several interventions showed that treatment had little impact on reducing IPV perpetration (Dunford, 2000). One proposed explanation for these modest outcomes is that existing treatments for IPV offenders tend to be “one-size-fits-all,” conceptualize all IPV offenders as a homogeneous group, and inadequately treat important co-occurring mental health problems (Kelly & Johnson, 2008). Although addressing mental health problems in the rehabilitation of IPV offenders remains controversial (Hamberger, 2008), clinicians and courts alike are eager to find approaches to differentiate offenders, guide treatment and justice decisions, and ultimately improve intervention efficacy (Ver Steegh & Dalton, 2008). This is particularly important among court-referred populations, who show greater offense, violence, and recidivism rates than the general populace (see Gerstle et al., 2010).

The Current Study

While previous studies have shown higher rates of IPV perpetration among military samples compared with civilian samples, none have specifically examined a court-referred sample of IPV offenders (Cronin, 1995; Griffin & Morgan, 1988; Heyman & Neidig, 1999). This previous literature indicates that military men in general may be at greater risk for committing IPV. However, higher rates of IPV perpetration among military samples may not be maintained in a justice-involved sample. Moreover, the relationship of posttraumatic stress symptoms with IPV perpetration among military and nonmilitary members warrants additional attention. The current work expands on previous studies by conducting a brief, preliminary investigation of IPV, posttraumatic stress symptoms, and military status among men involved in a court-referred intervention program for families experiencing IPV.

Using self-reported IPV perpetration, partner-reported IPV perpetration, and public court records of 1-year recidivism (IPV-related convictions), this study compared military and demographically matched, nonmilitary men mandated for IPV offense intervention on IPV perpetration frequency and posttraumatic stress symptoms. We had four specific hypotheses in the current study. First, based on Heyman and Neidig’s (1999) research, we anticipated that reported IPV perpetration frequency would be higher among men with military background than among men without military background. Second, we anticipated that rates of recidivism would be higher among men with military background than among men without military background (based on Jones, 2012). Third, it was anticipated that, although rates of trauma exposure would be equivalent for military and nonmilitary men (e.g., Delsol & Margolin, 2004), military veterans would endorse greater symptoms of posttraumatic stress than men without military background (e.g., Jordan et al., 1992). Fourth, consistent with the above cited literature (Hoyt et al., 2012; Tweed & Dutton, 1998), we anticipated that posttraumatic stress symptoms would be positively associated with IPV perpetration frequency among military samples but negatively associated with IPV perpetration among nonmilitary samples.

Method

Participants

Participants were 20 men court-referred to an assessment and intervention program who reported having served in any branch of the military during their baseline assessment for the program, as well as 40 demographically matched control participants from the same program who reported they did not serve in the military (Hoyt et al., 2012). All participants were identified as having perpetrated at least one physical assault or one injurious behavior against their partner. Demographic matching was completed using a Microsoft Excel macro that matched each participant in the military group with two controls from the treatment program database with the closest age and same ethnic background. As detailed in Table 1, there were no group differences in age, ethnicity, education, or marital status. No data regarding service era, military branch, or participation in combat or peacekeeping deployments were available.

Table 1.

Demographic Data.

Variable	Military	Nonmilitary	t / χ²
Age, M (SD)	35.5 (6.5)	34.7 (6.4)	.46
Education, M (SD)	13.2 (1.2)	13.2 (1.8)	.01
Race/ethnicity (%)			0.0
Hispanic	75	75
White	10	10
Asian/Pacific	5	5
Black	5	5
Native American	5	5
Marital status			2.6
Never married	10	27.5
Married	15	15
Separated	30	20
Divorced	45	37.5
Trauma exposure (%)
Unexpected death of loved one	35	27.5
Loved one surviving illness/injury	15	2.5
Life-threatening illness	10	2.5
Motor vehicle accident	5	7.5
Physical assault	5	5
Accident involving injury or death	5	5
Threatened with death or assault	0	7.5
Natural disaster	0	5
Physical abuse by partner	0	5
Sexual abuse during childhood	0	5
Other events	5	10
No reported trauma history	20	17.5

Note. Military group n = 20; nonmilitary group n = 40. Participants in both groups were demographically matched to ensure similar age and ethnic breakdown.

Procedure

The current project is a secondary analysis of data collected in an intervention study of a court-referred program for families experiencing IPV (see Gerstle et al., 2010; Wray, Hoyt, & Gerstle, 2013). Participants completed the listed measures as part of an intake assessment, which aimed to determine individualized treatment recommendations. Baseline measures were administered by students in a psychology doctoral program. Measures of convictions (baseline and annual follow-up) were collected by research assistants overseen by the second author. The Institutional Review Board at the University of New Mexico approved for research the use of intake, exit interview, and recidivism data from this program. Program acceptance, enrollment, and completion status did not significantly differ between military and nonmilitary groups, χ²(3, N = 60) = 7.43, ns.

Measures

IPV

IPV committed within the past year was assessed using the CTS-2 (Straus et al., 1996), a 39-item, Likert-type measure that assesses the past-year frequency of violent acts. Similar to previous typology work (e.g., Huss & Ralston, 2008), two of the five subscales (i.e., Physical Assault and Injury to differentiate severity) were used to determine frequency of IPV perpetration based on self- and partner report. Coefficient alpha for the CTS-2 was .81 for self-report and .88 for partner report.

Conviction data

Conviction data for IPV-related convictions (i.e., assault or battery against a household member, violation of an order of protection, false imprisonment, prevention or obstruction of sending a message, and trespassing) were collected from public court records for all participants for a period of 1 year following the last day each participant received services from the program. These data were aggregated to create a recidivism rate for each group.

Trauma exposure

Exposure to potentially traumatic life events was assessed using the Traumatic Life Events Questionnaire (TLEQ; Kubany, Haynes, et al., 2000). The TLEQ is a 23-item self-report measure of exposure to potentially traumatic events (e.g., natural disasters, assault, combat). Each occurrence is rated on a scale from “never” to “more than 5 times.” The TLEQ is widely used and has good test–retest reliability, as well as convergent and discriminant validity (Orsillo, 2001). Coefficient alpha for the TLEQ in the current sample was .86.

Posttraumatic stress symptoms

General levels of posttraumatic stress symptomatology were assessed using the Posttraumatic Stress Diagnostic Scale (PSDS; Kubany, Leisen, Kaplan, & Kelly, 2000), a 38-item self-report measure that assesses DSM-IV symptom criteria for posttraumatic stress disorder. Items are rated on a 5-point scale ranging from 0 (absent) to 4 (present to an extreme degree). The PSDS is widely used and has high internal consistency, test–retest reliability, as well as convergent and discriminant validity (Orsillo, 2001). As the current sample had a mixed trauma history, the established cutoff score of 18 for general samples was used to indicate clinically significant symptoms of posttraumatic stress (Kubany, Leisen et al., 2000; Orsillo, 2001). Coefficient alpha for the PSDS in the current sample was .90.

Data Analytic Strategy

Group means on measures of trauma exposure, posttraumatic stress symptoms, and IPV perpetration frequency for both groups were compared using independent samples t tests. Correlations among scores on the CTS-2, TLEQ, and PSDS were compared between groups using a z-test on Fisher’s Z-transformed values (Rosenthal & Rosnow, 1991; Table 2). One-year recidivism rates for each group were compared using a z-test for independent group proportions (Rosenthal & Rosnow, 1991). All calculations were conducted using Microsoft Excel 2010.

Table 2.

Correlations Between Measures.

Variable	1	2	3	4	5	6
1. CTS-PA	—	.32	−.04	−.05	.69^**,a	.40^*,a
2. CTS-INJ	.27	—	.06	.05	.38*	.19
3. PR-PA	.27	.17	—	.85**	.21	.38^*,a
4. PR-INJ	.09	−.03	.74**	—	.19	.19
5. TLEQ	.08^a	.02	−.04	−.14	—	.56**
6. PSDS	−.35^*,a	−.22	−.35^*,a	−.11	.72**	—

Note. CTS-PA = physical assault perpetration reported by the offender on the Conflict Tactics Scale–2; CTS-INJ = injury perpetration reported by the offender on the Conflict Tactics Scale–2; PR-PA = partner report of offenders’ perpetrated physical assault on the Conflict Tactics Scale–2; PR-INJ = partner report of offenders’ perpetrated injury on the Conflict Tactics Scale–2; TLEQ = Traumatic Life Events Questionnaire; PSDS = Posttraumatic Stress Diagnostic Survey.

Indicates significant z-test difference between military and nonmilitary groups. Correlations above the diagonal represent the military group; correlations below the diagonal represent the nonmilitary group.

p < .05. **p < .01.

Results

Intimate Partner Violence Perpetration

Participant report of perpetrated physical assault on the CTS-2 at baseline was significantly greater in the military group than the nonmilitary group (see Table 3). Partner report of the participants’ perpetrated physical assault and injury on the CTS-2 was significantly different between groups, with partners in the military group reporting receiving significantly greater physical assault and injury than partners in the nonmilitary groups (Table 3). This finding was consistent with Hypothesis 1. However, contrary to Hypotheses 2, when examining rates of recidivism, a significantly higher rate of recidivism was identified for the nonmilitary group than the military group (Table 3).

Table 3.

Comparison of Military and Nonmilitary Groups.

		Military	Nonmilitary
Report source	Variable	M (SD)	M (SD)	t / z	d’
Offender	Posttraumatic stress PSDS	20.1 (13.1)	9.3 (5.8)	3.4**	1.1
	Trauma exposure TLEQ	15.4 (9.4)	13.5 (7.8)	0.70	0.22
	PA perpetration CTS	10.2 (22.6)	2.3 (3.4)	2.2*	0.49
	Injury perpetration CTS	1.4 (3.6)	1.0 (4.0)	0.35	0.10
Partner	PA received CTS	39.1 (54.1)	17.1 (23.6)	2.2*	0.53
	Injury received CTS	11.2 (20.2)	4.1 (5.9)	2.1*	0.47
Public records	IPV recidivism (%)	5.0	27.5	−2.1*	—

Note. PSDS = Posttraumatic Stress Diagnostic Scale; TLEQ = Traumatic Life Events Questionnaire; PA = physical assault; CTS-2 = Conflict Tactics Scale–2; IPV = intimate partner violence.

p < .05. **p < .01.

Trauma Exposure and Posttraumatic Stress Symptoms

Based on report of the TLEQ, 82.5% (n = 33) of the nonmilitary group and 80% (n = 16) of the military group reported significant trauma exposure. No significant differences were detected between military and nonmilitary groups for overall trauma exposure scores (Table 3). No participants in the military group indicated combat exposure was their most significant traumatic life stressor. Based on the cutoff score of 18 (Kubany, Leisen, et al., 2000), 20% (n = 8) of the nonmilitary group and 35% (n = 7) of the military group scored in the clinical range on the PSDS. Consistent with Hypothesis 3, comparison of posttraumatic stress symptom scores between the military and nonmilitary groups showed a significant difference, with the military group reporting greater posttraumatic stress symptoms than the nonmilitary group (Table 3).

Trauma exposure, based on TLEQ scores, showed a significant positive correlation with IPV perpetration reported on the CTS-2 by the offender among the military group; however, there was no significant correlation between CTS-2 and trauma exposure among the nonmilitary group (see Table 2). The difference between these correlations was statistically significant, z = 2.38, p < .01. In the military group, correlations between IPV perpetration and posttraumatic stress symptoms were generally positive, whereas in the nonmilitary group, these correlations were generally negative. Comparison of these correlations indicated significant group differences in correlations between posttraumatic stress symptoms and physically assaultive behaviors on the CTS-2 based on the report of participants, z = 2.42, p < .01, and their partners, z = 2.47, p < .01 (Table 2). These findings were consistent with Hypothesis 4.

Discussion

The current study adds to the literature linking IPV perpetration, posttraumatic stress symptoms, and military background through a preliminary examination comparing court-referred IPV offenders with and without military experience using self- and partner-report of perpetrated physical assault and injury, as well as publicly available court records detailing IPV convictions. As anticipated, clinically meaningful differences emerged between military and nonmilitary IPV offenders. First, this study supported previously established findings that military men are at greater risk for IPV perpetration than their nonmilitary counterparts (Heyman & Neidig, 1999; Jones, 2012; Rentz et al., 2006), but is the first to establish this finding among a court-referred demographic. IPV offenders with military experience reported greater levels of physical assault reported both by the participant and his partner, and injury reported by the partner.

Despite equivocally high rates of trauma exposure across military and nonmilitary groups, posttraumatic stress symptoms were significantly greater and positively associated with IPV perpetration frequency among military members. These data indicate that while nonmilitary offenders with posttraumatic stress symptoms may engage in less frequent IPV than nonmilitary offenders (e.g., Hoyt et al., 2012; Tweed & Dutton, 1998), posttraumatic stress places military members at greater risk for IPV perpetration. One possible explanation for the differential impact of posttraumatic stress symptoms on IPV perpetration across these two groups may be that different symptoms of posttraumatic stress are activated during relationship conflict. For example, consistent with literature indicating a link between hyperarousal symptoms and IPV perpetration among military members (Savarese, Suvak, King, & King, 2001), it may be that aggressive behaviors are evoked more readily among veterans with significant symptoms of posttraumatic stress. This behavior also could be consistent with military training emphasizing aggression (Hoyt & Candy, 2011). On the other hand, consistent with literature indicating high rates of trauma and posttraumatic stress symptoms among nonmilitary offenders (Delsol & Margolin, 2004; Hotaling & Sugarman, 1986), these men may be more inclined to avoid or dissociate when physiologically aroused during relationship conflict. These speculations remain intriguing areas for future work.

Contrary to hypotheses, offenders with military experience showed a significantly lower rate of recidivism than offenders without military experience. This may be due to the availability of additional resources, such as mental health treatment services available within the Department of Veterans Affairs (VA) Health Care System, which may address ongoing problems in this group (Schaffer, 2010). Increased availability of these services within the VA may contribute to improvements in posttraumatic stress symptoms, in turn reducing IPV recidivism rates. Similarly, the availability of Veteran’s Justice Outreach services, partnering with courts to give diagnosis-specific treatment to veterans (rather than focusing exclusively on punishment for IPV perpetration and other offenses), may also contribute to reduced recidivism among veterans.

IPV Perpetration and Posttraumatic Stress: Clinical and Policy Implications

Consistent with previous studies (Byrne & Riggs, 1996; Sherman et al., 2006; Taft et al., 2005), this study echoed findings showing posttraumatic stress symptomatology is associated with significantly higher rates of IPV perpetration among military populations. These findings lend preliminary empirical support to the idea that treating mental health problems, such as symptoms of posttraumatic stress, may be imperative for effective IPV intervention in this demographic. An example of such intervention can be found in problem-solving courts (e.g., Slinger & Roesch, 2010). Such court programs aim to improve outcomes by diverting select defendants into judicially supervised, community-based treatment, and have been shown to reduce rates of recidivism, violence, and substance abuse (Desmond & Lenz, 2010; McNeil & Binder, 2007; Moore & Hiday, 2006). Fashioned after problem-solving courts, a recent movement in judicial systems has been the institution of Veterans Courts that focus on diverting justice-involved military veterans into treatment as an alternative to incarceration (Christy, Clark, Frei, & Rynearson-Moody, 2012).

While not diminishing the clear responsibility of the offender for his own actions, the rationale for diversion programs implies that posttraumatic stress symptoms or other military-related factors play a role in the commission of a crime and therefore must be addressed to reduce risk for recidivism (Schaffer, 2010). For example, a number of military spouse victims of IPV report that these incidents would never occur if their partners did not have symptoms of posttraumatic stress (Finley, Baker, Pugh, & Peterson, 2010). Preliminary evidence supporting the use of problem-solving courts suggests that these courts are efficacious, with mental health court recipients evidencing one quarter the recidivism rates of traditionally processed offenders (Slinger & Roesch, 2010). Because resources are limited in justice settings, it is critical to identify targeted individuals who require more intensive services such as problem-solving courts. However, the strong association of posttraumatic stress symptoms and IPV perpetration among this study’s military offenders, coupled with the lower recidivism rate, indicates that Veteran’s Treatment Courts may be promising for this population (Christy et al., 2012; Schaffer, 2010).

Limitations and Future Directions

The current study has several strengths including the investigation of trauma exposure, posttraumatic stress symptoms, and IPV perpetration frequency using self- and partner-reports, as well as conviction records among military and nonmilitary, ethnically diverse, court-referred IPV offenders. However, these findings should be interpreted within the context of some limitations that suggest direction for future study. First, no specific data were collected regarding several relevant military variables, including service era, combat exposure, or length of service, among others. Nonetheless, no participants in the military group identified combat exposure in their report of traumatic life events. The current sample size likewise limited comparisons of specific trauma history (such as a history of violence exposure) or specific symptom clusters (such as hyperarousal and dissociation) that may play a role in the perpetration of IPV. It is possible that these data would provide more detailed information regarding what military factors specifically may be responsible for group differences in posttraumatic stress symptoms, IPV perpetration, and recidivism. Although demographic matching was utilized in this study in an effort to isolate only military service as the variable differentiating the two groups, these questions provide avenues for future research. Similarly, follow-up data on CTS-2 reports were not collected for these individuals. Although follow-up recidivism data were collected from court records, a stronger case for group differences in continued IPV perpetration would have been made by utilizing self- and partner report of IPV perpetration in addition to IPV recidivism.

Finally, it is possible that cultural variables could play a role in the current results, particularly given the high proportion of Hispanic participants. Although the race/ethnicity breakdown in the current study is representative of the New Mexican population in general, these results may be less applicable to other populations, including other Hispanic and Latino populations that may vary from the New Mexico population. This also may limit the degree to which the current results will generalize to larger populations of veterans. Future research may need to conduct a more direct comparison of the role of ethnicity among IPV offenders with military background. Along these lines, replication of the current results in a larger sample would add additional evidence and empirical support for the potential use of treatment for IPV offenders with military background as a means of incarceration diversion.

Conclusion

IPV perpetration and recidivism are serious social issues with significant costs for the individual, as well as their families and communities. The medical and legal systems are burdened by costs including medical bills, court-appointed evaluations and public defenders, and mandated treatments. Problem-focused courts are a positive step for perpetrators of IPV and their families especially as a body of research suggests that “one-size-fits-all” intervention is not effective for men who engage in IPV. The current study, highlighting the influence of military background and posttraumatic stress symptoms on IPV perpetration, provides another example of the importance of tailoring interventions to specific needs within the IPV offender population

Footnotes

Acknowledgements

The authors acknowledge Dan Matthews, Kathleen Clapp, Alisa Hadfield, Michael Dougher, Tim Reed, Rene Rivas, Kathy Wiggins, Peggy MacLean, Melissa Gerstle, Seamus Gentz, and Beth Leitman for their assistance with this project.

Declaration of Conflicting Interests

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The opinions or assertions contained herein are the private views of the author and are not to be construed as official or reflecting the views of the U.S. Government, the Department of the Army, the Department of Defense, or the Department of Veterans Affairs.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by funds allocated by the New Mexico Legislature to the Second Judicial District Court of New Mexico, a Graduate Research Development grant awarded to the second author by the Graduate and Professional Student Association at the University of New Mexico, and a University of New Mexico Research Allocation Committee Grant awarded to Michael Dougher.

Author Biographies

Tim Hoyt is a Captain in the Medical Service Corps of the U.S. Army and a Brigade Psychologist at Fort Lewis in Washington State. His research focuses on the disclosure of traumatic events, including sharing war stories with social support figures, writing and blogging about traumatic events, and the effects of traumas on language use. He received his PhD in Clinical Psychology from the University of New Mexico.

Alisha M. Wray is a staff psychologist at the North Florida/South Georgia Veterans Healthcare System and an assistant professor in the Department of Psychiatry at the University of Florida. Her research interests include creating, evaluating, and disseminating evidence-based treatments for veterans and justice-involved populations including improving intimate partner violence intervention outcomes. She received her PhD in Clinical Psychology from the University of New Mexico.

Jennifer Klosterman Rielage is a staff psychologist at the New Mexico VA Healthcare System, with a joint appointment at the University of New Mexico, Department of Psychiatry, who specializes in research and care for veterans with comorbid PTSD and substance use disorders. She has also been involved in clinical work and research with men with military sexual trauma for many years, including the development of treatment groups for this population. She received her PhD in Clinical Psychology from Southern Illinois University at Carbondale.

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