Shock, fear, denial and withdrawal - these are among the distressing states a victim may experience in the aftermath of violent crime. Kathy Watson reports

One night Claire and her husband Ralph woke to find an intruder in their bedroom. When Claire screamed, the stranger threw a knife at them. It whizzed past Claire's head, so close it almost touched her ear, and embedded in the wall behind her. The stranger fled and Claire, numb with shock, sat up in bed, staring at the quivering knife.

In the days following the attack, Claire felt her personality change. Normally a calm, reasonable person, she became restless and angry. She would shout at her husband if he was late home. Work became her focus: she brought bags of files home and stayed up late poring over them. She refused to stay in the flat alone and would constantly check if all the windows and doors were locked. Talking to people became difficult and she wouldn't discuss the incident at all. Even giving a statement to the police was hard.

The psychologist's view
According to Alex Hossack, a consultant clinical psychologist in Liverpool, Claire's behaviour, frightening to her and worrying to her husband and friends, was entirely typical of someone who has been a victim of a crime.

'Anger, fear, withdrawal - these are normal responses to an abnormal situation,' he says, 'But for most people, these experiences are so unusual and disorientating they can feel as if they're going mad.'

1. The initial phase
Initially, crime victims go into shock and denial. Alex Hossack explains, 'I often hear phrases like "This can't be happening to me" or "I don't believe it". They simply don't have a frame of reference for the fact that, for example, their daughter has been run over or their husband beaten up, so they deny it. They try to block out the pain with drink, drugs or hyperactivity. Alternatively, they become completely withdrawn.'

2. The intrusive phase
When the realisation that it really did happen sets in, victims can find themselves moving between a number of different and equally distressing states.

'There's the intrusive phase where the person experiences flashbacks, as many as 200 a day,' says Hossack. 'They replay the event like a movie in their head. Most people think flashbacks are visible but they can also be auditory and felt in the body. One of my clients was raped. When she has a flashback, she feels it happening and she hears the voices of the men as they abuse her.

'Trauma memory isn't like normal memory. The memory of your last day at school is probably fuzzy, not clear, without sound. Trauma memories are sharp, colourful, loud and completely overwhelming. In therapy, we aim to turn those vivid, bright, fearful trauma memories into something vaguer and less disturbing, a nasty memory but a normal one.

'Victims analyse the event over and over again, trying to make sense of it. They say things like "If only I hadn't walked home that way, I wouldn't have been attacked". It's all part of trying to understand why. The problem is they end up owning the crime, blaming themselves and feeling guilty.'

3. The withdrawal phase
Then there is the withdrawal phase. Hossack explains: 'People remove themselves from places, people and environments associated with the event. If the crime involved a car, they might refuse to drive. Or they might refuse to be a passenger. If it was a man who hurt them, they avoid men. If it was youngsters, they cross the road when they see a group of kids. They stay away from social events because in social events, they can't predict what will happen. It's a way of dealing with their loss of control.

'They swing like a pendulum between the intrusive and withdrawal phase. Either state is dysfunctional. The idea of therapy is to get them to a mid-point where they can cope.'

Hossack is keen to stress that the size of the trauma is not significant; it's the individual's response that matters. 'I had a case of a 75-year-old who fell down a pothole in the road. She wasn't physically hurt but she went on to develop post-traumatic stress disorder. The key here is that as she fell, she truly believed she was going to die.

'If someone has their handbag snatched and develops anxiety about going outside the house, friends might not understand that it was a serious event for them. Most people feel bad that they can't get over something that they think is minor. And yet their feelings are entirely normal.'

The role of therapy
The good news is that about half of all victims of crime repair themselves, says Hossack. For the others who may go on to develop an anxiety disorder, it's important to remember that this is a very treatable condition and it doesn't necessarily mean a long time in therapy. The average number of sessions is between six and ten.

However, he advises that after a traumatic event, you can't do any formal therapy until a month has passed. 'You can't make a diagnosis until then,' he says. 'In the meantime, people need a listening ear and a helping hand. The sort of thing you get from a good friend.'

When it happens to someone you know
Gill Gridley works for Victim Support, a charity that offers emotional and practical help to crime victims. Victim Support's network of 13,000 volunteers sees over a million clients a year and their phone line receive 1,600 distress calls a month. She explains how best to help when someone close to you has been hurt by crime.

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