Community violence in the United States is a serious public health problem (Centers for Disease Control, 1993; Cooley, Turner, & Beidel, 1995; Earls, 1992; Fingerhut, Ingrain, & Feldman, 1992a, 1992b; Hausman, Spivak, & Prothrow-Stith, 1994; Koop & Lundberg, 1992; Lorion & Saltzman, 1993; Reiss, 1993; Richters, 1993; Shalala, 1993). Americans aged 12 years and above reported an estimated 1,750,000 nonsexual, nonfatal crimes according to the National Crime Victims Survey of 1998 (Rennison, 1999). Concern about exposure to community violence goes beyond physical trauma to include the psychological trauma that is assumed to be a consequence of such experience.
A number of psychological and biological models have attempted to explain the phenomenon of traumatic stress (Foy, Osato, Houskamp, & Neumann, 1992; Freedy & Hobfoll, 1995; Friedman, Charney, & Deutsch, 1995). Although the details of the models differ tremendously, they all share the central idea that traumatic stress involves exposure to adverse environmental events which produces a heightened negative emotional response that results in a resetting of homeostatic levels of the central nervous system that in turn produces an increase in the chronic level of negative emotional activation. A comprehensive theory of traumatic stress, however, is still a work in progress: the specification of the range of adverse environmental events, the mechanisms involved in resetting the homeostatic levels of the central nervous system, and the range of psychological symptoms have yet to be agreed upon. Nevertheless, the general theoretical perspective is that being a victim of violence is a stressful experience that requires psychological adaptation and may result in psychological sequelae (McCann, Sakheim, & Abrahamson, 1988).
Current thinking about traumatic stress has been much influenced by the conceptualization of Posttraumatic Stress Disorder (PTSD; American Psychiatric Association, 1994). However, whereas PTSD invokes a single extreme event and symptoms associated with recall of that event, more recent thinking about traumatic stress considers it a more general phenomenon that may involve multiple less extreme events and more diffuse symptoms of psychological distress. Several theorists have argued that less extreme events that nevertheless arouse negative affect should be considered stressors, and that the effects of multiple experiences
of these events may accumulate (Compas, 1987; Cowen & Work, 1988; Root, 1992; Wallen, 1993). Root (1992) has referred to such relatively minor, but cumulative, stressor experiences as "insidious" trauma. Other investigators have pointed out that several conceptually different sets of psychological symptoms, such as anger, anxiety, depression, and dissociation, tend to occur together (i.e., to display comorbidity) in association with trauma and should perhaps be considered general psychological reactions to traumatic stress (Briere, 1995; Freedy & Donkervoet, 1995; Herman, 1992; McCann et al., 1988).
Incidents of community violence generally involve few individuals, often are not reported to authorities, and seldom receive widespread publicity. That is, exposure to chronic community violence (other than such things as mass shootings and sniper attacks) is a low salience phenomenon that fits the definition of insidious trauma. It is beginning to receive wider attention; for example, Dohrenwend (1998) has stated: "If we are to assess the role of event-related adversity in the occurrence of psychopathology in the general population, we must consider possibly stressful events that occur more frequently in the lives of individuals than the events in the extreme situations of human-made and natural disasters" (p. 5). Others have argued that "violent crime is a predominant contributing factor to the development of mental health problems" (Hanson, Kilpatrick, Falsetti, & Resnick, 1995, p. …