The Mental Health Impact of Crime:
Fundamentals in Counseling and Advocacy
Abstract: The President's
Task Force on Victims of Crime in 1982 called on the mental health
community to study crime-related psychological trauma, to develop
psychological treatment programs for crime victims, and to work
with victim services to insure that crime victims have access
to competent psychological treatment. Considerable progress has
been made since 1982. This chapter discusses the types of trauma
likely to be experienced by crime victims, the factors that influence
victim recovery from crime-related trauma, what crime victims
expect from the criminal justice system, and how criminal justice
professionals can respond to the mental health needs of crime
Upon completion of this chapter, students will understand the
1. Identification of the major types of immediate and short-term
trauma associated with crime victimization.
2. Identification of long-term crime-related psychological trauma.
3. Why the criminal justice system should concern itself with
crime-related psychological trauma of crime victims.
4. Previctimization and postvictimization that are important to
consider in victim recovery.
5. How the criminal justice system can address the needs of traumatized
In 1982, The President's Task Force on Victims of Crime (President's Task Force, 1982) concluded that the criminal justice system's treatment of crime victims was a national disgrace and specifically noted that violent crime produces psychological as well as physical injuries. The President's Task Force also called on the mental health community to:
Short-term Crime-related Psychological Trauma
Many violent crime victims also describe experiencing extremely high levels of physiological anxiety:
Cognitive symptoms of anxiety include:
Such physiological and emotional reactions are normal "flight or fight" responses that occur in dangerous situations.
In the days, weeks, and first two or three months after the crime, most violent crime victims continue to have high levels of fear, anxiety, and generalized distress (Kilpatrick, Veronen & Resick, 1979; Kilpatrick, Resick & Veronen, 1981; Norris & Kaniasty, 1994).
Many victims also experience negative changes in their pre-crime
beliefs that the world is a safe place where you can trust other
people, and where people get the things they deserve out of life
(e.g., Janoff-Bulman & Frieze, 1983; McCann & Pearlman,
Crime-related psychological trauma is not limited to a few days,
weeks, or months after a violent crime. Nor is the psychological
trauma experienced only by the crime victim. The scientific literature
concerning long-term psychological trauma has grown enormously
since the publication of the President's Task Force Report in
1982, so it is only possible to provide a brief review of the
major types of long-term crime-related psychological trauma.
Post-traumatic Stress Disorder (PTSD)
The DSM-IV diagnosis of PTSD refers to a characteristic set of
symptoms that develop after exposure to an extreme stressor (APA,
Sexual assault, physical attack, robbery, mugging, being kidnaped, child sexual assault, observing the serious injury or death of another person due to violent assault, and learning about the violent personal assault or death of a family member or close friend are specifically mentioned in the DSM-IV as types of stressors that are capable of producing PTSD. When exposed to these stressor events, the person's response must (according to the DSM-IV) involve intense fear, helplessness, or horror. Characteristic symptoms after the traumatic event include:
1. Persistent re-experiencing of the event (i.e., distressing
dreams, distressing recollections, flashbacks, or emotional and/or
physiological reactions when exposed to something that resembles
the traumatic event.)
2. Persistent avoidance of things associated with the traumatic
event or reduced ability to be close to other people and have
3. Persistent symptoms of increased arousal (i.e., sleep
difficulties, outbursts of anger, difficulty concentrating, constantly
being on guard, extreme startle response).
4. Duration of at least one month of symptoms.
5. Disturbance produces clinically significant distress or
impairment in social, occupational or other important areas
There are substantial research data from adults indicating that crime-related PTSD is a common reaction to violent crime (e.g., Kilpatrick, Saunders, Veronen, Best & Von, 1987; Kilpatrick & Resnick, 1993; Kendall-Tackett, Williams & Finkelhor, 1993; Breslau, Davis & Andreski, 1991; Resnick & Kilpatrick, 1994; Freedy et al., 1994). This research has found:
These findings have been identified in a number of studies including: (Sorenson et al., 1987; Atkeson et al., 1982; Ellis, Calhoun & Atkeson, 1980; Kilpatrick, Edmunds & Seymour, 1992; Frank & Stewart, 1984; Saunders et al., 1992), thoughts of suicide (Kilpatrick et al., 1992; Saunders et al., 1992; Kilpatrick et al., 1985), attempting suicide (Kilpatrick et al., 1985; Kilpatrick et al., 1992; Saunders et al., 1992), developing alcohol or other drug abuse problems (Burnam et al., 1988; Cottler et al., 1992; George & Winfield-Laird, 1986; Kilpatrick et al., 1994; Sorenson et al., 1987), and anxiety disorders such as panic disorder (Burnam et al., 1988; Saunders et al., 1992), agoraphobia (Burnam et al., 1988; Saunders et al., 1992), and obsessive compulsive disorder (Burnam et al., 1988; Saunders et al., 1992).
In addition to these mental disorders and mental health problems, violent crime often results in profound changes in other aspects of the victims' life. Many victims experience problems in their relationships with family and friends.
Among the relationship problems they can experience is difficulty in sexual relations with their partner (Becker, Skinner, Abel & Tracy, 1982; Becker et al., 1986; Resick, 1986; Saunders et al., 1992). Often because of their high levels of crime-related fear, many victims change their lifestyles substantially and restrict their usual activities.
The negative changes in pre-crime beliefs and attributions
about the world that are short-term problems often become
long-term problems (e.g., Kilpatrick & Otto, 1987; Resick,
1993; Resick & Schnicke, 1993). Compared to non-victims, crime
victims also experience increased risk of future victimization.
Most crime victims think that the criminal justice system should be responsible for providing them with counseling for crime-related psychological trauma (Freedy, Resnick, Kilpatrick, Dansky, & Tidwell, 1994; Amick-McMullan et al., 1991; Kilpatrick, Amick & Resnick, 1990).
A national probability household sample of surviving family members of homicide victims (Kilpatrick et al., 1990) and a sample of South Carolina crime victims whose cases were recently adjudicated by the criminal justice system (Freedy et al., 1994) were asked if they thought the criminal justice system should be responsible for seeing that crime victims and their families receive access to psychological counseling and several other services.
This is particularly noteworthy because virtually all of these
crime victims would have been eligible for crime victim compensation
coverage for their mental health counseling. Clearly, a problem
exists because most crime victims expect the criminal justice
system to provide them with access to counseling, but most victims
-- including those with crime related PTSD -- say they don't get
the counseling they need.
Criminal justice system professionals and other victim advocates encounter crime victims with crime-related psychological trauma every day. Few criminal justice system professionals and other victim advocates are trained mental health professionals, so they often have questions about how they can best deal with victims to reduce their psychological trauma. Because they are not mental health professionals, criminal justice system professionals or other victim advocates are not expected to provide specialized mental health treatment to victims with crime-related psychological trauma.
However, criminal justice system professionals and victim advocates
do need to know about state-of-the-art specialized counseling
procedures for crime-related psychological trauma. They also need
to know how to help victims obtain access to adequate counseling.
In order to appropriately refer crime victims to mental health
counselors, criminal justice professionals must be familiar with
the training and credentials of the various professionals who
may be available.
Mental health professionals differ with respect to the amount and type of training they received prior to getting their professional degree. Here is a brief description of the major types of "mainstream" mental health professionals and their training.
In addition to these "mainstream" mental health providers, certain other groups also provide counseling services to victims. These include pastoral counselors from the clergy and some nurses with special mental health training. Traditional healers from Native American cultures may not fit into these traditional mental health professional categories, but have specific expertise and training based on the knowledge and mores of their culture.
Another important issue in evaluating the credentials of mental health professionals is whether they are licensed, certified, or registered in the state where services are being provided. These usually require passing an oral and written exam.
A final consideration in evaluating the credentials of mental
health professionals is the extent of their specific knowledge
and experience in working with crime victims. Unfortunately, there
is no requirement that graduate training for any type of mental
health professional include information about assessment and treatment
of crime-related psychological trauma. Nor does the licensure
process require possession of this knowledge and expertise. Thus,
there is no guarantee that any given mental health professional
will be knowledgeable about assessment and treatment of crime-related
psychological trauma. Therefore, it is necessary to inquire about
the extent of a mental health professional's expertise in this
There are literally hundreds of different psychotherapies, but relatively few are designed specifically for use with crime victims and have had their efficacy evaluated. Most of the research on efficacy of treatment for crime-related psychological trauma has been conducted with adult victims of rape rather than with child victims or with adult victims of other types of crimes. However, much of what has been learned from research on treatment of rape victims is probably applicable to treatment of other crime victims.
As was previously noted, many mental health professionals who treat crime victims have no specific training or expertise in crime-related psychological trauma. Therefore, they tend to use generic treatment procedures rather than treatment specifically targeted to crime-related trauma. However, there are specialized treatments that have received some type of evaluation as to their effectiveness. Most work has been done developing and evaluating treatments for rape-related psychological trauma and/or for victims of various types of traumatic events who developed PTSD. Readers interested in learning more about specialized treatment procedures should consult the following references (Briere, 1992; Calhoun & Atkeson, 1991; Falsetti & Resnick, in press; Foa, Rothbaum, Riggs, & Murdock, 1991; Foa, Rothbaum & Steketee, 1993; Kilpatrick, Veronen, & Resick, 1982; McCann & Pearlman, 1990; Resick & Schnicke, 1993).
Length and Timing of Treatment
How long treatment should be depends on a number of factors including
the extent of the victim's crime-related psychological trauma
and the amount of external social support the victim has. Most
treatment should be relatively short term in nature, however.
Crime-related psychological trauma does not end with the trial,
so victims may need brief booster sessions at other stressful
times in their lives including during parole hearings or release
Not all crime victims need or can benefit from specialized mental health counseling. Research has contributed to our understanding of which victims who are most likely to develop crime-related psychological trauma and who are most likely to require consultation with a trained mental health professional.
Of course, these are general guidelines. Not all victims
with these characteristics need mental health counseling, and
some victims without these characteristics do need counseling.
A more detailed treatment of this topic is contained in the following
references: (Hanson et al., 1995); Lurigio and Resick, 1990; Resnick
and Kilpatrick, 1994; Weaver and Clum, 1995).
Previctimization Characteristics of Victims
Before a crime occurs, victims differ in respect to their demographic characteristics, whether they have ever been a crime victim before, and how well adjusted they were before the crime. It is reasonable to assume that some of these previctimization characteristics might influence the traumatic impact of a new violent crime experience.
Although there are some exceptions, most studies show that victims' demographic characteristics such as gender, race, and age have little (if any) impact on crime-related psychological trauma (Lurigio and Davis, 1989; Calhoun and Atkeson, 1982; Kilpatrick and Resnick, 1993).
Prior victimization history has been consistently found to increase the likelihood of psychological trauma following a new crime (Burnam et al., 1988; Kilpatrick, Resnick, Saunders and Best, in press; Resnick, 1987). Specifically, victims with a prior victimization history suffer more crime-related psychological trauma after experiencing a new crime than victims without prior victimization. This highlights the importance of inquiring about prior victimizations.
The prior mental health history of the victim appears to be related to the extent of crime-related psychological trauma a victim experiences (see Lurigio and Resick, 1990, review; Kilpatrick, Resnick, Saunders and Best, in press; Resnick and Kilpatrick, 1990). Kilpatrick et al (in press) found that women who had PTSD in the past were substantially more likely to get PTSD after experiencing a new crime than women who had not had PTSD previously.
Resnick, Kilpatrick, Best and Kramer (1992) found that prior history of most mental disorders did not increase risk of developing PTSD after experiencing a stressful, violent crime. However, a history of major depression did increase the risk that PTSD would develop, but only if the crime was highly stressful. This suggests that victims with PTSD or depression may be particularly vulnerable to crime-related psychological trauma, but also confirms the important role played by the stressful nature of the crime itself.
Seriousness of the crimes has consistently been found to be related to the degree of crime-related psychological trauma (Kilpatrick et al., 1989; Lurigio and Resick, 1990; Kilpatrick et al, in press; Kilpatrick and Resnick, 1993; Weaver and Clum, 1995; Resnick et al., 1993).
In general, violent crime such as rape, aggravated assault, homicide
and alcohol-related vehicular homicide produce more crime-related
psychological distress than property crimes like burglary. Also,
victims' appraisals of how dangerous the crime was are related
to crime related psychological trauma. (See Weaver and Crum's
review, 1995). In particular, a belief that one might have been
seriously injured or killed in a crime is a more powerful predictor
of distress than objective factors such as physical injury, force
and use of a weapon. Research evidence is clear that how serious
and dangerous the crime is constitutes the most important factor
in determining crime-related psychological trauma.
Two major postvictimization factors are thought to play an important role in victim recovery from crime-related psychological trauma. The first is social support. In general, most studies find that good relationships and support from family members and friends assist victims' recovery (e.g. Hanson et al., 1995); Lurigio and Resick, 1990; Kaniasty and Norris, 1992). Consequently, it is important to determine the extent and supportiveness of a crime victim's potential social support network. Victims with little social support are probably more likely to need professional counseling.
The second major postvictimization factor is the degree and nature of exposure to the criminal justice system. Although participation in the criminal justice system is generally regarded as a negative factor in victims' recovery (e.g., Kelly, 1990; President's Task Force on Victims' of Crime, 1982; Symonds, 1980), there are some data suggesting that involvement with the criminal justice system need not always have a negative effect (Kilpatrick and Otto, 1987; Lurigio and Resick, 1990; Resick, 1988). A positive experience, however, is largely reliant on treatment of victims that is comprehensive, sensitive and inclusive.
There is no question that the criminal justice system is stressful
for victims. The whole point of making the criminal justice system
more "victim friendly" is the assumption that doing
so may actually reduce the trauma to the victims. It is also reasonable
to assume that being believed and treated well by the criminal
justice system could make things better for victims, notwithstanding
the inherently stressful nature of the criminal justice system.
Kilpatrick (1986) provided the following list of suggestions about how criminal justice system personnel can avoid producing additional trauma to crime victims:
Self Examination Chapter 10
The Mental Health Impact of Crime:
Fundamentals in Counseling and Advocacy
1) Identify three possible victim reactions that
constitute short-term crime related trauma.
2) What are the five characteristic symptoms of post-traumatic
3) Are there any previctimization characteristics
that might affect how a victim reacts following a crime? If you,
4) Name 3 factors related to the crime or postvictimization
factors that influence victim recovery from crime related psychological
5) How can the criminal justice system address the
mental health needs of crime victims?
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