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Retraumatization

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Retraumatization is a traumatic stress reaction that most commonly occurs in the context of repeated exposure to a particular traumatic event[1][2][3][4]. Frequently cited examples include childhood sexual or physical abuse, domestic violence, and exposure to war[1][2][3][4]. Overall, there has been a lack of consensus regarding the definition of retraumatization. Consequently, this concept is much more difficult to operationalize because it is unclear how to conceptualize the nature of triggers, intensity, and duration of symptoms[1][2][3][4][5][6][7][8][9]. In research, reporting issues have been problematic because interpretation and standardization of information given can be subjective. One of the more common definitions of retraumatization explored comes from Retraumatization: assessment, treatment, and prevention where it states that “traumatic stress reactions that occur consequent to multiple exposures to traumatic events… These responses can occur in the context of repeated multiple exposures within one category events or multiple exposures across different categories of events.” - Duckworth, M. P., Follette, V. M. (pg. 2., 2012)[1].

There is a lack of well-designed empirical research on retraumaization. This is likely due the variety of definitions used in discussion of retraumatization, making it somewhat difficult to study in a consistent or repeatable manner[1][2][3][4][5][6][7][8][9]. There is also an overlap in definitions used in revictimisation literature, complicating the ability for researchers to reach consensus on a definition[2][4][7][8]. Despite use of various interpretations of the term, one commonality across definitions is that retraumatization occurs with recurrent exposure to traumatic events resulting in psychological and physical trauma related symptoms[1][3][4][5] [7][10]. It occurs in a variety populations, but is most documented in sexual assault victims and those who have experienced domestic abuse[2][3][4].

There are several theories that attempt to explain the occurrence of retraumatization. The majority of theories are rooted in either cognitive-behavioral or attachment perspectives[1]. Cognitive-behavioral theory asserts that all humans are driven to conserve the resources they have. Traumatic reactions occur when resources are lost, or when their loss is threatened[1][6]. Further exposure to stressors and a increased risk of retraumatization occur as a result of loss of resources which makes it more difficult for an individual to effectively adapt[1][6].

Attachment theory argues that infants adapt to develop attachment with their primary caregiver, even in unsafe environments[1][11]. In situations of abuse or neglect, a child will adapt to maintain safety and connection with their caregiver[1][11]. The child will use this attachment relationship as a blueprint for future relationships[11]. Therefore, the individual will be prone to seeking unhealthy relationships, as they do not have a foundation for safe and secure attachment[1][11]. This puts them at greater risk for retraumatization, as they have difficulty determining safety, making them more prone to being exposed to dangerous situations or abusive relationships[1].

Children, women and populations that have experienced war related traumas (i.e., military or civilians in a war environment) are among the highest impacted by retraumatization [12][10]. Additionally, a meta-analysis found that victims of sexual trauma are 48% more likely re-experience another sexual trauma[13][10]. Retraumatization is associated with increased risk in the development of mental health issues[1]. Psychological problems that are linked to retraumatization are substance abuse, emotion dysregulation, post-traumatic stress disorder, depression[1][5][14].

Retraumatized individuals are also more likely to experience symptoms of dissociation. It is hypothesized that dissociation acts as a protective factor in which an individual can distance themselves from their abuser, especially if the trauma is ongoing[7]. Over time, this may negatively impact the ability to assess risk across the lifetime, as it becomes difficult for the individual to distinguish between threatening and non-threatening cues, making these them more susceptible to being exposed to similar situations later in life[2]. Dissociation has been most widely identified in victims of physical or sexual traumas[1][3][6][7][9][12][15]. A strong positive correlation between level of dissociation and severity of trauma have been identified [15][10].   

Despite, problems with operationalizing retraumatization, trauma-informed practices have been identified and potential useful methods of prevention and treatment of retraumatization[16]. Trauma informed practices have been defined as an integrative approach treatment that strives to increase awareness and realization of the detrimental effects of trauma. In addition, tools such as promoting safety, transparency, trust, empowerment, and peer support can assist in developing resiliency to retraumatization[1][16]. Trauma informed practices have been analyzed in school systems to identify factors that enhance effectiveness and to identify gaps in the prevention of retraumatization. Among the trauma informed practices reviewed, those programs that tailored to unique differences in trauma, population type, and provided high intensity interventions were identified as most effective in reducing retraumatization[16].

References

  1. ^ a b c d e f g h i j k l m n o p q Retraumatization : assessment, treatment, and prevention. Duckworth, Melanie P., Follette, Victoria M. New York: Routledge, Taylor & Francis Group. [2012]. ISBN 9780415872768. OCLC 700377062. {{cite book}}: Check date values in: |date= (help)CS1 maint: others (link)
  2. ^ a b c d e f g Brewin, Chris; Andrews, Bernice; Valentine, John D. (2000). [Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in Trauma-Exposed Adults "Meta-Analysis of Risk Factors for Posttraumatic Stress Disorder in Trauma-Exposed Adults"]. Journal of Consulting and Clinical Psychology. 68 (5): 748–766. doi:10.1037/0022-006X.68.5.748. PMID 11068961. S2CID 13749007. Archived from the original (PDF) on 2000. {{cite journal}}: Check |archive-url= value (help); Check date values in: |archive-date= (help)
  3. ^ a b c d e f g Cloitre, Marylene; Scarvalone, Polly; Difede, JoAnn (1997-07-01). "Posttraumatic stress disorder, self- and interpersonal dysfunction among sexually retraumatized women". Journal of Traumatic Stress. 10 (3): 437–452. doi:10.1002/jts.2490100309. ISSN 1573-6598. PMID 9246651.
  4. ^ a b c d e f g Nicola, Graham-Kevan; Matthew, Brooks; VJ, Willan; Michelle, Lowe; Phaedra, Robinson; Roxanne, Khan; Rachel, Stokes; May, Irving; Marta, Karwacka (2015-05-08). "Repeat Victimisation, Retraumatisation and Victim Vulnerability". The Open Criminology Journal. 8 (1).
  5. ^ a b c d Beutler, Larry D.; Maguin, E.; Carello, J. (Mar. 10, 2017). "Retraumatization Mediates the Effect of Adverse Childhood Experiences on Clinical Training-Related Secondary Traumatic Stress Symptoms". Journal of Trauma & Dissociation : The Official Journal of the International Society for the Study of Dissociation (Issd). 19 (1): 25–38. doi:10.1080/15299732.2017.1304488. PMID 28281919. S2CID 205869540. Retrieved 11/17/17. {{cite journal}}: Check date values in: |access-date= and |date= (help)
  6. ^ a b c d e Bockers, Estelle; Roepke, Stefan; Michael, Lars; Renneberg, Babette; Knaevelsrud, Christine (11/17/17). "Risk Recognition, Attachment Anxiety, Self-Efficacy, and State Dissociation Predict Revictimization". PLOS ONE. 9 (9): e108206. doi:10.1371/journal.pone.0108206. PMC 4169587. PMID 25238153. {{cite journal}}: Check date values in: |date= (help)
  7. ^ a b c d e f Iverson, Katherine M.; Litwack, Scott D.; Pineles, Suzanne L.; Suvak, Michael K.; Vaughn, Rachel A.; Resick, Patricia A. (11/17/17). "Predictors of Intimate Partner Violence Revictimization: The Relative Impact of Distinct PTSD Symptoms, Dissociation, and Coping Strategies". Journal of Traumatic Stress. 26 (1): 102–110. doi:10.1002/jts.21781. PMID 23417878. Retrieved 2017-10-18. {{cite journal}}: Check date values in: |date= (help)
  8. ^ a b c Barlow, David H. "Anxiety and Its Disorders: Second Edition: The Nature and Treatment of Anxiety and Panic". Guilford Press. Retrieved 2017-10-31.
  9. ^ a b c Wager, Nadia (11/17/17). "Psychogenic amnesia for childhood sexual abuse and risk for sexual revictimisation in both adolescence and adulthood". Sex Education: 1–19. doi:10.1080/14681811.2011.615619. S2CID 143440455. Retrieved 2017-10-18. {{cite journal}}: Check date values in: |date= (help)
  10. ^ a b c d Banyard, Victoria L.; Williams, Linda M.; Siegel, Jane A. (2003-06-16). "Retraumatization Among Adult Women Sexually Abused in Childhood: Exploratory Analyses in a Prospective Study". Journal of Child Sexual Abuse. 11 (3): 19–48. doi:10.1300/J070v11n03_02. ISSN 1053-8712. PMID 16221645. S2CID 45072781.
  11. ^ a b c d Costello, Peter (2013). Attachment-based psychotherapy : helping patients develop adaptive capacities (First ed.). Washington, D.C. ISBN 9781433813023. OCLC 822229881.{{cite book}}: CS1 maint: location missing publisher (link)
  12. ^ a b Dutra, Lissa; Bureau, Jean-Francois; Holmes, Bjarne; Lyubchik, Amy; Lyons-Ruth, Karlen (2009-6). "Quality of Early Care and Childhood Trauma: A Prospective Study of Developmental Pathways to Dissociation". The Journal of Nervous and Mental Disease. 197 (6): 383–390. doi:10.1097/NMD.0b013e3181a653b7. ISSN 0022-3018. PMC 2697443. PMID 19525736. {{cite journal}}: |last2= has generic name (help); Check date values in: |date= (help)
  13. ^ Walker, Hannah E.; Freud, Jennifer S.; Ellis, Robyn A.; Fraine, Shawn M.; Wilson, Laura C. (2017-02-08). "The Prevalence of Sexual Revictimization: A Meta-Analytic Review". Trauma, Violence, & Abuse. 20 (1): 67–80. doi:10.1177/1524838017692364. ISSN 1524-8380. PMID 29333937. S2CID 28640720.
  14. ^ Ozer, Emily J.; Best, Suzanne R.; Lipsey, Tami L.; Weiss, Daniel S. (Jan 15, 2013). "Predictors of Posttraumatic Stress Disorder and Symptoms in Adults: A Meta-Analysis". ResearchGate. Retrieved Nov 17, 2017. {{cite web}}: |archive-date= requires |archive-url= (help)
  15. ^ a b Draijer, Nel; Langeland, Willie (1999-03-01). "Childhood Trauma and Perceived Parental Dysfunction in the Etiology of Dissociative Symptoms in Psychiatric Inpatients". American Journal of Psychiatry. 156 (3): 379–385. doi:10.1176/ajp.156.3.379 (inactive 2022-06-05). ISSN 0002-953X. PMID 10080552.{{cite journal}}: CS1 maint: DOI inactive as of June 2022 (link)
  16. ^ a b c Zakszeski, Brittany N.; Ventresco, Nina E.; Jaffe, Aliza R. (2017-12-01). "Promoting Resilience Through Trauma-Focused Practices: A Critical Review of School-Based Implementation". School Mental Health. 9 (4): 310–321. doi:10.1007/s12310-017-9228-1. ISSN 1866-2625. S2CID 149057645.
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