Journal of Abnormal Psychology [617352]

Journal of Abnormal Psychology
2000, Vol. 109, No. 1. 69-73Copyright 2000 by ihe American Psychological Association, Inc.
OOZI.843X/00/S5.00 DOI: 10.1037//0021-843X.1M.I.69
Predicting PTSD Symptoms in Victims of Violent Crime: The Role of
Shame, Anger, and Childhood Abuse
Bernice Andrews, Chris R. Brewin, Suzanna Rose, and Marilyn Kirk
Royal Holloway, University of London
To examine the role of cognitive-affective appraisals and childhood abuse as predictors of crime-related
posttraumatic stress disorder (PTSD) symptoms, 157 victims of violent crime were interviewed within 1
month postcrime and 6 months later. Measures within 1 month postcrime included previous physical and
sexual abuse in childhood and responses to the current crime, including shame and anger with self and
others. When all variables were considered together, shame and anger with others were the only
independent predictors of PTSD symptoms at 1 month, and shame was the only independent predictor
of PTSD symptoms at 6 months when 1-month symptoms were controlled. The results suggest that both
shame and anger play an important role in the phenomenology of crime-related PTSD and that shame
makes a contribution TO the subsequent course of symptoms. The findings are also consistent with
previous evidence for the role of shame as a mediator between childhood abuse and adult psycho-
pathology.
Diagnostic criteria for posttraumatic stress disorder (PTSD) in
the Diagnostic and Statistical Manual of Mental Disorders, 4th
edition (DSM-IV; American Psychological Association [APA],
1994) do not include specific cognitive-affective appraisals, such
as shame, concerning the traumatic experience, although it is
mentioned as an associated feature. General irritability and out-
bursts of anger arising from any source are among the DSM-IV
criteria (APA, 1994), but there is similarly no specific consider-
ation of anger arising directly from the person's appraisal of the
trauma. In the extensive and growing empirical literature on
PTSD, relatively little consideration has been given to whether
these appraisals are simply concomitants of PTSD or whether they
play a significant role in the disorder. In this article we investigate
whether shame, anger, and childhood abuse (shown to systemati-
cally precede shame; see Andrews, 1995) are related to the devel-
opment and course of posttraumatic symptoms in victims of vio-
lent crime.
Although there is no direct evidence that shame is implicated in
the onset or course of PTSD, there are good reasons to hypothesize
a link. Community studies of women have shown that shame acts
as a mediator between reported childhood abuse and disorders
such as depression and bulimia (Andrews, 1995, 1997). Biosocial
theory may provide one explanation for its role in psychological
adjustment to physical and sexual assaults (Andrews, 1995). From
Bemice Andrews, Chris R. Brewin, Suzanna Rose, and Marilyn Kirk,
Department of Psychology, Royal Holloway, University of London, Lon-
don, England.
Chris R. Brewin is now at the Subdepartment of Clinical and Health
Psychology, University College London, London, England.
This research was supported by a grant from the National Health Service
Executive Research and Development Programme, England.
Correspondence concerning this article should be addressed to Bernice
Andrews, Department of Psychology, Royal Holloway, University of Lon-
don, Egham, Surrey TW20 OEX, England. Electronic mail may be sent to
[anonimizat] viewpoint, shame is related to physical attacks and hence to
psychopathology through submission and defeat. Even among
nonhuman primates, loss of resources through attacks by conspe-
cifics has been shown to result in submission and defeat, involving
a major change in physiological state (Gilbert & McGuire, 1998).
Just as shame has been viewed as a primitive response to defeat
in humans, anger motivates attack and may be viewed as a core
component of the human survival response. However, whereas
heightened anger may be adaptive for survival in the face of
physical attack, it may be maladaptive in its aftermath. Within
the context of combat-related PTSD, researchers have argued
that heightened anger involves the failure to inhibit context-
inappropriate activation of a survival mode of functioning (Chem-
tob, Novaco, Hamada, & Gross, 1997, p. 184). There is evidence
for the role of anger in crime-related PTSD from a study of 116
women victims (and 67 nonvictim controls) assessed on various
questionnaire measures of anger 10-11 days postassault (Riggs,
Dancu, Gershuny, Greenberg, & Foa, 1992). Victims had higher
state anger scores than controls, and this was the only anger
measure to make an independent contribution to PTSD symp-
toms 1 month postassault. The authors suggested that these results
may be best understood from the theory of PTSD developed by
Foa, Steketee, and Rothbaum (1989). Within this conceptualiza-
tion, the activation of anger may allow victims to avoid feelings of
anxiety and thereby impede the processing of distressing feelings,
which is seen as necessary for psychological adjustment. What is
not known, however, is whether anger in general is associated with
a poor outcome or whether the direction of anger (against others or
self) is crucial.
The paucity of studies on the role of shame and anger in PTSD
points to the need for prospective research, over a longer time
period than has hitherto been considered, to investigate their pre-
dictive role in the disorder. There is also evidence that a previous
history of abuse in childhood may be a risk factor for PTSD in
trauma victims (Bremner, Southwick, Johnson, Yehuda, & Char-
ney, 1993). Because past research (Andrews, 1995,1997; Andrews

70 ANDREWS, BREWIN, ROSE, AND KIRK
& Hunter, 1997) has shown a relationship between shame and
childhood abuse, a further objective was therefore to examine the
relative contribution of childhood abuse in the prediction of crime-
related PTSD and to investigate the possibility that shame and
anger reactions to current victimization are rooted in past abusive
experiences and might mediate their effect.
Specific aims of the study were as follows: (a) to examine the
interrelationships between shame, self- and other-directed anger,
childhood abuse, and PTSD symptoms, all measured within 1
month of the crime; and (b) to investigate the relative contributions
of shame, anger and childhood abuse to predicting PTSD symp-
toms within 1 month postcrime and the course of PTSD symptoms
over the first 6 months.
Method
The Sample
To qualify, victims of a violent crime (actual or attempted physical or
sexual assault, or bag snatch) had to be over 18 years old and to have been
assaulted by someone who was not a member of their household. Local
police and medical services assisted in identifying potential participants,
who were sent a letter asking them to contact the research team if they, as
recent crime victims, would be willing to take part in a study of attitudes
to crime and punishment. Initially, 2,161 eligible victims were approached
by letter and 11% responded. Of the 243 responders, 157 completed an
interview within 1 month of the assault (M = 21 days postcrime).1
Ninety-two of the 157 were recruited through the police, 64 through
hospital departments, and 1 through a local doctor's office. Seventy-five
percent of those not recruited through the police had nevertheless reported
the crime to the police. Most of the 86 with incomplete interviews were
ineligible for the study, either because they turned out to have been abused
by a household member or because the crime had occurred more than 1
month before they were contacted.
Eighty-eight percent (N = 138) of the 157 respondents were followed
up 6 months later. Those not followed up were significantly younger than
those who were, ((155) = 2.16, p < .05. However, they were not signif-
icantly different on any other variable considered in the analyses (ps
ranged from .08 to .87).
The 157 respondents (118 men. 39 women) had an average age of 35
years (SD = 13, range = 18-76) and were broadly representative of
victims in the British Crime Survey (BCS) in terms of gender and age
(Mayhew, personal communication, March 10, 1998; Mirrlees-Black,
Mayhew, & Percy, 1996). Compared with our gender distribution of 75:25,
the BCS figure was 68:32, and the BCS mean age was 33 years. Data from
the police referrals, but not from the hospital referrals, were available as an
additional check on the representativeness of our sample. In comparison
with those crime victims identified by the police who did not enter the
study, whose mean age was 30.6 years, those crime victims whom we
interviewed were significantly older, t(940) = 4.04, p < ,001, but did not
differ in gender, type of offense, or extent of injury, largest )f(1, N =
942) = 3,29, p > .10.
Forty-five percent of our sample were married or cohabiting, 38% were
single, and 18% were separated, divorced, or widowed. Forty-five percent
had ended full-time education by age 16, 26% were educated to high school
level, and 28% to degree level. Overwhelmingly, the sample had experi-
enced actual (94%) or threatened (4%) physical assault, with 4% (18% of
the women) experiencing actual or threatened sexual assault. At least some
injury was reported by 90% of the sample.
Measures
At first contact a tape-recorded, semistructured interview covered de-
mographic and crime details, shame, anger, and childhood abuse. Inter-viewers were blind to respondents's diagnostic status at the time of the
interviews. PTSD symptoms were assessed by a self-report questionnaire at
first contact and 6 months later.
Shame. Following previous research (Andrews, 1995, 1997; Andrews
& Hunter, 1997), participants were asked, "Do you feel ashamed about any
aspect of the crime or your reactions to it?" At any hint of an affirmative
response, they were asked, "Can you describe how you feel? Do you feel
like that often?" Reported frequency of the feelings and intensity of
comments were taken into account in the investigator-based ratings. Rat-
ings were made on a 4-point scale (4 = marked, 3 = moderate, 2 = some,
and 1 – little or none). Interrater reliability for the shame scale was good
(weighted K = .83). Disagreements were resolved by discussion.
Anger. Anger with self and anger with others were assessed on sepa-
rate 5-point scales. Because we wanted to measure anger as an emotion,
ratings were based purely on respondents' subjective judgment of affect. In
the context of questions about the assault, respondents were asked, "On a
5-point scale where 1 is not at all angry and 5 is very angry, could you rate
how angry you currently feel with other people, including the perpetrator
(i.e., since the crime), and could you rate how angry you currently feel with
yourself?"
Abuse in childhood. After discussing the crime and their reactions to it,
respondents were questioned in detail about abusive experiences before
age 17. Sexual abuse was defined as that involving direct physical contact
of the sexual parts but excluded willing contact in teenage years with
nonrelated peers. Physical abuse excluded smacks and slaps, but included
being punched, kicked, or hit with an instrument such as a stick or a belt.
This childhood abuse interview has been described in greater detail else-
where (e.g., Andrews, 1995). Twenty-nine percent reported physical abuse
only, 5% sexual abuse only, and 1% both.
PTSD symptomatology. Following the interview, the Posttraumatic
Stress Disorder Symptom Scale—Self-Report (PSS-SR; Foa, Riggs,
Dancu, & Rothbaum, 1993) was used to measure PTSD symptoms within 1
month postcrime and again at 6 months. The scale has been shown to have
good internal and test-retest reliability and good concurrent validity (Foa
et al., 1993). In the current study, internal reliability (Cronbach's a) was
.94 at 1 month and .93 at 6 months.
Results
Examination of the Predictor Variables: Shame, Anger,
and Childhood Abuse
Gender differences. No significant gender differences were
found for shame or either of the anger scales (ps ranged from .46
to .64). Women victims were no more likely than their male
counterparts to report childhood physical abuse, ^(1, N = 157) =
.68, p > .05, but they were more likely to report childhood sexual
abuse, ^(1, N = 157) = 12.6, p < .001. However, the overall
childhood abuse index (physical or sexual abuse) showed no
significant gender difference, ^(1, N = 157) = .48, p > .05. The
data for the two genders were therefore combined, but correlations
between childhood abuse and other variables were verified sepa-
rately for the two components of the index.
1 Participants were randomly assigned to three different types of inter-
view: education about trauma, psychological debriefing plus education, or
assessment only. However, interview type was unrelated to clinical out-
come either initially or at follow-up and hence is not included as a factor
in the following analyses (Rose, Brewin, Andrews, & Kirk, 1999).

PREDICTING PTSD IN VICTIMS OF VIOLENT CRIME 71
Table 1
Correlations Between Childhood Abuse, Shame, Anger, and PSS-SR at 6 Months Postcrime
Measure 12345
1 . Degree of injury
2. (Low) educational level
3. Gender (women)
4. Childhood abuse
5. (High) shame
6. Anger with others
7. Anger with self
8. PSS-SR 1 month postcrime
9. PSS-SR 6 month postcrime
Mean*
% with variable.15
-.20**
.12
.07
.01
.17*
.20*
.17*
' 3.1
—.00
.28***
.01
-.05
-.07
.14
.31***
45.06
.03
.00
.10
.22**
.21*
25—
.23**
.10
.26***
.21**
.23**
41—
.11
.36***
.35***
.37***
22—.21**
.31«**
.26**
3.2
——
.29***
.22*
1.9
——
.76*** —
16.0 12.5
— —
Note. PSS-SR = Posttraumatic Stress Disorder Symptom Scale—Self-Report.
a Before transformation.
*p<.05. **/> < .01. ***/)< .001, two-tailed.
Interrelationships between the predictor variables. Table 1
shows the correlations between the predictor variables.2 The anger
scales were significantly correlated with each other, and shame
was significantly related to anger with self but not to anger with
others. Reported childhood abuse was significantly related to
shame; this was the case for both physical and sexual abuse,
r(154) = .16, p < .05, and .26, p < .01, respectively. Reported
child abuse was also significantly related to anger with self, but
this was due to physical abuse, r(\55) — .27, p < .001, rather than
sexual abuse, r(155) — .12, p > .05. Neither the combined child-
hood abuse index nor either of its components was significantly
correlated with anger with others.
Relationships Between the Predictor Variables and PTSD
Symptom Outcomes
Table 1 also shows the correlations between the predictor vari-
ables and PTSD symptom scores at 1 and 6 months. All of the
predictor variables were significantly correlated with the PSS-SR
at both time points. As both components of the childhood abuse
index were similarly and significantly correlated with the PSS-SR
at both time points, the combined index was retained in the
following multiple regression analyses. Age, gender, marital sta-
tus, educational level (educated, or not, beyond age 16) and injury
severity (4-point scale) were considered as control variables; those
significantly correlated with the PSS-SR at either time point are
shown in Table 1. Women and those more severely injured had
higher symptom scores at both time points, and those with no
education beyond age 16 had higher symptom scores at 6 months.
Correlations between predictor variables, control variables, and
outcomes at both time points were broadly similar for both gen-
ders, and there were no significant gender differences for any of
the correlations (zs ranged from 0 to 1.7).
Predicting PTSD symptoms 1 month postcrime. We chose a
hierarchical multiple regression analysis to determine the relative
contributions of the control and predictor variables to PSS-SR
score within 1 month postcrime. The significant control variables
were entered on the first step, and the predictor variables on the.
second step. On each step the variables were entered simulta-
neously. Table 2 shows that, after controlling for gender, educa-tion, and injury, shame and anger with others were the only
independent predictors of the PSS-SR.
Predicting PTSD symptoms at 6 months postcrime. In the next
hierarchical analysis, 1 month PSS-SR was entered into the equa-
tion on a separate first step, the control variables on a second step,
and the predictor variables on a third step. This was to see if
childhood abuse, shame, or anger was predictive of symptoms over
and above symptoms at 1 month, that is, whether they could
predict subsequent increases or decreases in symptoms. Table 2
shows that 1 -month symptoms were by far the strongest predictors
of later symptomatology, explaining over half of the variance in 6
month PSS-SR results. The only predictor variable to indepen-
dently predict PTSD symptom course at 6 months was shame.
Shame and childhood abuse were correlated with each other, and
both were correlated with the PSS-SR (Table 1). This analysis was
therefore repeated while omitting the anger measures to investigate
the role of shame as a mediator between childhood abuse and
6-month PSS-SR symptoms reported. Again, shame was the only
predictor variable to make an independent contribution to 6-month
outcome (/3 = .15, p < .01), demonstrating its mediating effect.
Content of the Shame Responses
We analyzed shame accounts for content to further understand
the phenomenology of the crime-related shame experiences. Of
the 34 respondents rated as having high shame, the most common
theme (apparent in 62% of the accounts) was shame due to feeling
they had not taken effective action to prevent the crime. One man
said he felt ashamed, "because basically I feel a bit like I can't
handle it. Physically I can't defend myself." The second most
common theme identified was shame felt at looking bad to others
(29%), either because others had witnessed the crime or because of
2 To meet the assumptions of the statistical tests, we screened data for
normality and performed transformations where appropriate. Square-root
transformations reduced skewness of the PSS-SR at both time points, and
log transformations reduced the skewness of the anger scales. The more
severely skewed shame scale was dealt with by dichotomizing as little or
no shame (scale points 1 and 2) versus high shame (points 3 and 4).

72 ANDREWS, BREWIN, ROSE, AND KIRK
Table 2
Relative Contributions of Childhood Abuse, Shame, Anger, and
Control Variables at 1 Month Postcrime to PSS-SR
at 1 and 6 Months Postcrime
PSS-SR 1 month
postcrime
Step 1
Degree of injury
Low education level
Gender
Multiple R
F(3, 147)
R2 (adjusted)
Step 2
Childhood abuse
High shame
Anger with others
Anger with self
Multiple R
F(7, 143)
R2 (adjusted)
R2 change(3
.24**
.10
.29***
.35
7.0***
.11
.05
25***
25***
.07
.54
8.4***
.26
.17***PSS-SR 6 months
postcrime
Step 1
1 month PSS-SR
F(l, 132)
R2 (adjusted)
Step 2
Degree of injury
Low education level
Gender
Multiple R
F(4, 129)
R2 (adjusted)
R2 change
Step 3
Childhood abuse
High shame
Anger with others
Anger with self
Multiple R
F(8, 125)
R2 (adjusted)
R2 change0
.75**«
175.2***
.57
.07
.18**
.02
.78
48.6***
.59
.03*
.02
.17**
.03
-.09
.80
26.5***
.61
.03
Note. PSS-SR = Posttraumatic Stress Disorder Symptom Scale—Self-
Report.
•p<.05. **p<.01. ***p<.001.
the visible injuries sustained. One woman victim of street mugging
said, "I feel shame that people didn't help me…. [A]ll those
people know me that was outside, makes you feel very embar-
rassed." Subsidiary themes included feeling ashamed of emotional
reactions to the crime (15%) and feeling humiliated (12%). Inter-
rater reliability for the derived themes was good (weighted
K = .82).
Discussion
To our knowledge, this is the first study to investigate longitu-
dinally the role of shame in the development and course of crime-
related PTSD symptoms. It is also the first to consider the relative
contributions of shame and anger in the same study and to inves-
tigate their role in the link between previous childhood abuse and
PTSD symptoms. The results suggest that both shame and anger
play a role in the phenomenology of crime-related PTSD symp-
toms and that, in addition, shame appears to make some contribu-
tion to their subsequent course. The results are also consistent with
previous evidence for the role of shame as a mediator between
childhood abuse and adult psychopathology (Andrews, 1995,
1997).
The results add weight to theories that have related universal
experiences of submission and defeat to human shame and psy-chopathology (Andrews, 1995; Gilbert & McGuire, 1998). The
ways in which shame is bound up with such experiences is illus-
trated by themes in the shame accounts: for example, concerns
about not taking effective action to defend oneself, being humili-
ated, and looking bad to others (which involves the humiliation of
having others actually witness one's defeat).
The current results are also in accord with those of Riggs et al.
(1992) in demonstrating a unique and significant relationship
between anger and PTSD symptoms 1 month postcrime. They
refine and extend those of these previous authors by demonstrating
its specificity to appraisals of the crime and the importance of the
direction of anger to outcome. Anger with others, but not anger
with self, made an independent contribution to PTSD symptoms
when all variables were considered together. The relatively poor
performance of anger with self may have been due to its overlap-
ping variance with both shame and anger with others. These
findings represent a new contribution because previous studies in
this area have focused on the separate (though perhaps related)
issue of the expression of anger in PTSD and have distinguished
between the tendency to hold anger in or express it outwardly
(Chemtob, Hamada, Roitblat, & Muraoka, 1994; Riggs et al.,
1992).
When all variables were considered together, anger with others
was less potent than shame in predicting the course of PTSD
symptoms 6 months postcrime. However, given its strong relation-
ship with PTSD symptoms 1 month postcrime, which in turn
explained most of the variance in 6-month symptoms, it is likely
that the association between anger with others and subsequent
symptomatology is through its association with these earlier symp-
toms. The results nevertheless support the identification of anger
as an important emotion in PTSD symptomatology. Whether this
is because anger blocks the processing of fear (Foa et al., 1989) or
whether anger contributes in its own right to PTSD symptoms
(Chemtob et al., 1997) remains a question for future research. In
such research it may be valuable to develop investigator-based
ratings of crime-related anger and to explore the phenomenology
of this important emotion.
It is of interest that although anger and shame independently
predicted PTSD symptoms, the correlation between them was low.
This is inconsistent with theory and evidence that shame provokes
outward-directed anger (e.g., Tangney, Wagner, Fletcher, &
Gramzow, 1992). Tangney and colleagues reported, in a student
sample, significant correlations between a questionnaire measure
of general shame-proneness and questionnaire measures of anger
in hypothetical situations. One explanation for the discrepancy
could be that, within the context of a physical assault, the two
emotions are associated with two opposing fundamental concerns:
shame with defeat, and anger with counterattack and survival.
However, this is not meant to imply that shame bears no relation-
ship to anger in this context. Shame was related to anger, but to
anger with the self rather than with others.
Our results provide evidence of possible fundamental differ-
ences between shame and anger in response to physical attack in
terms of their relation to past abusive experiences. Shame, but not
anger with others, was related to reported childhood abuse. In
accord with Bremner et al. (1993), we also found a significant
association between reported childhood abuse and PTSD symp-
toms. Consistent with previous investigations of depression and

PREDICTING PTSD IN VICTIMS OF VIOLENT CRIME 73
bulimia (Andrews, 1995, 1997), shame mediated the contribution
of early victimization to later adult psychopathology.
In common with many other investigations of crime-related
PTSD, the current study is limited in terms of the representative-
ness of the sample because the response rate to our initial recruit-
ment letter was very low. Although the low response rate need not
compromise the current results, caution is advisable in generaliz-
ing beyond this sample. It is possible that our sample was unrep-
resentative in terms of some or all of the cognitive-affective
factors and that a sample in which these variables were differently
distributed might have yielded a different pattern of correlations.
Participants appeared to be representative of British crime victims
and of people reporting violent crimes to the police with respect to
most variables on which we had data, although they were probably
slightly older. However, age did not appear to affect our results.
Furthermore, our findings concerning the relationship between
anger and PTSD, and childhood abuse and PTSD, replicate other
results from very different samples of women crime victims (Riggs
et al., 1992) and combat veterans (Bremner et al., 1993; Chemtob
et al., 1994) in the United States.
The results are also limited to crime-related PTSD symptoms.
Shame and anger may be less salient for adjustment to traumatic
events that were not caused by another person (e.g., natural disas-
ters), although shame may be relevant when considering reactions
following trauma. Nevertheless, we believe our data have impor-
tant implications for the treatment of crime victims, both in helping
to identify those at risk of severe reactions and in identifying
variables that could beneficially be targeted in therapy. Our find-
ings suggest that treatments for PTSD that explicitly address and
attempt to modify shame and anger (e.g., Chemtob et al., 1997)
will be particularly effective.
References
American Psychiatric Association. (1994). Diagnostic and statistical man-
ual of mental disorders (4th ed.). Washington, DC: Author.
Andrews, B. (1995). Bodily shame as a mediator between abusive expe-
riences and depression. Journal of Abnormal Psychology, 104, 277-285.
Andrews, B. (1997). Bodily shame in relation to abuse in childhood and
bulimia. British Journal of Clinical Psychology, 36, 41-50.Andrews, B., & Hunter, E. (1997). Shame, early abuse and course of
depression in a clinical sample: A preliminary study. Cognition and
Emotion, 11, 373-381.
Bremner, J. D., Southwick, S. M., Johnson, D. R., Yehuda, R., & Chamey,
D. S. (1993). Childhood physical abuse and combat-related posttrau-
matic stress disorder in Vietnam veterans. American Journal of Psychi-
atry, 150, 235-239.
Chemtob, C. M., Hamada, R. S., Roitblat, H. L., & Muraoka, M. Y. (1994).
Anger, impulsivity and anger control in combat-related posttraumatic
stress disorder. Journal of Consulting and Clinical Psychology, 62,
827-832.
Chemtob, C. M., Novaco, R. W., Hamada, R. S., & Gross, D. M. (1997).
Cognitive-behavioral treatment for severe anger in posttraumatic stress
disorder. Journal of Consulting and Clinical Psychology, 65, 184-189.
Foa, E. B., Riggs, D. S., Dancu, C. V., & Rothbaum, B. O. (1993).
Reliability and validity of a brief instrument for assessing post-traumatic
stress disorder. Journal of Traumatic Stress, 6, 459-473.
Foa, E. B., Steketee, G., & Rothbaum, B. O. (1989). Behavioral/cognitive
conceptualization of post-traumatic stress disorder. Behavior Ther-
apy, 20, 155-176.
Gilbert, P., & McGuire, M. (1998). Shame, status and social roles: The
psychobiological continuum from monkey to human. In P. Gilbert & B.
Andrews (Eds.), Shame: Interpersonal behavior, psychopathology and
culture (pp. 99-125). New York: Oxford University Press.
Mirrlees-Black, C., Mayhew, P., & Percy, A. (1996). The 1996 British
Crime Survey (Home Office Statistical Bulletin. Issue 1996). London:
Home Office Research and Statistics Directorate.
Riggs, D. S., Dancu, C. V., Gershuny, B. S., Greenberg, D., & Foa, E. B.
(1992). Anger and post-traumatic stress disorder in female crime vic-
tims. Journal of Traumatic Stress, 5, 613-625.
Rose, S., Brewin, C. R., Andrews, B., & Kirk, M. (1999). A randomized
trial of psychological debriefing for victims of violent crime. Psycho-
logical Medicine, 29, 793-799.
Tangney, J. P., Wagner, P. E., Fletcher, C., & Gramzow, R. (1992).
Shamed into anger? The relation of shame and guilt to anger and
self-reported aggression. Journal of Personality and Social Psychol-
ogy, 62. 669-675.
Received July 27, 1997
Revision received April 26, 1999
Accepted April 26, 1999