A step towards a broader understanding of complex traumatization in victims of crime: psychological and physical health impacts and implications for psychological interventions and treatment evaluation.

Abstract

Epidemiological studies have revealed high rates of criminal victimization in the general community as well as in treatment seeking populations. As a consequence, many crime victims present with a broad range of psychological and physical health impacts which exceed far beyond the current conceptualization of posttraumatic stress disorder. Accordingly, the current project aimed at an exploration of the complex problems faced in the context of severe interpersonal violence, using a mixed methodological design within a pragmatist paradigm. The first study (n=58) involved a quantitative exploration of the psychological and physical health problems in victims of crime as compared to a normally stressed community sample without a history of traumatization. Psychological impacts were assessed by standardized psychological measures, whereas influences on physical health were captured by an analysis of biochemical markers that reflect stress- related changes in immune functioning. Once impacts on psychological and physical health were established, a second study (n=17) was conducted to gain a better understanding of individual stress conceptualizations. This study involved a qualitative framework analysis of semi-structured interviews with victims of crime. The results from Study I and II informed the development of a phase oriented psychological treatment program for victims of crime, using cognitive-behavioural and hypnotherapeutic treatment components. This was followed by an outcome –and process evaluation of a combined CBT/Hypnotherapy treatment in comparison to a CBT treatment only to explore additive benefits of hypnotherapy. Although a multiplicity of traumatic sequelae was indicated by the results of the preceding studies, the treatment process revealed an even greater complexity of traumatization which was difficult to accommodate in the proposed treatment program. Moreover, twelve out of nineteen participants discontinued treatment, making it difficult to determine the additive benefits of hypnotherapy. A qualitative analysis of the treatment sessions was conducted to elucidate critical treatment variables with a particular emphasis on the differences between treatment completers and non-completers. The results were interpreted with respect to recently suggested theories and associated treatment approaches such as the Theory of Structural Dissociation (Van der Hart, Nijenhuis, & Steele, 2006) which may better accommodate the needs of complex trauma survivors encountered in a real world clinical practice. Furthermore, the challenges associated with interventions and treatment evaluations involving a highly complex clinical sample such as victims of crime are discussed in light of the current debate on evidence-based practice and the dilemma of providing reliable, methodologically sound evidence without compromising internal validity of the treatment.