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

3.0 The Basics - Common Reactions to Crime

Reactions

• As people deal with having been 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 and also for the supports and workers. Much care is needed to make sure that it is handled properly (Greenberg and 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, judgment 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.

• 1 Casarez-Levison (1992)
• 2 Everly et al. (2000)
• 3 Greenberg and Ruback (1992)
• 4 Leahy et al. (2003)
• 5 Mezy (1988)
• 6 Nishith et al. (2002)
• 7 Norris et al. (1997)

Updated references:

• 8 Amstadter et al. (2007)
• 9 Boccellari et al. (2007)
• 10 Boeckmann and Turpin-Petrosino (2002)
• 11 Courtois (2004)
• 12 Danieli et al. (2004)
• 13 Daniels et al. (2007)
• 14 DeValve (2005)
• 15 Dunbar (2006)
• 16 Gabriel et al. (2007)
• 17 Garnetts et al. (1990)
• 18 Herek et al. (1997)
• 19 Janoff (2005)
• 20 Lebel and Ronel (2005)
• 21 Manktelow (2007)
• 22 Miller and Heldring (2004)
• 23 Mock (1995)
• 24 Nordanger (2007)
• 25 Orth et al. (2008)
• 26 Pivar and Prigerson (2004)
• 27 Spataro et al. (2004)
• 28 Staub (1996)
• 29 Thielman 2004
• 30 Wertheimer (1990)
• 31 Young et al. (2007)

Severity of Reaction

All victims of crime experience some distress (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).

Victims of sexual assault reported more severe reactions and took longer to heal than victims of non-sexual assault (Gilboa-Schechtman and Foa 2001).

Workers need to be careful of groups that mix victims who 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 and Ruback 1992). Workers should think about how to best match client needs to service level for their clients' benefit (see Table 2).

• Women may be at risk for more severe reactions since they are more likely than men to experience sexual assault or repeated victimizations (including sexual assault) (Pimlott-Kubiak and 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 et al. 1999).

Table 2: Severity by Service type: A proposed model

Level	Description	Possible service options
Low	They are coping well with few symptoms, easily managed through natural coping skills and social support. They may not have experienced a severe crime and/or may have many ways to cope.	Minimal services: information sharing – provide written material, brochures of available supports, and education about signs of deeper problems. These services would also be useful for those who do not feel they have any problems, but are trying to hide their suffering. These same written materials might be given to people in the victim's support system.
Moderate	Experiencing some symptoms and need to expand coping skills or need a place to deal with overwhelming emotions. Generally, they cope well but are overwhelmed by being victimized.	Peer-run support groups, paraprofessional and volunteer support. Some professional support may be needed, but only on a short-term basis.
High	Experiencing many symptoms or problems and displaying poor coping behaviours. Overwhelmed by being victimized and with few effective supports. Severe trauma may have occurred. Likely evidence of multiple problems and multiple victimizations.	Need for professional treatment. This may include long-term individual or group therapy or even hospitalization to help the person stabilize.

Previous Victimization

Researchers have found that previous victimization is a very strong predictor of further victimization (Byrne et al. 1999; Messman and 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 tends to affect the victim's reaction to new victimization, perhaps through low self-esteem, habits of learned helplessness, poor relationship skills or choices, difficulty in reading risky situations, or poverty (Byrne et al. 1999; Messman and 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 to use this information in our interventions.

Common Diagnoses of Victims of Crime

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 or weight loss, sleep problems, energy changes, self-blame or feelings of guilt, feelings of worthlessness or hopelessness, difficulty concentrating, and thoughts of death (American Psychiatric Association 1994).

Anxiety symptoms can include fear, distress, and worry or physical symptoms (e.g. sweating, shaking, difficulty breathing, nausea, chest pain, dizziness), 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, or accident (American Psychiatric Association 1994). PTSD may include such symptoms as fear, helplessness, intrusive and recurrent memories, nightmares, reliving the event, intense distress, being jumpy, avoidance or suppression of thoughts or feelings, and specific symptoms such as sleep problems, irritability, angry outbursts, poor concentration, hypervigilance and exaggerated startle response (American Psychiatric Association 1994).

Complicated grief, or intense grief that goes on for a long time, can be a problem for some victims and their survivors.

Risk factors for developing PTSD include crime- or trauma-related factors (Brewin et al. 2000; Gilboa- Schechtman and Foa 2001; Ozer et al. 2003); a 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 after the crime (Ozer et al. 2003).

When to Refer to Mental Health Professionals

Workers should carefully consider when to refer clients to mental health professionals.

If they are not trained in mental health issues, workers should consult and make appropriate referrals to professionals. Partnerships with healthcare and telehealth, consultation, and visiting professionals are possible solutions for workers in isolated areas.