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Reactive Aggression and Posttraumatic Stress in Adolescents Affected by Hurricane Katrina

DOI:10.1080/15374410802148152
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Monica Marsee at Iowa State University
Monica Marsee
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Abstract

The current study tests a theoretical model illustrating a potential pathway to reactive aggression through exposure to a traumatic event (Hurricane Katrina) in 166 adolescents (61% female, 63% Caucasian) recruited from high schools on the Gulf Coast of Mississippi. Results support an association between exposure to Hurricane Katrina and reactive aggression via posttraumatic stress disorder (PTSD) symptoms and poorly regulated emotion. The proposed model fits well for both boys and girls; however, results suggest that minority youth in this sample were more likely to experience emotional dysregulation in relation to posttraumatic stress than Caucasian youth. Further, results indicate that hurricane exposure, PTSD symptoms, and poorly regulated emotion are associated with reactive aggression even after controlling for proactive aggression. These findings have implications for postdisaster mental health services. Researchers examining mental health problems in youth after a significant disaster have traditionally focused on the presence of internalizing problems such as anxiety, depression, and posttraumatic stress disorder (PTSD) symptoms, with very little empirical attention paid to the incidence of post-disaster externalizing problems such as aggression. Specific types of aggressive responses, particularly those that involve poorly regulated emotion (i.e., reactive aggression), have been shown to be associated with a history of trauma and thus may be especially common following a traumatic event such as a hurricane.
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The current study found support for a theoretical model in
which hurricane exposure is indirectly linked to reactive
aggression through the experience of emotional dysregulation
brought on by posttraumatic stress. This model illustrates a
potential mechanism by which traumatic exposure can lead to
aggressive acting out, particularly in youth who have difficulty
regulating their emotions. These results are consistent with the
idea that traumatic exposure and posttraumatic stress may
engender intense emotional reactivity (e.g., anger) and
regulation problems that in turn lead to the inability to
suppress aggressive responses (Greenwald, 2002).
Findings from the current study also indicated that
reactive aggression was uniquely associated with both PTSD
symptoms and emotional dysregulation while controlling for
levels of proactive aggression. These results support past
research documenting differential emotional correlates among
these two highly correlated subtypes of aggression (e.g.,
Marsee & Frick, 2007), and suggest that similar to maltreated
or violence-exposed youth, hurricane-exposed youth who
exhibit PTSD symptoms and emotional regulation problems
may be more likely to show impulsive, angry aggression rather
than unprovoked and/or calculated aggression.
The findings from this study and others suggest that
youth may experience significant externalizing behavior
problems after a disaster. Thus, researchers and clinicians
involved in the assessment and treatment of PTSD and
traumatic exposure in adolescents should consider including
measures to assess potential behavior problems as well as
internalizing problems such as anxiety or depression.
Recent studies indicate that children exposed to Hurricane
Katrina reported high levels of posttraumatic stress as well as
other internalizing and externalizing symptoms after the storm
(e.g., Scheeringa & Zeanah, in press). One mechanism through
which traumatic exposure may contribute to externalizing
problems may be via the disruptions in emotional regulation (e.g.,
inability to control angry emotional responses) that occur
following a trauma (Greenwald, 2002). Past research supports a
link between traumatic exposure, PTSD symptoms, and emotional
dysregulation (Chemtob et al., 1997); however, this research is
limited in that it has primarily focused on samples of youth who
either experienced some form of maltreatment or were exposed to
violence (Greenwald, 2002). A second limitation is the lack of
attention to subtypes of aggression that have been found in past
research (Frick & Marsee, 2006). Specifically, previous findings
suggest that exposure to a traumatic event such as abuse or
community violence may place an individual at risk for reactive
aggression (as opposed to proactive aggression; Connor et al;
2003; Steiner et al., 1997). It follows then, that youth may be also
likely to exhibit reactive aggression following a traumatic event
such as a major hurricane.
Based on past research, a theoretical model (see Figure 1)
was developed to examine the associations between traumatic
exposure, PTSD symptoms, emotional dysregulation, and reactive
aggression. Specifically, it is hypothesized that the link between
hurricane exposure and reactive aggression can be best accounted
for by an indirect path model in which exposure is linked to
reactive aggression through the experience of emotional
dysregulation brought on by posttraumatic stress. It is also
hypothesized that hurricane exposure will be significantly
associated with PTSD symptoms and with reactive aggression.
Finally, it is expected that hurricane exposure, PTSD symptoms,
and emotional dysregulation will be more strongly associated
with reactive aggression than proactive aggression.
Participants included 166 students (61% female) aged 14 to
18 (M = 14.97; SD = 1.10) enrolled in 9th through 12th grade at two
local public schools in southern Mississippi. The sample was
primarily Caucasian (63%), and African-American (30%).
Permission was obtained through signed consent forms from the
parents. Measures included the Peer Conflict Scale, which assesses
reactive (RA) and proactive aggression (PA) , the Reaction Index
for Children, which assesses PTSD symptoms, the Hurricane-
Related Traumatic Experiences, which assesses hurricane
exposure, and the Abbreviated Dysregulation Inventory, which
assesses emotional dysregulation (ED).
The current study tests a theoretical model illustrating a potential pathway to reactive aggression through exposure to Hurricane Katrina in 166 adolescents recruited from high schools on the Gulf Coast of
Mississippi. Results support an association between exposure to Hurricane Katrina and reactive aggression via PTSD symptoms and poorly regulated emotion. The proposed model fits well across gender;
however, results suggest that minority youth were more likely to experience emotional dysregulation in relation to posttraumatic stress than Caucasian youth. Further, results indicate that hurricane exposure,
PTSD symptoms, and poorly regulated emotion are associated with reactive aggression even after controlling for proactive aggression.
Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Anger regulation
deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10, 17-36.
Connor, D.F., Doerfler, L.A., Volungis, A.M., Steingard, R.J., & Melloni, R.H. (2003). Aggressive
behavior in abused children. In J.A. King, C.F. Ferris, & I.I. Lederhendler (Eds.), Roots of mental
illness in children (pp. 79-90). New York: New York Academy of Sciences.
Frick, P.J., & Marsee, M.A. (2006). Psychopathy and developmental pathways to antisocial behavior in
youth. In C.J. Patrick (Ed.), Handbook of psychopathy (pp. 355-374). New York: Guilford.
Greenwald, R. (2002). The role of trauma in conduct disorder. Journal of Aggression, Maltreatment, &
Trauma, 6, 5-23.
Marsee, M.A. ,& Frick, P.J. (2007). Exploring the cognitive and emotional correlates to proactive and
reactive aggression in a sample of detained girls. Journal of Abnormal Child Psychology, 35,
969-981.
Scheeringa, M.S., & Zeanah, C.H. (in press). Reconsideration of harm’s way: Onsets and comorbidity
patterns of disorders in preschool children and their caregivers following Hurricane Katrina.
Journal of Clinical Child and Adolescent Psychology.
Steiner, H., Garcia, I.G., & Matthews, Z. (1997). Posttraumatic stress disorder in incarcerated juvenile
delinquents. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 357-365.
Reactive Aggression and Posttraumatic Stress in Adolescents
Affected by Hurricane Katrina
Monica A. Marsee1, Cassandra Dailey2, Julie S. Strange2, Allison Marks1, Kimberly Fyffe2, Rachel Shelhamer2, & Greg Fassnacht1
1University of New Orleans, 2University of Southern Mississippi
Figure 1 presents the results for the indirect path model. Estimation of this model indicated
good fit of the model to the data according to the chi-square and CFI values (²[3] = 7.35; p= n.s.;
CFI = .97, RMSEA = .09). Invariance testing indicated that the model fit equally well for boys and
girls, but that there was a significant difference in the path coefficient from PTSD symptoms to ED
for Caucasian (= .22; p< .05) versus minority (= .69; p< .01) participants. A set of partial
correlations were calculated examining the relation between RA and the other variables of interest
while controlling for levels of PA. Results indicated that RA was uniquely associated with both
PTSD symptoms (partial r= .19, p< .05) and ED (partial r= .48, p< .001) while controlling for
PA. However, RA did not remain significantly correlated with hurricane exposure after controlling
for PA (partial r= .12, p= n.s.).
Means, Standard Deviations, and Correlations among the Variables of Interest
1 2 3 4 Mean SD
1. Hurricane Exposure 2.38 1.92
2. PTSD .35*** 16.43 11.82
3. Reactive Aggression .17* .17* 9.20 8.12
4. Proactive Aggression .12 .05 .76*** 3.91 5.51
5. Emotional Dysregulation .17* .44*** .63*** .46*** 10.11 7.17
*p < .05; ***p< .001
Hurricane
Exposure
PTSD
Symptoms
Emotional
Dysregulation
Reactive
Aggression
.35** .44**
.63**
Structural model illustrating the indirect path from hurricane exposure to reactive aggression.
Note. **p < .01
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Article
  • May 1996
The authors used an integrative conceptual model to examine the emergence of posttraumatic stress disorder (PTSD) symptoms in 568 elementary school-age children 3 months after Hurricane Andrew. The model included 4 primary factors: Exposure to Traumatic Events, Child Characteristics, Access to Social Support, and Children's Coping. Overall, 62% of the variance in children's self-reported PTSD symptoms was accounted for by the 4 primary factors, and each factor improved overall prediction of symptoms when entered in the analyses in the order specified by the conceptual model. The findings suggest that the conceptual model may be helpful to organize research and intervention efforts in the wake of natural disasters.
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The Dysregulation Inventory: A New Scale to Assess the Risk for Substance Use Disorder
Article
  • Jun 2001
Emerging evidence indicates that psychological dysregulation is an integral component of the liability for substance use disorder (SUD). To date, the measurement of dysregulation entails using a variety of disparate unstandardized instruments. This report discusses the rationale underlying the Dysregulation Inventory (DI), the methods employed in item selection and scale construction, and describes preliminary results regarding psychometric properties. Satisfactory to superior reliability and validity were observed for the self-report, teacher-report, and parent-report versions of the DI. The scores on the DI discriminate youth who are at high and low average risk for SUD ascertained on the basis of paternal SUD. Moreover, the score on the DI at age 10–12 was found to account for a significant proportion of the variance on substance use at age 12–14, thereby pointing to its predictive validity. In addition, the DI score covaried with SUD severity in a sample of female adolescents. These results indicate that the DI may be useful for detecting youth who are at high risk for SUD.
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Traumatic Victimization in Childhood and Persistent Problems with Oppositional-Defiance
Article
  • Jul 2002
A number of studies suggest similarities between the psychosocial impairment caused by traumatic victimization and the “cascade” (Patterson, 1993) of problems experienced by youths with severe and persistent problems with oppositional-defiance. Evidence indicating that traumatic victimization may be a factor in disruptive behavior disorders is reviewed. A preliminary conceptual model is proposed as a basis for clinical and research hypothesis testing concerning the potential relationship between traumatic victimization and problematic oppositional-defiance. The model postulates a chronological sequence from (a) victimization in childhood, to (b) escalating dysregulation of emotion and social information processing (“survival coping”), to (c) severe and persistent problems with oppositional-defiance and overt or covert aggression which are compounded by post-traumatic symptoms (“victim coping”). Implications for diagnosis, prevention, treatment, and research are discussed.
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