A model of the retraumatization process: A meta-synthesis of childhood sexual abuse survivors' experiences in healthcare

Childhood sexual abuse survivors frequently report feeling violated and reabused during routine healthcare encounters. The goal of the current study was to develop a model that will aid in understanding difficulties abuse survivors face when accessing healthcare. Meta-synthesis was used to combine data from 20 papers representing 15 independent, qualitative studies. The combined studies represented interviews with 411 sexual abuse survivors (113 males and 298 females). Study themes and concepts were reciprocally translated using the technique developed by Noblit and Hare (1988) using a grounded theory approach. The resultant Healthcare Retraumatization Model was revised based on input from eight experts including the lead investigators of five studies included in the synthesis. The Model postulates that retraumatization is a cyclical process with four interrelated subprocesses: hypersensitivity to threats to safety, exposure to triggers, post-traumatic stress reactions, and avoidant coping. Hypersensitivity to threats to safety causes childhood abuse survivors tend to feel threatened in situations which require trust and evoke vulnerability, powerlessness, and/or loss of control. Triggers are situations and events that cause abuse survivors to feel threatened and elicit stress reactions. Triggering is caused by the interplay of internal factors (hypersensitivity to threats to safety) and external factors (threatening situations and dynamics encountered during healthcare) and is associated with survivors feeling that their current safety is being threatened. Survivors typically cope with retraumatization by employing avoidant coping strategies originally developed during childhood to cope with the original abuse. The experience of retraumatization appears to lower survivors' threshold for future retraumatization by confirming survivors' view of healthcare as a threatening experience. Without intervention, retraumatization can result in unhealthy outcomes due to the negative effects of stress on survivors' mental and physical health along with interruptions in healthcare caused by avoidant coping. Interruptions in healthcare can take the form of avoiding preventive care, delaying treatments, poor compliance with therapeutic regimes, and prematurely terminating treatment. Through therapeutic actions that recognize and respect survivors' safety needs, healthcare providers can help survivors interrupt the retraumatization cycle and help abuse survivors heal from their childhood trauma.