Conclusions and Future Directions in the Assessment, Treatment, and Prevention of Retraumatization
In editing the current retraumatization book, we considered it essential to clearly articulate our conceptualization of retraumatization and to place that conceptualization in the context of other ideas about repeat traumatization that are present in the empirical literature and in the arena of clinical practice. In de¢ning retraumatization and in guiding contributors’ use of the term, we de¢ned a traumatic event as an event that results in actual or possible death, serious injury, or threat of serious injury to self or others and that elicits a response characterized by extreme horror, helplessness, and fear. We de¢ned retraumatization as traumatic responding that occurs as a consequence of multiple exposures to physically or psychologically traumatizing events. Retraumatization can occur as a function of multiple exposures to one category of traumatic events (e.g., experiences of child and adult sexual assault) or as a function of multiple exposures across different categories of traumatic events (e.g., child physical abuse and involvement in a serious, injury-causing motor vehicle collision as an adult). While we recognize that the term retraumatization has been used in a more circumscribed way to capture distress that occurs with the retelling of a trauma narrative, we employed a more literal de¢nition of retraumatization that emphasized traumatic stress reactions occurring consequent to multiple traumatic events. Our de¢nition of retraumatization was forwarded to highlight the number
and range of potentially traumatizing events to which an individual might be exposed over the developmental lifespan, to re¢ne our thinking related to the distress reactions and functional compromise that are possible consequent to trauma exposure, and to increase the effectiveness of assessment and intervention efforts that are employed in response to an individual’s exposure to multiple traumatizing events. This concluding chapter summarizes some of the major points contained within the book, highlights some of the ongoing controversies related to repeat trauma exposure and diagnostic accuracy in characterizing responses to trauma exposure, and provides some ideas related to the direction to be taken in identifying and evaluating those factors that most inŽuence trauma exposure and retraumatization. Given the extensive literature reviews provided in the various content chapters that comprise the book, we structured this concluding chapter not as a further reference-based review of the literature but as a context for proposing directions for future research and practice efforts.