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4.0 Common Reactions to Crime

4.1 Severity of Reaction

4.2 Previous Victimization

4.3 Diagnoses Commonly Applied to Crime Victims

4.4 When Do I Need to Refer to Mental Health Professionals?

4.5 The Basics…

Working with Victims of Crime: A Manual Applying Research to Clinical Practice

4.0 Common Reactions to Crime

It is useful to know common reactions that victims may face when trying to cope with the crime. Recall, that each victim will have his own unique path towards recovery, but workers should be aware of common reactions to help them better help victims recover. About 25% of violent crime victims reported extreme levels of distress, including depression, hostility and anxiety (Norris et al., 1997). Another 22% to 27% reported moderate to severe problems. This means that around 50% of violent crime victims report moderate to extreme distress. In order to help us understand the type of reactions we might encounter when working with victims, Table 1 shows the reactions that researchers and theoreticians have observed in crime victims. However, workers may also recognize these reactions in the victim’s friends and family. The crime affects family and friends, school, work and the broader community (Burlingame & Layne, 2001).

Table 1: Common reactions to crime victimization

Of note, the issue of anger as a reaction is more complicated than one might first assume. Researchers often link anger to property crime and fear to violent crime (Greenberg & Ruback, 1992). However, anger is basically a reaction wherein the person feels cheated out of something she felt she deserved. In the case of criminal victimization, she has been cheated out of her feelings of safety and fairness and belief in a just world, etc. Thus, anger can be a reasonable reaction to any type of crime. In life, anger can act as a motivator to change. Greenberg and

Ruback (1992) pointed out that many victims create internal fantasies about getting revenge or justice. If these fantasies have positive outcomes (e.g., the perpetrator is caught), it may increase the chance the victim will take action. Thus, so-called “righteous anger” can help the person move forward, helping to energize her to deal with the criminal justice system or get help. Under this view, anger management programs may do a disservice to victims.

Having said this, workers need to be careful of confusing anger with empowerment. If not handled properly, chronic anger can be very harmful to the victim. Each victim must be treated as an individual. Workers should help her learn to manage all emotions in a way that helps her cope with challenges while remaining healthy. This will help the victim move forward and rebuild her life. All workers, regardless of training, should reflect on whether they are able to help victims in this area. If not, they need to refer clients to other professionals.

4.1 Severity of Reaction

Severe reactions can be overwhelming to workers. As reactions become less severe, they do not necessarily become easier for the victim. This mismatch poses a challenge to both workers and victims. Norris et al.’s (1997) research indicated that violence during the crime increases response severity; victims of non-violent crime, however, also fear for their safety and can have increased psychological symptoms. Although there was no overall pattern based on victim type, all victims of crime experience distress. The general finding that the more violent the crime, the more severe the reaction offers workers insight into how to work with clients. Thus, a victim of a violent crime that reports that he feels no distress may need closer monitoring. His statement should be examined in relation to his coping skills, current behaviour and life experience. Workers need to work with the client to help him understand his distress levels and how the crime has affected his life.

The victim is the best source of information about what is happening in his life. Recall that research has shown that around 50% of violent crime victims experience moderate to severe distress (Norris et al., 1997). This also means that around 50% of victims do not experience these higher levels of distress. Research on sexual assault victims found that they experience more severe reactions and took longer to heal than non-sexual assault victims (Gilboa-Schechtman & Foa, 2001). Both groups had similar post-traumatic stress disorder (PTSD) and anxiety levels, but the sexual assault group showed higher levels of depression.

Of possible importance to workers, Gilboa-Schechtman and Foa (2001) also examined “peak reactions”. Peak reactions refer to the point at which the victim experiences the strongest symptoms. They found that the longer the person took to have her peak reaction the more symptoms she experienced. In other words, those who experienced the strongest symptoms shortly after the assault had lower levels of depression and PTSD. Thus, workers should watch a victim’s symptoms closely and pay particular attention to victims who are having intense symptoms long after the crime. These clients may benefit from more intensive treatment from mental health professionals.

What workers need to take away from this research is that the unique experience of some people makes one-to-one attention an extremely important part of treatment. Thus, even if seen in a group setting, workers should work to monitor and check in with all clients, not just those who seem to be experiencing problems during a particular session.

Fortunately, group interventions can be helpful since all victims will have some reaction to dealing with the crime and its effects. However, workers need to be wary of mixing those with highly severe reactions to those with less severe reactions. Social comparison could negatively affect either group (Greenberg & Ruback, 1992). Those with more severe reactions may feel that they should be “stronger” and those with less severe reactions could fear that they will get worse. It may not be possible to have groups for different levels of severity. Workers need to be aware of this challenge and make sure that victims understand that reaction to victimization is a very individual path. It is important for group work to emphasize that victims can learn something from each other.

A final point on severity, in a large-scale study, Pimlott-Kubiak and Cortina (2003) examined assault history and gender. In grouping their sample of 16,000 people (8,000 women and 8,000 men), they found that most men and women reported little or no victimization. Of those who reported victimization, two groups were over 90% female, both related to sexual assault: 1) those reporting primarily sexual assault and, 2) those reporting repeated violence that included sexual violence. Both of these groups would likely experience severe reactions. This research likely reinforces workers’ experience of seeing mostly female victims in daily practice. Men were more likely to be in the group who described physical abuse in childhood (67% male) and repeated violence that did not include sexual violence (66% male) (Pimlott-Kubiak & Cortina, 2003). Although any good assessment needs to ask about a wide variety of issues, workers working with women need to ask about sexual assault either as a single event, or as part of several violent assaults. When working with men, we need to be more aware of a history of physical abuse in childhood and repeated violence. These results remind us that we need to go beyond the specific crime and ask about trauma history and use this in our interventions.

Client matching

A major reason for looking at severity of reaction is to develop ideas of how to best help victims rebuild their lives. Some victims may benefit the most from relatively minor interventions, for example, sharing information. Others with more severe reactions might require more intensive support that might be provided in a peer group. Finally, there are those clients experiencing severe reactions that may require a referral to mental health counselling or even hospitalization. It would not make sense to only give information to someone experiencing severe distress, nor would it make sense to require a person coping well to enter therapy. Table 2 describes a proposed model to help workers think about these issues. The key element to understand is that crime victims are a diverse group with diverse needs. This diversity requires workers to adapt to the victim in providing those services that best meet the victim’s needs.

Secondary victimization

Secondary victimization is related to severity as it can worsen an already difficult situation. Basically this happens when the person comes into contact with professionals and paraprofessionals and is further traumatized by their response. This can happen through retelling her story, being treated unfairly or experiencing other behaviours that make her feel as though people aren’t listening or don’t believe her. It is noteworthy that when victims described police as “helpful” they felt more connected to others (Norris et al., 1997). However, negative experiences with professionals increased post-traumatic stress symptoms (Campbell, Sefl, Barnes, Ahrens, Wasco & Zaragoza-Diesfeld, 1999). It is fortunate that those victims who received mental health services after having a negative experience with the system showed decreased distress (Campbell et al., 1999).

4.2 Previous Victimization

Researchers have found that some people become victimized again and again throughout their lives (Byrne et al., 1999; Messman & Long, 1996; Norris et al., 1997; Nishith et al., 2000). New victimization interferes with the person’s ability to cope with past trauma. Furthermore, previous victimization affects how he will cope with the new trauma. In effect, the repeated victimizations interrupt the person’s normal healing process. Norris et al. (1997) noted that crime challenges victims’ views of themselves or their worlds. Several studies report that previous victimization is a very strong, and possibly the strongest, predictor of further victimization (Byrne et al., 1999; Messman & Long, 1996; Norris et al., 1997; Nishith et al., 2000). Furthermore, previous victimization seems to affect the victim’s reaction to new victimization, perhaps through low self-esteem, learned helplessness, poor relationship skills/choices, difficulty reading risky situations or poverty (Byrne et al., 1999; Messman & Long, 1996; Nishith et al., 2000).

Furthermore, those victims who had a very bad reaction to previous trauma are likely to have a bad reaction to new trauma (Brunet et al., 2001). Basically, revictimization gets in the way of the victim’s ability to rebuild herself and her life. Workers need to ask about previous traumas, both crime-related and otherwise. In addition, following-up with questions about how the victim normally handles stressful situations should also help workers to better predict how their client will react to the current trauma.

4.3 Diagnoses Commonly Applied to Crime Victims

Workers can benefit from having a basic understanding of diagnostic terms that they may encounter in files or in speaking to mental health professionals. Diagnoses commonly linked to being a crime victim include: anxiety and post-traumatic stress disorder (PTSD) and depression (definitions in Figures 2 and 3). Researchers have noted that these problems can appear in victims of workplace violence (Rogers & Kelloway, 2000), stalking (Pimlott-Kubiak & Cortina, 2003), sexual assault (Byrne et al., 1999), childhood sexual abuse (Merrill, Thomsen, Sinclair, Gold & Milner, 2001), violent crime (Byrne et al., 1999), gang related violence (Ovaert, Cashel & Sewell, 2003) and family violence (Wolkenstein & Sterman, 1998). PTSD is often discussed as related to victimization, especially when violence occurs (Byrne et al., 1999). Several researchers have noted success in reducing PTSD symptoms through treatment. Successful treatments often include opportunities for the victim to share his trauma story while applying new skills to manage his feelings and thoughts (Bryant, Moulds, Guthrie, Dang & Nixon, 2003; Nishith et al., 2002).

Dempsey (2002) found that criminal violence and negative coping predict PTSD, anxiety and depression to varying degrees. Daley, Hammen and Rao (2000) found that more chronic stressors, such as the stress experienced by a victim of family violence, are more likely to wear down the victim. Whereas an acute stress, such as single episode assault by a stranger, may deepen feelings of depression. In a study of adolescents who were victims of violence, Kilpatrick, Ruggiero, Acierno, Saunders, Resnick and Best (2003) found that almost 75% of adolescents who had PTSD also had either substance abuse problems or depression. Gilboa-Schechtman and Foa (2001) noted that victims of sexual assault, versus non-sexual assault, were more likely to experience depression. They theorized that anxiety and PTSD are common to all traumas, but that depression is related to only certain types of trauma (Gilboa-Schechtman & Foa, 2001).

One question that is often raised when examining PTSD is, “Why does one person develop the disorder while others do not?” The following list of characteristics has been shown to be linked to increased chances of developing PTSD:

• Crime/trauma related factors (e.g., trauma severity related to sexual assault) (Brewin, Andrews & Valentine, 2000; Gilboa-Schechtman & Foa, 2001; Ozer, Best, Lipsey & Weiss, 2003);
• Lack of social support (Brewin et al., 2000; Ozer et al., 2003);
• Additional life stress (Brewin et al., 2000; Ozer et al., 2003);
• Previous PTSD (Brunet et al., 2001; Ozer et al., 2003); and,
• Dissociation during or immediately following the crime (Ozer et al., 2003).

Researchers have noted a lesser link between the following and development of PTSD:

• Previous trauma (Brewin et al., 2000; Ozer et al., 2003);
• Personal psychiatric history (Brewin et al., 2000; Ozer et al., 2003), depression in particular (Ozer et al., 2003);
• Family psychiatric history (Brewin et al., 2000; Ozer et al., 2003);
• Report of childhood abuse (Brewin et al., 2000);
• Education (Brewin et al., 2000);
• General childhood adversity (Brewin et al., 2000);
• Gender (Brewin et al., 2000);
• Age at trauma (Brewin et al., 2000); and,
• Race (Brewin et al., 2000).

Fortunately mental health professionals can help clients with these disorders. Both medical and psychological treatments can be effective. Researchers collaborate with clinicians to develop the best treatment possible. For example, effective PTSD treatment often includes an exposure element wherein the person needs to psychologically face his fear and anxiety (Bryant et al., 2003; Nishith et al., 2002). Workers untrained in these issues need to keep in mind the importance of consultation and making appropriate referrals to mental health professionals.

4.4 When Do I Need to Refer to Mental Health Professionals?

Mental health workers can provide support for more challenging clients. Although many victims can benefit from traditional services, some people may need the more intensive treatment that professionals trained to deal with mental health issues can provide. These include victims who may have a mental illness, intense stress reactions, complex life histories or other problems. As Lawson (2001) noted, most mental health professionals are trained to understand different types of abuse, can help clients process emotions, can teach skills and help with planning/problem solving. Mental health professionals can also help victims identify and use social support systems, and act as an additional support to the natural supports. Basically, professionals can work with the client to help them cope (Gorman, 2001).

Norris et al. (1997) found that about 12% of victims sought mental health services. Most of these were victims of violent crime. They found that violence and depression were the biggest predictors of seeking help. Of note, they also found that professional help was only effective if the help was prompt and ongoing (Norris et al., 1997).

Understanding your limits is an important part of being an effective worker. You need to use consultation from both your supervisors and co-workers to understand your limits. Thus, there are no set rules as to when to refer your client to more professional services. However, there are some issues that should make you think about whether bringing someone else in may be in your client’s best interest. This does not mean that you cannot work with the client but, rather, that you should consider if you need help when:

1. You suspect the person has depression, anxiety, post-traumatic stress disorder, continued dissociation or other mental health problems.
2. Suicide is a concern.
3. Intense emotions (anger/sadness/grief) are beyond your skills or resources.
4. The person seems to be unmotivated and stuck.
5. The person does not seem to get as much from group/self-help/other interventions.
6. The person does not seem to be getting better even though they seem to be motivated and working hard.
7. The person has a long, complicated history of victimization or abuse.
8. The person has a long history of mental health or substance abuse problems.

Those working in more isolated areas should contact their local health care professionals to problem-solve around how to best meet the needs of victims in general. These partnerships can be invaluable in providing new information and professional support. Isolated workers might also use strategies such as tele-health consultation (using phone, email or video-conferencing) to get guidance or receive supervision. Tele-health systems can also be used to deliver therapy, with the local supports working with the victim and possibly participating in therapy with a professional in another area. Other possibilities include bringing in professionals to conduct workshops, crisis treatment or supervision sessions. Of importance, workers should be cautious about digging deeply into complex victims issues without backup. Sometimes this cannot be avoided since the victim may be ready to deal with these issues. It is important for the worker to ensure that she consults with others when outside her areas of expertise. Acting ethically and being respectful of your clients includes being aware of you own limits.

4.5 The Basics…

Reactions

• As people deal with being victimized, workers can identify common reactions. These reactions are normal, but may still mean that the victim requires help to deal with being overwhelmed. Table 1 lists some common reactions discussed in research.
• Anger is a difficult emotion for the victim, supports and workers. Much care is needed to make sure that it is handled properly (Greenberg & Ruback, 1992). Workers should understand that anger is a natural reaction to victimization but that it can also interfere with getting better. Thus, there is no easy answer to how to handle anger; training/judgement and empathy are your best tools for deciding how to help victims showing anger. Supervision/consultation will be key in dealing with your reaction to anger and other emotions.

Table 1: Common reactions to crime victimization

Severity of Reaction

• All crime victims experience some distress upon being victimized (Norris et al., 1997).
• Research indicates that violence during the crime increases the severity of the reaction and about 50% of victims of violent crime report moderate to severe reactions (Norris et al., 1997).
• Sexual assault victims reported more severe reactions and took longer to heal than non-sexual assault victims (Gilboa-Schechtman & Foa, 2001).
• Workers need to be careful of groups that mix victims that have severe reactions with those that have less severe reactions. Social comparison (feeling better off or worse off) with other group members may interfere with treatment if not handled properly (Greenberg & Ruback, 1992).
• Workers should think about how to best match client needs to service level as a way to benefit clients (see Table 2).

• Women may be at risk for more severe reactions as they are more likely than men to experience sexual assault or repeated victimizations (including sexual assault) (Pimlott-Kubiak & Cortina, 2003).
• Professionals need to be careful of causing the victim even more distress (secondary victimization) by not being sensitive to the victim’s state of mind (Campbell, Sefl, Barnes, Ahrens, Wasco & Zaragoza-Diesfeld, 1999).

Previous Victimization

• Researchers have found that previous victimization is a very strong predictor of further victimization (Byrne et al., 1999; Messman & Long, 1996; Norris et al., 1997; Nishith et al., 2000).
• Victims who have had a bad reaction to previous trauma are likely to have a bad reaction to new trauma (Brunet et al., 2001).
• Previous victimization likely affects the victim’s reaction to new victimization, perhaps through low self-esteem, learned helplessness, poor relationship skills/choices, difficulty reading risky situations or poverty (Byrne et al., 1999; Messman & Long, 1996; Nishith et al., 2000). These results remind us that we need to go beyond the specific crime and ask about trauma history and use this in our interventions.

Diagnoses Common to Victims

• Diagnoses commonly linked to being a crime victim include depression, anxiety and post-traumatic stress disorder (PTSD).
• Depression symptoms can include: low mood, low appetite/weight loss, sleep problems, energy changes, self-blame/guilt, worthlessness/ hopelessness, difficulty concentrating and thoughts of death (American Psychiatric Association, 1994).
• Anxiety symptoms can include: fear/distress/worry, physical symptoms (e.g., sweating, shaking, difficulty breathing, nausea, chest pain, dizziness, etc.), behaviour change (e.g., avoidance, rituals) and behaviours that try to reduce distress (American Psychiatric Association, 1994).
• PTSD is a form of anxiety disorder that is linked to a specific incident, such as a crime, natural disaster, accident, etc. (American Psychiatric Association, 1994).
• PTSD may include symptoms such as: fear, helplessness, intrusive and recurrent memories, nightmares, reliving the event, intense distress, being jumpy, avoidance/suppression of thoughts/feelings, and specific symptoms such as sleep problems, irritability, angry outbursts, poor concentration, hypervigilance and exaggerated startle response (American Psychiatric Association, 1994).
• Some risk factors to developing PTSD include: Crime/trauma related factors (Brewin et al., 2000; Gilboa-Schechtman & Foa, 2001; Ozer et al., 2003), lack of social support (Brewin et al., 2000; Ozer et al., 2003), additional life stress (Brewin et al., 2000; Ozer et al., 2003), previous PTSD (Brunet et al., 2001; Ozer et al., 2003) and dissociation during or immediately following the crime (Ozer et al., 2003).

When Do I Need to Refer to Mental Health Professionals?

• Worker should carefully consider when to refer to mental health professionals.
• Workers untrained in mental health issues should consult and make appropriate referrals to mental health professionals.
• Partnerships with healthcare, tele-health, consultation and visiting professionals are possible solutions for workers in isolated areas.

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