Chapter 6

Impact of Crime on Victims

## Eidell Wasserman and Carroll Ann Ellis[^1]

The trauma of victimization can have a profound and devastating impact
on crime victims and their loved ones. It can alter the victim's view of
the world as a just place and leave victims with new and difficult
feelings and reactions that they may not understand. It is important for
victim assistance professionals to understand the different ways that
crime can affect victims---psychologically, financially, physically and
spiritually. Any discussion of the impact of crime on victims is
necessarily general in scope. The following information is offered to
help victim assistance professionals to be aware of the common types of
reactions that victims experience, and should be used as general
guidelines to provide direction and references for additional resources.

Crime has significant, yet varying consequences, on individual crime
victims, their families and friends, and communities. The impact of
crime on victims results in emotional and psychological, physical,
financial, social and spiritual consequences. While there are no
consistent findings about victims' challenges in coping with the
aftermath of criminal victimization with respect to demographic
characteristics, a victim's ability to cope with the impact of crime
depends on a variety of factors (National Institute of Mental Health,
2006):

-   A history of victimization increases trauma following a new crime.

-   A history of mental health problems increases trauma following a new
    crime, particularly a history of post-traumatic stress disorder or
    major depression.

-   A higher degree of threat to life and physical injury increases the
    risk of difficulty in coping.

-   Generally, violent crime victims have a more difficult time coping
    than property crime victims.

-   Research also indicates two key post-victimization factors that can
    increase the likelihood of victims to develop mental health
    problems:

    -   A lack of or poor social support systems.

    -   The degree of exposure to the justice system.

The incidence of violent crime in the United States decreased from 1994
to 2004 (U.S. Department of Justice, 2006); however, according to the
FBI Uniform Crime Reports (2006), violent crime increased in 2005. Rape
was the only violent crime that showed a decrease. Americans are still
concerned about becoming crime victims. Americans' fear of becoming a
victim of a crime affects more people than crime itself (Warr, 2000).

According to the Bureau of Justice Statistics, in 2004:

-   About 14 percent of households in the United States (16 million
    households) experienced one or more property crimes or had a member
    age 12 or older who experienced one or more violent crimes.

-   About one in 250 households included a member victimized by an
    intimate partner, such as a spouse, ex-spouse, boyfriend, or
    girlfriend.

-   About 5 percent of households had at least one incident of
    vandalism. Over 5.6 million households were vandalized during this
    period (Klaus, 2006).

Recent research has shown that Native Americans and Alaska Natives are
victims of violent crime more often than members of any other group.
American Indians experienced a per capita rate of violence twice that of
the U.S. resident population. On average, American Indians experienced
an estimated one violent crime for every 10 residents age 12 or older
(Perry, 2004).

As the field of victim services has evolved, so has understanding of the
multidimensional impact of crime on victims, their families, and their
communities. Victims of either violent or nonviolent crimes can face a
multitude of challenges as the result of their victimization. Crime
affects victims and their families on a variety of levels: physical,
physiological, behavioral, emotional, cognitive, financial, social, and
spiritual. Victim assistance programs may offer resources to deal with
many or all of these issues.

Victim service providers need to:

-   Understand the dynamics of trauma and the vital role victim service
    providers have in trauma response and victims' rights advocacy.

-   Remember that every victim is unique.

-   Never make assumptions concerning how a victim will react.

-   Recognize that a person's reaction to victimization will be
    influenced by a variety of factors.

-   Try to identify the specific needs of individual victims and develop
    a plan to meet them.

-   Know and use the wide range of community, cultural, and justice
    system resources to meet the myriad needs of victims.

-   Become familiar with the culture and traditions of the populations
    being served.

The impact of crime is frequently described through the results of
research studies. Participants in these studies often are people who
have sought services from agencies (for example, victim assistance
agencies, social services, and hospitals) or who are involved in the
criminal justice system. Research allows us to present information in
easily understood numerical terms. The impact of crime is not easily
understood or quantifiable, however. Many cultures and groups have a
more experiential approach to human events and do not find empirical
approaches helpful. This chapter focuses on the more mainstream
empirically based approach. Students are encouraged to think beyond the
numbers and research results and develop an awareness of the
multilayered impact of crime, as well as the individual, highly personal
meaning that victims, their families, and their communities attach to
crime victimization.

## WHO IS AFFECTED BY CRIME?

Everyone is affected by crime, either as a direct victim or a friend or
family member of a victim. Even individuals who are not direct victims
of crime can be negatively affected in a variety of ways, such as
developing an increased fear of crime or experiencing the financial
impact of crime (e.g., higher insurance rates, lost work days). While
primary victims of crime might be identified easily, secondary victims
such as family and clan members may not be so readily identifiable and
may not receive needed services. Identifying services offered for
neighborhoods and communities can be even more difficult.

Another group affected by crime is first responders---the people who
typically are first on the scene or first to respond to crime, including
police officers, firefighters, and emergency medical technicians. A
vivid example of the impact of crime on first responders involves those
who responded to the September 11, 2001, terrorist attacks. Descriptions
of stepping through or on body parts while trying to find survivors
illustrate the experiences that can cause long-term trauma to first
responders. However, crimes need not have devastating, large-scale
impact to affect those who respond. An officer interviewing a child
sexual abuse victim may be reminded of her or his own child of the same
gender and age.

The term "trauma" often is used to describe the experience of crime
victims. Trauma refers to both a medical and a psychiatric condition.
"Medically, 'trauma' refers to a serious or critical bodily injury,
wound, or shock. Psychiatrically, 'trauma' has assumed a different
meaning and refers to an experience that is emotionally painful,
distressful, or shocking, which often results in lasting mental and
physical effects" (National Institute of Mental Health, 2006, p. 2).

## POTENTIAL VICTIM REACTIONS IN THE AFTERMATH OF CRIME

**Immediate and Short-term Trauma Reactions**

Number range CHAPTERShort-term trauma occurs during or immediately after
the crime and lasts for about 3 months (Kilpatrick, 2000). This time
frame for short-term versus long-term trauma is based on several studies
showing that most crime victims achieve considerable recovery sometime
between 1 and 3 months after the crime. Some common responses to trauma
include the following:

-   Few crime victims are anticipating a violent assault as the crime
    occurs, so most are shocked, surprised, and terrified when it
    happens.

-   Crime victims often have feelings of unreality when an assault
    occurs and think, "This can't be happening to me."

-   People who have been victimized in the past are at greater risk of
    developing emotional problems than newly victimized individuals.
    Victims do not "get used to it."

-   Many victims of violent crime describe experiencing extremely high
    levels of physiological anxiety, including rapid heart rate,
    hyperventilation, and stomach distress.

-   Crime victims often experience cognitive symptoms of anxiety,
    including feeling terrified, helpless, guilty, or out of control.

Such physiological and emotional reactions are normal "flight or fight"
responses that occur in dangerous situations. In the days, weeks, and
first 2 or 3 months after the crime, most victims of violent crime
continue to have high levels of fear, anxiety, and generalized distress.
The following are examples of distress that may disrupt crime victims'
ability to perform simple mental activities requiring concentration:

-   They are preoccupied with the crime; they think about it a great
    deal, talk about it, or have flashbacks and bad dreams about it.

-   They are often concerned about their safety from attack and about
    the safety of their family members.

-   They are concerned that other people will not believe them or will
    think that they were to blame for what happened.

-   Many victims also experience negative changes in their belief
    systems and no longer think that the world is a safe place where
    they can trust other people.

-   For victims of some crimes, such as child abuse or domestic
    violence, the trauma occurs many times over a period of weeks,
    months, or even years. Victims in such cases often experience the
    compounded traumatic effects of having to always worry about when
    the next attack will occur.

**Long-term Trauma Reactions**

Most victims of crime are able to cope with the trauma of victimization.
This is especially true of those who receive counseling, other
supportive services, and/or information about justice processes and
their relevant rights. However, if victim trauma is neither identified
nor addressed with mental health assistance, the initial and short-term
trauma reactions can exacerbate and turn into long-term trauma
reactions, including:

-   Major depression.

-   Thoughts of suicide and suicide attempts.

-   Use and abuse of alcohol and other drugs.

-   Ongoing problems with relationships.

-   Anxiety disorders.

-   A changing view of the world as a safe place.

-   Increased risk of further victimization.

**Posttraumatic Stress Disorder (PTSD)**

The American Psychiatric Association (2000) describes a characteristic
set of symptoms that develop after exposure to an extreme stressor.
Types of stressors that are capable of producing PTSD include sexual
assault, physical attack, robbery, mugging, kidnapping, or child sexual
assault, as well as 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. People who respond
to these stressors with intense fear, helplessness, or horror, and whose
symptoms persist over a specified length of time and influence their
functioning in major areas of life, may be experiencing symptoms of
PTSD. In such cases, appropriate medical attention is required. However,
PTSD is a psychiatric illness that can only be diagnosed by a trained
professional. The following are characteristic symptoms after a
traumatic event:

-   Persistent reexperiencing of the event (i.e., distressing dreams,
    distressing recollections, flashbacks, or emotional or physiological
    reactions when exposed to something that resembles the traumatic
    event).

-   Persistent avoidance of things associated with the traumatic event
    or reduced ability to be close to other people and experience or
    sustain loving feelings.

-   Persistent symptoms of increased arousal (i.e., sleep difficulties,
    outbursts of anger, difficulty concentrating, constantly being on
    guard, extreme startle response).

Research studies with adults (Resnick, 1993) indicate that PTSD is a
frequent reaction to violent crime:

-   Rates of PTSD are much higher among those who have been victims of
    violent crime than those who have been victims of other types of
    traumatic events. For example, one study found that the lifetime
    prevalence of PTSD was 25.8 percent among crime victims compared to
    9.4 percent among victims of other traumatic events.

-   Victims of crimes that resulted in physical injuries, and who
    believed they might have been killed or seriously injured during the
    crime, were much more likely to suffer from PTSD than victims whose
    crimes did not involve life threat or physical injury (45.2 percent
    compared to 19 percent).

-   Rates of PTSD appear to be higher among victims who report crimes to
    the justice system than among non-reporting victims, probably
    because these crimes are more serious or more likely to result in
    injury.

Evidence shows that many crime victims with PTSD do ***not***
spontaneously recover without treatment, and some crime victims
experience PTSD years after they were victimized.

**Physical, Spiritual, Emotional, and Financial Impact of Crime**

Victims may face a wide range of immediate, short-term, and long-term
reactions in the aftermath of crime. Every crime victim is unique.
Individual trauma is affected by previctimization and postvictimization
factors related to individual experiences, degree of personal and social
support, resiliency, and exposure to supportive services.

Brief summaries of the physical, spiritual, emotional/psychological, and
financial impacts of crime are shown in Exhibits VI-1 and VI-2, which
provide an overview of *the range of possible reactions* that victims
*may* experience.

### [Exhibit VI-1]{.smallcaps}

### [Physical and Spiritual Impact of Crime on Victims]{.smallcaps}

+-----------------------------------+-----------------------------------+
| **Physical Impact**               | ### Spiritual Impact              |
+-----------------------------------+-----------------------------------+
| -   Physiological anxiety         | -   In an attempt to understand   |
|     (including rapid heart rate,  |     events that make no sense,    |
|     hyperventilation, and stomach |     people who do and do not      |
|     distress)                     |     engage in religious practice  |
|                                   |     often turn to the spiritual   |
| -   Physical injuries (such as    |     beliefs with which they were  |
|     gunshot wounds, lacerations,  |     raised. These spiritual       |
|     broken bones, sprains, and    |     insights are sometimes        |
|     burns)                        |     helpful; more often than not, |
|                                   |     however, victims express      |
| -   Physical injuries that lead   |     disappointment in the         |
|     to other health conditions    |     reactions of their faith      |
|     (such as heart attack,        |     communities.                  |
|     stroke, fractures from        |                                   |
|     falling, and loss of          | -   All religions accept          |
|     dexterity)                    |     suffering as a component of   |
|                                   |     the human experience but      |
| -   Increased risk of cardiac     |     understand its role           |
|     distress, irritable bowel     |     differently. Hindus and       |
|     syndrome, and chronic pain    |     Buddhists understand the role |
|                                   |     of karma in tragic events and |
| -   Permanent disability          |     seek to accept what has       |
|                                   |     happened rather than seek     |
| -   Disfigurement                 |     justice. Jews believe that    |
|                                   |     God expects human beings to   |
| -   Immune disorders that         |     act in kindness to one        |
|     increase the potential for    |     another; when they do not,    |
|     infectious diseases           |     justice is sought and         |
|                                   |     forgiveness must be earned.   |
| -   Substantial lifestyle         |     The wide gamut of             |
|     changes, including            |     Christianity practiced in the |
|     restriction of activities     |     United States includes all    |
|     once enjoyed                  |     perspectives, from acceptance |
|                                   |     of suffering as "God's will"  |
| -   Lethargy and body fatigue     |     and forgiveness of offenders  |
|                                   |     to strong drives for justice  |
| -   Sleep disorders               |     in the secular arena. Muslims |
|                                   |     believe they have a special   |
| -   Loss of appetite, excessive   |     mission from God/Allah to     |
|     appetite, or eating disorders |     create a just society. They   |
|                                   |     typically condemn violence    |
| -   Decreased libido and sexual   |     and willingly participate in  |
|     dysfunction                   |     the justice system.           |
|                                   |                                   |
| -   Inability to work             |                                   |
|                                   |                                   |
| -   Increased risk of future      |                                   |
|     victimization                 |                                   |
|                                   |                                   |
| -   For sexual assault victims:   |                                   |
|     possible exposure to sexually |                                   |
|     transmitted diseases,         |                                   |
|     exposure to HIV, and unwanted |                                   |
|     pregnancy                     |                                   |
+-----------------------------------+-----------------------------------+

**[Exhibit VI-2]{.smallcaps}**

Emotional/Psychological and Financial Impact of Crime on Victims

+------------------------------------+---------------------------------+
| ### Emotional/Psychological Impact | ### Financial Impact            |
+------------------------------------+---------------------------------+
| -   Shock                          | -   Medical bills (e.g.,        |
|                                    |     emergency transportation,   |
| -   Terror                         |     hospital stays, inpatient   |
|                                    |     and outpatient physical     |
| -   Feelings of unreality          |     care, medical supplies)     |
|                                    |                                 |
| -   Feelings of numbness           | -   Medication and prescription |
|                                    |     drugs                       |
| -   Confusion                      |                                 |
|                                    | -   Replacement of eyeglasses,  |
| -   Helplessness                   |     hearing aids, or other      |
|                                    |     sensory aid items damaged,  |
| -   Fear                           |     destroyed, or stolen        |
|                                    |                                 |
| -   Anger or rage                  | -   Rental and related costs    |
|                                    |     for physical mobility       |
| -   Grief or intense sorrow        |     restoration equipment       |
|                                    |     (e.g., wheelchairs, ramps,  |
| -   Enhancement of particular      |     crutches)                   |
|     senses (e.g., hearing, smell,  |                                 |
|     sight)                         | -   Physical therapy            |
|                                    |                                 |
| -   Anxiety (including terror,     | -   Occupational therapy        |
|     helplessness, and feeling out  |                                 |
|     of control)                    | -   Job retraining              |
|                                    |                                 |
| -   Difficulty trusting self or    | -   Mental health counseling    |
|     others                         |     and therapy                 |
|                                    |                                 |
| -   Depression                     | -   Loss of wages due to        |
|                                    |     incapacitation,             |
| -   Panic symptoms                 |     rehabilitation, or taking   |
|                                    |     time off from work to       |
| -   Anxiety disorders (e.g., panic |     repair damage from property |
|     disorder, agoraphobia,         |     crimes, participate in      |
|     obsessive-compulsive disorder) |     criminal or juvenile        |
|                                    |     justice proceedings, or     |
| -   Inability to concentrate       |     seek medical or mental      |
|                                    |     health treatment            |
| -   Guilt and self-blame           |                                 |
|                                    | -   Crime scene cleanup         |
| -   Shame                          |                                 |
|                                    | -   Loss of or damage to        |
| -   Preoccupation with the crime   |     personal property           |
|                                    |                                 |
| -   Concerns about personal safety | -   Costs of replacing locks    |
|                                    |     and changing security       |
| -   Problems with important        |     devices                     |
|     relationships                  |                                 |
|                                    | -   Child and elder care        |
| -   Social withdrawal              |                                 |
|                                    | -   Fees incurred in changing   |
| -   Concerns about being believed  |     banking or credit card      |
|                                    |     accounts                    |
| -   Concerns about being blamed    |                                 |
|                                    | -   Higher insurance premiums   |
| -   Negative changes in belief     |                                 |
|     system                         | -   Relocation expenses         |
|                                    |                                 |
| -   Increased feelings of          | -   For families of homicide    |
|     vulnerability                  |     victims, funeral and burial |
|                                    |     expenses and loss of income |
| -   Increased risk of alcohol or   |                                 |
|     other drug abuse               |                                 |
|                                    |                                 |
| -   Isolation                      |                                 |
|                                    |                                 |
| -   Persistent avoidance of things |                                 |
|     associated with the traumatic  |                                 |
|     event                          |                                 |
|                                    |                                 |
| -   Suicide ideation               |                                 |
|                                    |                                 |
| -   PTSD                           |                                 |
+------------------------------------+---------------------------------+

**THE FINANCIAL COSTS OF CRIME**

Some of the financial costs of crime---such as property damage,
replacement of stolen or damaged items, medical bills, lost days at
work, and therapy expenses---are easy to identify. However, emotional
pain and suffering, fear, damage to interpersonal relationships,
community-wide fear and loss, and other intangible costs can be
difficult to measure. In 1996, the U.S. Department of Justice published
a study of the costs and consequences of crime victimization that
attempted to quantify both the monetary costs of crime victimization as
well as the psychological/emotional costs (Miller, Cohen, and Wiersema,
1996). Among the findings were:

-   Personal crime is estimated to cost **\$105 billion** annually in
    medical costs, lost earnings, and public program costs related to
    victim assistance.

-   Including pain, suffering, and the reduced quality of life increases
    the cost of crime to victims to an estimated **\$450 billion**
    annually.

-   Violent crime (including drunk driving and arson) accounts for
    **\$426 billion** of this total, with property crime at **\$24
    billion.**

One method for assigning value to fear, pain, suffering, reduced quality
of life, and other intangible costs is to use the amount of money given
in jury awards for these losses. This method is imperfect, however, as
it does not take into account the impact on a person's extended family
or clan nor the impact on the wider community. Some crimes, such as hate
crimes, may negatively affect every member of a particular group in a
city or state or even the entire country. In fact, one of the purposes
of a hate crime is to affect all members of the targeted group (Craig,
2002).

**Who Pays for Crime?**

Victims and their families pay the actual financial costs for some
crimes, while insurance companies, government, taxpayers, and employers
also pay. Insurers pay \$45 billion annually due to crime, or \$265 per
American adult (Miller, Cohen, and Wiersema, 1996).

***Community Impact***

Crime has an impact not only on primary and secondary victims but also
on the entire community. High-profile major crimes, such as school
shootings or multiple-victim molestations, understandably will have an
impact on all community members. Other crimes, such as kidnappings,
sexual assaults, or drunk driving crashes, can also have a wide effect.
Some communities have begun to use community victim impact statements to
assess the effect of crime. Similar to individual victim impact
statements, these statements can be introduced after conviction to
assist the judge in sentencing. The use of such statements, even on a
limited basis, shows that the court system is beginning to acknowledge
the wider impact of crime beyond the primary victim and family members.

## THE IMPACT OF TRAUMA ON BRAIN DEVELOPMENT

A variety of research studies have examined the impact of trauma on
brain development (DeBellis, 1999; Perry, 1997; van der Kolk, 1994). The
research strongly suggests that physiological changes take place in a
child's developing brain due to the experience of trauma. Changes in the
developing brain can even take place in utero, based on the mother's
experience of trauma or stress (Dowling, Martz, Leonard, and Zoeller,
2000). A child's brain continues to develop after birth, weighing 75
percent of its adult weight by age 2 and being almost completely
developed by age 5 (Wasserman, 2004).

Traumatic experiences before age 5 may alter the development of neural
pathways, sensitizing pathways that are related to fear and arousal.
This sensitization predisposes the child to react to external stimuli in
a certain way. A child who has been exposed to traumatic events may be
predisposed to react to all situations as potentially dangerous.
Physiological changes, such as the release of stress hormones, can cause
the child to become hypervigilant, fearful, and anxious.

Successful emotional and social development are dependent on successful
brain development. As the child grows and the brain matures, the brain
is dependent upon external stimuli for normal growth. There appear to be
critical time periods for the development of certain skills. A child who
does not learn verbal language skills by a certain age may never be able
to develop these skills. The parts of our brains that control higher
order functions such as social skills, emotional control, and logical
thinking are among the last areas to develop. If a child experiences
trauma in the early years, normal brain development may be affected,
making it more difficult to develop these higher order skills.

> The brain develops, in part, in response to the infant's experiences.
> If the relationship with the primary caregiver is neglectful or
> abusive, this will have a negative impact on the child's development
> of appropriate coping skills. Trauma in early life can lead to
> problems in maintaining interpersonal relationships, coping with
> stressful situations, and controlling emotion (Wasserman, 2004, p.14).

## THE IMPACT OF TRAUMA ON THE DEVELOPED (ADULT) BRAIN

Response to trauma leading to psychological and physiological disorders
should be viewed as a spectrum of conditions rather than a single
disorder. On one end is acute stress reaction that resolves on its own
without treatment. "Complex" posttraumatic stress disorder (PTSD) is at
the other end of the spectrum, and "classic" or "simple" PTSD lies
somewhere in between (Herman, 1997). While there is also a spectrum of
adaptation to traumatic events, the various conditions have some basic
features in common. One of these features is the effect of trauma on the
adult brain.

Trauma's effect on the brain has become of increasing interest to
researchers, clinicians, victims, and victim advocates. With
advancements over the last decade in the field of neuroimaging,
scientists are better able to document and understand the structural,
biochemical, and functional condition of individuals who have
experienced trauma that results in posttraumatic stress disorder. The
causal relationship between trauma and brain adaptation, however, is not
without controversy. Some scientists question whether a preexisting
brain anomaly might serve as a risk factor for development of PTSD
following a person's exposure to trauma (Stein, Hanna, Koverola,
Torchia, and McClarty, 1997). Others suggest that brain abnormality
occurs only in persons with chronic or complicated PTSD (Bonne, Brandes,
Bilboa, et al., 2001). While study findings to date are tentative,
scientists do know that certain areas of the brain are consistently
implicated in PTSD.

These regions of the brain play an important role in learning and memory
(hippocampus), emotional regulation (medial prefrontal cortex), and
encoding of emotional memories, sensitization, and fear conditioning
(amygdala). They are all part of what is called the limbic system of the
brain. Emotion and memory are very closely related. In ordinary
circumstances, we tend to remember things that carry some emotional
content. For example, we are more apt to recall someone we just met if
that person made us laugh or feel embarrassed. Exposure to severe stress
affects the memory and emotional regulation portions of the brain. The
medial prefrontal cortex is then less able to inhibit the amydala,
thereby further intensifying and increasing occurrences of traumatic
memories. This confluence of brain deficits creates one of the hallmark
symptoms of PTSD: exaggerated emotional reaction coinciding with
difficulty recalling the emotional event (Elzinga and Bremmer, 2001).
Other symptoms include emotional numbing, avoidance, and reexperiencing
the trauma.

Neuroimaging studies, which reveal changes in the brain's structure and
function in persons with PTSD, underscore deficits found in hippocampal
function using neuropsychological measures. Magnetic resonance imaging
(MRI) has shown reduction in the volume of the hippocampus in
individuals exposed to trauma. Positron emotion tomography (PET) studies
have shown dysfunction in the prefrontal cortex in individuals
responding to stimuli associated with their PTSD (Bremmer, 1999). In
addition, it is reported that chronic hyperarousal symptoms (mediated by
the amygdala) contribute to atrophy of the hippocampal region of the
brain (Villarreal and King, 2001).

Being able to measure---to document---changes in the brain carries
enormous implications for individuals with PTSD. For example, a
diagnosis of PTSD may have bearing on an individual's job security and
workplace accommodation (based on regulations set forth by the Americans
With Disabilities Act). The Social Security Administration's disability
claim evaluation process does not focus on specific diagnoses, but on
functional limitations imposed by an illness or impairment. But if and
when impairment is documented through assessment, it can be a
determining factor in obtaining eligibility for Social Security
Disability Insurance (SSDI) or Supplemental Security Income (SSI). In
most states, eligibility for these programs also confers eligibility for
Medicaid. Medicaid benefits enable recipients to obtain better access to
health care and enable providers to obtain compensation for these health
services. Less defined, but equally critical, is the impact a diagnosis
of PTSD may have on personal relationships. Family members, friends,
coworkers, as well as the patients themselves, are more likely to accept
emotional abnormalities when they are viewed and understood as a medical
issue, not simply a "mood problem."

Examining the physiological impact of trauma on the brain through
neuroimaging has another benefit. There is recent evidence that damage
to the limbic brain regions can be reversed. The effects of trauma can
be countered in a number of ways. Both cognitive processing therapy
(CPT)) and prolonged exposure therapy have been found to mediate
negative outcomes of trauma (Resick, Nishith, Weaver, Astin, and Feurer,
2002). Also, studies using serotonin reuptake inhibitors (SSRIs), a
class of antidepressants, and phenytoin, a medication commonly used for
epilepsy, reported that these treatments increased the volume of the
hippocampus (by 5 percent and 6 percent, respectively) in patients with
PTSD. At the same time, the SSRI increased memory function by 35 percent
(Bremmer, 2006).

Posttraumatic stress disorder is a highly disabling condition associated
with an extremely high rate of medical and mental health service use. It
is diagnosed in combat veterans, victims of child abuse, and mothers of
chronically ill children. It occurs in victims of crime as well as
witnesses to crime, victims of physical abuse and victims of emotional
abuse, persons who receive a threat as well as persons who only perceive
a threat. As the vulnerable hippocampus and other portions of the limbic
system are exposed to trauma, the brain is altered. Some people are more
vulnerable to trauma than others. Coping mechanisms, age, social
supports, and drug use are all mitigating factors. Anyone can get PTSD.
It is a "normal response to an abnormal occurrence."

Scientists know that other regions of the human body are also affected
by trauma. People with PTSD tend to have abnormal levels of key hormones
involved in response to stress. Cortisol levels are lower than normal
and epinephrine and norepinephrine are higher than normal Also, when
people are in danger, they produce high levels of natural opiates, which
can temporarily mask pain. People with PTSD tend to produce higher
levels of these opiates after the danger has passed, which can lead to
blunted emotions (National Institute of Mental Health, 2002).

Additional studies to examine how the brain functions will help
researchers better understand the physiological impact of trauma on
brain development and brain damage. This area of research may help
service providers understand the long-term impact of trauma and the
importance of prevention.

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[^1]: Authors of this chapter are Eidell Wasserman, Ph.D., Sebastopol,
    CA; and Carroll Ann Ellis, J.D., Fairfax County Police Department,
    Fairfax, VA