as posttraumatic stress disorder, which is discussed
later in this chapter.COMMUNITY VIOLENCE
The CDC (1999), the U.S. Department of Education,
the Department of Justice, and the National School
Safety Center have been examining homicides and
suicides associated with schools. The study examined
events on the way to and from school, on school prop-
erty, and at school-sponsored events and found that
83% of the victims of school homicide or suicide were
male and 65% of school-associated violent deaths
were students, 11% were teachers or staff, and 23%
were community members killed on school property.
The original study was expanded to cover school-
associated violent deaths from July 1994 to June 1998.
The results showed 173 incidents, most of which were
homicides committed with firearms. The total number
of events decreased since the 1992–1993 school year,
but the number of multiple-victim events during that
period increased. This means that fewer events in-
volving one person have occurred, but multiple-victim
events increased from one per year in 1992 to 1995 to
five events per year from August 1995 through July
- A person only has to watch the evening news to
know that this is the trend.
The CDC has been working with schools to de-
velop curricula that emphasize problem-solving skills,
anger management, and social skills development.
In addition, parenting programs that promote strong
bonding between parents and children and conflict
management in the home, as well as mentoring pro-
grams for young people, show promise in dealing with
school-related violence. A few people responsible for
such violence have been diagnosed with a psychiatric
disorder, often conduct disorder, which is discussed
in Chapter 20. Often, however, this violence seems to
occur when alienation, disregard for others, and little
regard for self predominate.
Exposure to community violence tremendously
affects children and young adults (Veenema, 2001).
Scarpa (2001) reports that a history of violence victim-
ization and witnessing of violence in both high-risk and
low-risk youth can lead to future problems with ag-
gression, depression, relationships, achievement, and
abuse of drugs and alcohol. She suggests that ad-
dressing the problem of violence exposure may help to
alleviate the cycle of dysfunction and further violence.
On a larger scale, violence such as the terrorist
attacks in New York, Washington, and Pennsylvania
in 2001 also has far-reaching effects on citizens. In the
immediate aftermath, children were afraid to go to
school or have their parents leave them for any rea-
son. Adults had difficulty going to work, leaving
their homes, using public transportation, or flying.
Research is now showing that 1 in 10 New York area
residents suffer lingering stress and depression. An
additional 532,240 cases of posttraumatic stress dis-
order have been reported in the New York City Metro-
politan area alone (Schlenger et al., 2002). In addition,
people are reporting higher relapse rates of depression
and anxiety disorders. The study showed no increase
of PTSD nation-wide as a result of television watch-
ing, however, which had been an initial concern.
Early intervention and treatment are key to deal-
ing with victims of violence. Following several in-
stances of school or workplace shootings, immediate
counseling, referrals, and ongoing treatment were in-
stituted immediately to help those involved deal with
the horror of their experience. After the 2001 terror-
ist attacks, teams of physicians, therapists, and other
health professionals (many associated with univer-
sities and medical centers) have been working with
survivors, families, and others affected. Despite such
efforts, many people will continue to experience long-
term difficulties as described in the next section.PSYCHIATRIC DISORDERS RELATED
TO ABUSE AND VIOLENCE
Posttraumatic Stress Disorder
Posttraumatic stress disorder(PTSD) is a dis-
turbing pattern of behavior demonstrated by some-
one who has experienced a traumatic event—for ex-
ample, a natural disaster, combat, or an assault. The
person with PTSD was exposed to an event that posed
a threat of death or serious injury and responded with
intense fear, helplessness, or terror. Three clusters of
symptoms are present: reliving the event; avoiding
reminders of the event; and being on guard, or hyper-
arousal.The person persistently re-experiences the
trauma through memories, dreams, flashbacks, or
reactions to external cues about the event and, there-
fore, avoids stimuli associated with the trauma. The
victim feels a numbing of general responsiveness and
shows persistent signs of increased arousal such as
insomnia, hyperarousal or hypervigilance, irritabil-
ity, or angry outbursts. He or she reports losing a
sense of connection and control over his or her life. In
PTSD, the symptoms occur 3 months or more after the
trauma, which distinguishes PTSD from acute stress
disorder.This DSM-IV-TR diagnosis is appropriate
when symptoms appear within the first month after
the trauma and do not persist longer than 4 weeks.
PTSD can occur at any age including childhood.
Estimates are that up to 60% of people at risk, such
as combat veterans and victims of violence and nat-
ural disasters, develop PTSD. Complete recovery oc-
curs within 3 months for about 50% of people. The
severity and duration of the trauma and the proxim-11 ABUSE ANDVIOLENCE 223