Home > Public Resources > Trauma Blog > 2014 - April > Bank Robbery – A Neglected Potential Traumatic Exposure? Bank Robbery – A Neglected Potential Traumatic Exposure? Maj Hansen, MSc March 22, 2014 The annual number of bank robberies in Europe and the United States (the European Banking Federation, 2013; The Federal Bureau of Investigation, 2013) has decreased in the past 10 years. But even though the number of incidents has decreased, many bank robbery victims do exist, as there is often multiple victims per incidence. Victims of bank robbery can be people either directly affected by the robbery (e.g. employees, customers and security guards) or indirectly (e.g. relatives, random people on the street and police officers). Employees are most often the primary victims, as often it is they that are held at gun-point and threatened with violence. When held at gun-point, most people fear for their lives and experience helplessness and intense horror (Elklit, 2002). However, little is known about the psychological impact of bank robbery. A systematic review of all abstracts in all studies found through literature searches on the databases: “PsychInfo”, “Medline” and “PubMed” using keywords like bank robber*, robber*, bank robbery and robbery resulted in only twelve studies which concerned the psychological impact of bank robbery on the victims (Hansen, in prep.). Instead, research had primarily focused on the perpetrator, eye witness testimoniesband forensic or sociological aspects of robberies. From the twelve studies, four studies were excluded from this current overview article. One study was excluded, as it concerned employee kidnappings or extortion-related kidnapping of relatives of the employees to facilitate robberies (Paes-Marchado & Nascimento, 2006), which is a type of crime more related to kidnaping than robbery. A second study was excluded because it was in Italian (Fichera et al., 2011). Finally, two other studies were excluded because they concerned the latent structure of acute stress disorder (ASD) rather than the psychological impact of bank robbery per se (Hansen, Armour, & Elklit, 2012; Hansen, Lasgaard, & Elklit, 2013). Thus, there were eight remaining studies of the psychological impact of bank robbery (Dyregrov, Kristoffersen & Muller, 1991, Hansen & Elklit, 2011; 2013; Harrison & Kinner, 1998; Kamphuis & Emmelkamp, 1998; Ladwig et al., 2002; Leymann, 1988; Miller-Burk, Attridge & Fass, 1999). Combined, the eight studies show that exposure to bank robbery is a potential traumatizing event associated with both immediate and long-term posttraumatic stress symptoms. The studies used different measurements of psychological distress and posttraumatic stress symptoms making them difficult to directly compare and most of them are subjected to numerous limitations (e.g. convenience samples, small sample size, cross-sectional studies etc., Hansen, in prep.). However, the studies showed a tendency for the symptoms to peak in the acute phase following the robbery and afterwards decline (Dyregrov et al., 1991; Hansen & Elklit, 2011; 2013; Ladwig et al., 2002; Leymann, 1988). Only one study investigated the estimated prevalence rates of ASD and posttraumatic stress disorder (PTSD, Hansen & Elklit, 2011; 2013). A convenience study of bank robbery victims found an estimated ASD prevalence rate of 14.5 % (n = 22, N = 152) and an estimated PTSD prevalence rate of 6.8 % (n = 9, N = 132, Hansen & Elklit, 2011; 2013). These prevalence rates are relatively low compared to the ones found after other forms of nonsexual assault (ASD =17-25 % and PTSD = 20-30%; Brewin, Andrews, Rose, & Kirk, 1999; Elklit, 2002; Elklit & Brink, 2004, Kleim, Ehlers, & Glucksman, 2007). According to the dose-response relationship between traumatic exposure and the development of PTSD, this may simply indicate that exposure to bank robberies is less traumatizing than other types of nonsexual assault (Friedman, Resick, & Keane, 2007). However, according to Dowrenwend (2006) it is not simply the specific type of traumatic exposure that determines whether PTSD is developed. Instead, a combination of different factors determines whether or not the trauma exposed victim develops PTSD. Thus, it is possible that bank robbery is a traumatizing event, but bank employees may be at low risk of developing posttraumatic stress symptoms as they may be a more resistant and resourceful group (e.g. more education, better social networks etc.) compared to other trauma populations. The subclinical levels of ASD and PTSD indicate that the prevalence rates are limited by the avoidance criterion (ASD and PTSD without avoidance: 22.0 % and 18.9 %, respectively). Thus, it appears that bank robberies are a potential traumatizing event and that bank employees are a special trauma population when it comes to meeting the avoidance criterion. As argued by Hansen and Elklit (2013, p. 37) bank employees “have difficulty avoiding the place of the traumatic event as well as difficulty avoiding talking and thinking about the robbery” as they need to return to their jobs. Although, the Hansen and Elklit (2013) study was subjected to several limitations (e.g. based on a convenience sample and a small sample size), a recently published national cohort study of bank robberies has found similar results (Hansen & Elklit, 2014). In a national study of all Danish bank employees exposed to robbery, an estimated ASD prevalence rate of 11.1 % (n = 41) and an estimated PTSD prevalence rate of 6.2 % (n = 23) were found. Additionally, the subclinical prevalence rates of ASD and PTSD (i.e. ASD and PTSD without avoidance) were also similar to the convenience study at 14.0 % and 18.1 %, respectively). In conclusion, the few existing studies show that bank robbery is a potentially traumatizing event associated with both acute and long-term posttraumatic stress symptoms. Furthermore, the high subclinical prevalence rates of both ASD and PTSD without avoidance found in two studies (Hansen & Elklit, 2011; 2013; 2014) indicates that bank employees are a special trauma population when it comes to meeting the diagnostic criteria of avoidance for both ASD and PTSD. Psychologists and other treatment experts should be aware of this fact when they diagnose possible ASD and PTSD cases and offer treatment to bank robbery victims. It is further possible that this may hold true for victims of other forms of violence at work. For further comprehensive reading on the topic of bank robbery a PhD thesis is scheduled for publication in the near future (Hansen, in prep.). About the Author Maj Hansen, MSC, has a master’s degree in psychology and is currently a PhD student at the National Centre for Psychotraumatology, the Institute of Psychology, University of Southern Denmark. Maj works under the supervision of Professor Ask Elklit, where her main research area is the study of the psychological impact of violence at the workplace – more specifically bank robbery and the development of acute stress disorder and posttraumatic stress disorder. Maj will complete her doctoral studies this year. References Brewin, C. R., Andrews, B., Rose, S., & Kirk, M. (1999). Acute Stress Disorder and Posttraumatic Stress Disorder in Victims of Violent Crime. American Journal of Psychiatry, 156, 360-366. Retrieved from http://journals.psychiatryonline.org/data/Journals/AJP/3698/360.pdf. Dohrenwend, B. P. (2006). 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