Although it is estimated that rates of intimate partner violence (IPV) victimization are similar between civilian and military samples,¹ studies have found that rates of veteran perpetration of IPV are up to three times higher than among civilians.² The higher rate of physical and psychological IPV perpetration among veterans is attributed, in part, to post-traumatic stress disorder (PTSD); PTSD symptom severity, in particular hyperarousal, is significantly associated with physical IPV perpetration in military samples.^3,4

To address the issue of violence against women, including IPV, recent efforts have focused on engaging men in prevention and intervention strategies.⁵ With men comprising the majority of Veterans Administration (VA) patients and the VA increasingly focusing on including veterans’ partners/family in treatment,⁶ the male veteran voice is crucial in this dialog. Understanding male veterans’ perspectives is critical to effectively engaging them in violence prevention and reduction strategies. Therefore, the current study describes themes that emerged from interviews with male veterans (with and without PTSD) who were seeking treatment in a VA setting and who reported perpetrating physical and verbal IPV. Questions included coping strategies and preferences for and barriers to IPV treatment.

Participant characteristics are presented in Table I. Twenty veterans (80%) had a Posttraumatic Stress Disorder Checklist—Military⁸ version score of 50+ (mean = 62.4, SD = 16.1), which is suggestive of PTSD. Sixteen veterans (64%) fell in the distressed range (above 16) of couple functioning on the Dyadic Adjustment Scale⁹ (mean = 18.1, SD = 7.1). On the Conflict Tactics Scale Revised,¹⁰ the average number of psychologically aggressive acts in the past year was 30.6 (SD = 23.0), physically assaultive acts was 7.84 (SD = 16.6), and sexually coercive acts was 3.68 (SD = 8.3). To contextualize these quantitative findings and provide additional information about the veterans’ conflict and relationships, some additional information related to the nature of the violence that was obtained during the interview is provided as well.

Participants identified several common factors that preceded conflict in their relationships, including money (n = 10, 38%), infidelity (n = 5, 19%), alcohol (n = 3, 12%), partner bringing up the past (n = 4, 15%), veteran’s feeling nagged and wanting space (n = 5, 19%), parenting differences (n = 4, 15%), and sexual activity (n = 2, 8%). For instance, two participants described factors that preceded relationship conflict: “Our last altercation was when I found out she was talking to her other baby daddy; it got physical then” (34-year-old single [with girlfriend] Persian Gulf War Veteran with PTSD); “I’m not as sexually active as she is, and she thinks there’s a problem there (61-year-old married Vietnam Veteran with PTSD).

Of veterans who were able to describe length of fights, 6 (30%) noted <10 minute duration, 10 (50%) noted 11 to 20 minutes, and 4 (20%) noted over 20 minutes. Almost all veterans reported that their conflicts occurred in the home, with only 2 (8%) noting conflicts occurred in public. Nota–bly, almost half (n = 12, 48%) reported that their children or grandchildren are sometimes present during the arguments, 3 (12%) said friends are around, and 10 (40%) said no one is present. Although nine (36%) veterans reported that weapons (guns and knives) are accessible during the arguments, none of the veterans reported that they use the weapons during the fights. Five (20%) of the veterans reported that they used alcohol in the 6 hours preceding the argument in all of the fights in the year before their interview; another 6 (24%) indicated they had been drinking before 50 to 75% of their recent arguments. Most veterans reported that their partners usually initiated fights (n = 10, 40%) or that both members sometimes initiated (n = 9, 36%); 6 veterans (24%) report that they initiate most fights. Veterans described a range of negative effects of their relationship violence including: damage to relationship/increased emotional distance between couple (n = 7, 27%), guilt/regret (n = 6, 23%), decreased trust (n = 3, 12%), and decreased communication (n = 3, 12%). Twelve (48%) participants indicated that they had been involved with the legal system because of fights with their current partner.

This study is a first step in filling a critical gap in the knowledge base about IPV among veterans; although prevention and intervention efforts for IPV typically focus on men, very little work has examined men’s perspectives on violence or engagement in treatment. A particular gap exists for male veterans, a population whose relationships are at high risk for violence as a function of the social and emotional sequelae of PTSD. Two major themes relevant to engaging men in treatment emerged in our interviews, including (1) coping mechanisms used to avoid and handle violent incidents and (2) perceived barriers to and preferences for IPV treatment. Although the anger management strategies the participants used to cope with violence were not always successful, this understanding of their efforts can guide the development and refinement of treatment strategies. Importantly, the entire sample indicated a need and desire for IPV treatment. They preferred for such treatment to be offered through the VA, a place that may be more comfortable for many veterans than the private sector. Although such services are not widely available throughout the VA system at this time, further examination of these issues may be a potential opportunity for the VA system to strengthen veterans’ relationships.

Interviews underscored the importance of considering the dyad and family when addressing IPV rather than simply focusing on the male perpetrator. For example, male veterans reported that a substantial amount of the conflict-related violence was perceived as mutual or initiated by their female partner, a finding that has been supported by quantitative research.¹⁵ In addition, most were interested in treatment that included their partner or family. Almost half of participants reported that their conflict occurred in front of children or grandchildren, which highlights the potential negative effects on the broader family. Children’s exposure to family violence is subject to mandated reporting in some states, so treatment providers should be aware of their state’s requirements when working with distressed couples. The current study adds to research highlighting the importance of considering including both partners in IPV prevention and treatment.¹⁶ Clinical determinations about the appropriateness of this must be carefully made based on a thorough assessment of the nature, chronicity, and severity of the violence.¹⁷

Alcohol use was also identified as a precursor to couple violence. This finding is consistent with a large literature on alcohol use as a predictor of IPV.¹⁸ Similarly, research has found that addressing substance abuse in couples is associated with reductions in IPV¹⁹ as a function of reductions in alcohol use and increases in relationship functioning achieved during substance abuse treatment. It is possible that VA’s efforts to address substance abuse in couples, such as the recent pilot work with Behavioral Couples Therapy for Alcoholism,²⁰ may result in decreases in IPV in these relationships; however, this warrants specific investigation.

The findings from this study are limited in several ways. We interviewed a small sample of male veterans who had self-reported previous IPV perpetration and agreed to participate in an interview. Many participants also had diagnoses of PTSD and/or other mental health problems. This sample may not be representative of other groups of veterans. Responses may have been influenced by social desirability. Given that the interview questions focus on conflict-related IPV, it is unlikely that responses apply to sexual IPV or stalking, as these forms of violence are typically not conflict related. It is noteworthy that we initially attempted to recruit veterans’ female partners in the study to provide both partner’s perspectives of the conflict and services; however, only 2 women completed interviews. Although many women initially expressed willingness to participate, most cancelled the appointment or did not attend the scheduled appointment. Because of the small number of interviews, the partner data were not analyzed. Despite these challenges, it is critical to gain both perspectives and future research may consider barriers veterans’ partners may face in engaging in couples research or couples therapy; exploration of recruitment and study methods to safely and confidentially obtain this information is warranted.