Lieutenant Commander and military psychologist Andreas Espetvedt Nordstrand, along with a Navy SEAL, on their way up to patrol Mentor Hill outside Kabul, Afghanistan. Credit: Photo: Private.

The results of a major new study suggest Norwegian military personnel who served in Afghanistan are more prone to ‘problematic anger’.

War affects veterans in many ways. PTSD is the most well-known problem, but anger poses another challenge. From 2001 to 2021, roughly 9,200 Norwegian soldiers served in Afghanistan. The vast majority of them have managed well in the years that have followed.

According to a new survey conducted by the Norwegian Armed Forces Joint Medical Services, however, a significant number of the veterans struggle with mental health issues.

“All Norwegian veterans who served in Afghanistan were invited to participate in a large health survey in 2020,” says Associate Professor Andreas Espetvedt Nordstrand at the Norwegian University of Science and Technology (NTNU’s) Department of Psychology. He is also a senior researcher and a lieutenant commander in the Norwegian Armed Forces.

Veterans tend to be highly disciplined people, so it isn’t a surprise that the response rate was so high, with 6,205, or 68%, responding to the survey. This means that the results are credible and likely to be representative for the entire veteran population.

‘Problematic anger’

One topic the survery raised is known as ‘problematic anger’ which in recent years has become an important part of research regarding veterans and trauma. Previously researchers have often chosen to concentrate on Post-Traumatic Stress Disorder (PTSD).

But PTSD, a so-called ‘fear dysregulation disorder’ which is often a consequence of exposure to life-threatening events, is increasingly seen as just one of several possible trauma-related mental disorders.

Nordstrand said: “In recent years, we have seen that factors other than fear often contribute to health problems among veterans. These factors include witnessing suffering or death in others, or exposure to serious moral transgressions.

“Trauma-related disorders can manifest in various ways beyond just fear dysregulation. For example, they can trigger alcohol problems, depression or insomnia.”

Warfare takes its toll on soldiers in many ways. New research shows that for Norwegian veterans who were deployed to Afghanistan, anger was more likely to be a problem than PTSD. The photo shows a security guard at NATO headquarters in Kabul. Credit: Photo: Torbjørn Kjosvold, Norwegian Armed Forces.

Little attention

Trauma research has rarely addressed the connection between trauma exposure and anger issues and Nordstand believes this is probably due to researchers concentrating on fear dysregulation instead.

He advised: “No one has studied anger among Nordic veterans before. Anger among veterans has received little attention internationally too, and leading military psychology researchers have gone so far as to call anger ‘the forgotten emotion’ in veteran research.

“Anger issues, also referred to as ‘problematic anger’, occur when a person becomes so frequently, intensely, and persistently angry that it significantly disrupts their functioning, social life, and quality of life. So this is a problem we must take seriously.”

High numbers

The researchers used a standard instrument to measure anger – the Dimensions of Anger Reactions Scale (DAR-5). They consider it a useful tool for identifying clinical anger problems, ie problems so severe that individuals require treatment.

Among the many findings are:

• 8.4% of Norwegian Afghanistan veterans have clinical anger problems, ie problematic anger. This makes anger by far the largest single mental health problem among these veterans. Anger problems are about three times as common as classic PTSD, which affects 2.9% of these veterans.
• The second most common mental health problem is insomnia, which affects 5.1% of the veterans.

Norstrand stated: “If we combine all types of mental illness, 10.4% of all Afghanistan veterans suffer from mental health problems – without including problematic anger – meaning we have potentially underestimated how many veterans are struggling with mental health problems after serving in Afghanistan.

“The veterans who struggle with problematic anger often have several other mental health problems as well. [It] is closely associated with feeling guilt and shame related to things you saw or did during overseas service.”

Problematic anger is also closely associated with having chronic pain problems after serving in Afghanistan. Nordstrand explained: “This means that we probably need to adopt a more holistic approach to treating veterans who are struggling than previously.

“Anger and chronic pain can quickly lead to a vicious circle where these two issues mutually exacerbate each other.”

Level of protection

Nordstrand added: “We also see that people who leave the Armed Forces after having served in Afghanistan are much more likely to develop anger problems than people who continue to serve.

“For the individuals who leave the military, maintaining a connection to the Armed Forces, such as through service in the Home Guard, provides nearly the same level of protection against anger issues as continuing active duty.

“We need to be very cautious about assuming cause and effect here, but previous veteran research indicates that the transition from military to civilian life is a vulnerable phase for veterans.

“As civilians, veterans lose the social identity of being a soldier or officer, and this identity often provides significant protection when dealing with military trauma.”

Nordstrand concluded: “In addition, many veterans feel alienated from civilians as they attempt to reintegrate into civilian life.”