There is good evidence that assaultative violence is more damaging to the individual's mental health than other types of traumatic events. (!4) Good recovery from criminal victimization is largely dependent on how the victim processes and makes sense of what has happened, whether the act can be incorporated and accommodated into an existing frame of reference or whether the experience is so overwhelming and out their ordinary everyday experience as to render them incapable of reaching some kind of resolution. The effects of criminal victimization can be profound and long lasting; (!5) however, when victims of crime present to health professionals they are rarely asked about criminal victimization and are unlikely to volunteer this information spontaneously. (!6)
Victims of violent or contact crime often report a sense of detachment, depersonalization, or derealization during the act. This may have survival value, in allowing an individual to cope with an overwhelming event, to minimize the immediate pain but it may interfere with longer-term recovery. The importance of dissociative symptoms in the later development of post-traumatic stress disorder has been explored by a number of researchers. Dancu et al/HD found that peritraumatic dissociation was predictive of post-traumatic stress disorder development in women who had experienced a serious violent assault, but not in women who had been raped. However, Foa et alAl8) found that numbing symptoms were associated with the subsequent development of post-traumatic stress disorder in victims of rape and sexual assault. Whilst dissociation is not a part of the post-traumatic stress disorder symptomology, it is included as a prominent feature in the new diagnosis of acute stress disorder/,19 Features include dissociation in the form of numbing, reduction in awareness, derealization, depersonalization, and amnesia. The relationship between acute stress disorder and the subsequent development of post-traumatic stress disorder in victims of crime has been examined by Brewin et al.(2.9 who found that a diagnosis of acute stress disorder at the 1-month point predicted 83 per cent of post-traumatic stress disorder cases at 6 months follow-up.
Many of the psychological responses exhibited by victims of crime fit within a post-traumatic stress disorder framework (see Chapter.4.6.2) and may also be observed in witnesses to crime and helpers. In a study of 391 women, 27 per cent of all crime victims developed post-traumatic stress disorder. (1..5) Highest rates of post-traumatic stress disorder are found in relation to crimes involving a perception of life threat and resulting in physical injury. (2 22) Symptoms include alternating intrusive recollections of the experience, avoidance of situations that resemble or symbolize the trauma (including thinking or talking about it), and hyperarousal. Features of avoidance include detachment and a blunting of emotional affect, as well as avoidance of places and people associated with the event. Symptoms of hyperarousal include increased vigilance and startle responses, sleep disturbance, anger and irritability, and impaired concentration and memory. Aspects of life that were previously judged important lose their significance and the capacity for intimate emotional relationships may be reduced or lost. There may be increased impulsivity and risk taking, as well as an increase in alcohol and drug use, often as an attempt to counteract the high level of arousal and anxiety. Individuals who are diagnosed with post-traumatic stress disorder also experience impaired work or social functioning.
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