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Betrayal trauma

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Betrayal trauma is defined as a trauma perpetrated by someone with whom the victim is close to and reliant upon for support and survival.[1][2] The concept was originally introduced by Jennifer Freyd in 1994, betrayal trauma theory, occurs when people or institutions on which a person relies on for protection, resources, and survival violate the trust or well-being of that person.[2] BTT emphasized the importance of betrayal as a core antecedent of dissociation implicitly aimed to preserve the relationship with the caregiver.[3] BTT suggests that a child who is dependent on their caregiver for support will have a higher need to dissociate traumatic experiences from conscious awareness.[3]

Background

Betrayal trauma theory emerged to integrate evolutionary processes, mental modules, social cognitions, and developmental needs with the extent to which the fundamental ethic of human relationships are violated.[2] A foundational component of the dissociative aspect of BTT postulated that all humans possess an inherent mental mechanism to detect violations of social contracts (i.e., "cheater detectors").[4] While BTT proposed that one lacking the ability to identify cheaters would be unable to evolve and thus be victim to natural selection, BTT provides a different theoretical framework. Positing that in the context of abusive betrayals in which escape is not a viable option, the cheater-detecting mechanism may be suppressed for the higher goal of survival. Thus, betrayal trauma offered a theory of psychogenic amnesia designed to evaluate both the role of attachment in human survival and the significance of blocking the painful experience.

Types

Child sexual abuse

Child sexual abuse (CSA) can involve molestation by one or more caregivers or close relatives.[5] While physical and emotional abuse during childhood is present in the context of BTT, research has found that CSA leads to more significant disruption in capacities and is more characteristic of a substantial violation of fundamental human ethics.[6] Notably, the degree to which one is violated by a caregiver or close relationship can influence the nature of and response to trauma.[7] BTT suggests that CSA is closely linked with the psychogenic amnesia or dissociative processes occurring as a means to maintain an attachment with the caregiver and promote survival.[2] For the victim to acknowledge the violation of CSA could increase their risk of impaired attachment provided by the caregiver and increase the potential of danger to the child.[8] Such trauma has direct links to eliciting the process of "betrayal blindness".[2] Similarly, evidence suggests that such trauma is more likely to be forgotten as compared to non-sexual childhood abuse.[6]

Institutional betrayal

Institutional betrayal refers to wrongdoings perpetrated when an institution fails to prevent or appropriately respond to wrongdoings by other individuals. In instances when individuals experiencing traumatic events place a great deal of trust in the legal, medical, and mental health systems they risk disbelief, blame, and refusal for help.[9] Deep lack of validation and interpersonal trauma can be examined through a BTT lens and have been described as a "second assault".[9] Examples of institutional betrayal often regarded in the literature include sexual assault on college campuses in which the system is unhelpful and unresponsive,[10] sexual abuse in the Catholic church, assault or harassment during military service, and medical care fraught with victim blaming and implicit policies of disrespectful treatment. Additionally emerging research has found that institutions (e.g., occupational settings, religious organizations, and schools) have the potential to worsen posttraumatic outcomes or be a source of social harm and injustice.[9] BTT as a conduit of institutional betrayal can be particularly pervasive in environments that normalize abusive contexts, adopt procedures and policies that are unclear and potentially stigmatized, supporting cover-ups and misinformation, and punishing victims and whistleblowers. Similarly, sexual assault committed by close others in the context that the betrayal is implicit and challenging to detect[9] has received increased attention in the media through campaigns oriented to highlight the prevalence of abuse in professional and academic institutions.

Romantic betrayal

When evaluating betrayal trauma in romantic relationships, earlier literature focused on the impact of infidelity in monogamous relationships. Within this context, the betrayal is present in the relationship as a breach of an unspoken agreement.[11] More recent literature exploring BTT in romantic partnerships has focused on the inclusion of domestic violence (DV). DV is present when one partner is repeatedly beaten, degraded, and violated has been shown to constitute BTT particularly in instances when the victim remains with or returns to the abuser, does not report the abuse, or underreports the severity of ongoing abuse.[12] Attachment injury has been indicated as an additional component of BTT in romantic contexts, characterized by abandonment or betrayal of trust during moments of need.[13]

Key features

Attachment theory

John Bowlby in 1969 was the first to identify the link between attachment processes and dissociative psychopathology. He referred to internal representations as Internal Working Models (IWM) with which one can discern which internal content is dominant and warrants attention and that which can be segregated into one's unconscious awareness.[14] Once the attachment system is activated, the IWM is identified as a guide to the formation of both the attachment behavior and the appraisal of attachment emotions in self and others. Bowlby emphasizes that traumatizing experiences with one's caregiver which is likely to result in negative impacts a child's attachment security, stress, coping strategies, and the sense of self.[15]

Securely organized IWM: Evidence indicates that secure attachment is associated with positive appraisals of one's own attachment emotions and expectations that the child's request will be experienced as significant and legitimate by their caregiver.[16]

Insecurely organized IWM (avoidant or resistant): Associated with a negative appraisal of attachment emotions and expectations that one's request for attention and attachment will be received as a nuisance or an intrusion to the caregiver.

Disorganized IWM: Linked to unresolved traumas and losses experienced by the caregiver and the effect had on the subsequent attachment style with their offspring. Main and Hesse in 1990 theorized that in the context of BTT disorganized attachment develops when the caregiver is both a source of the child's solution and a source of fright.[17] This form of attachment is proposed to more frequently experience altered consciousness akin to dissociation.

Dissociation

Dissociation is described as the disruption of conscious memory, identity, or perception of one's immediate environment.[1] Freyd and colleagues (2007) identified "knowledge isolation" or the extent to which information is hidden from awareness.[6] From a neurological perspective, dissociation during times of extreme stress or trauma can invoke neural mechanisms resulting in long-term alterations in brain functioning.[15] Additional evidence has implicated the effect of childhood trauma as an etiological factor of dissociation.[18] Research suggests that the level of betrayal trauma experienced (e.g., high, moderate, low) can influence the level of dissociation.[18]

Trauma and stressor-related disorders frequently include dissociative experiences. Evidence suggests that dissociation during trauma enables affected individuals to compartmentalize the traumatic experience from their conscious awareness.[19] In the context of BTT, dissociation is conceptualized as an adaptive process aimed to maintain self-preservation and serve as protection against psychological pain.[2] Perspectives from the development of psychopathology paired with attachment theory cite the mechanism of dissociation as a core feature in understanding environmentally produced psychiatric disorders.[15][19] Evidence has indicated that dissociation can occur in extreme cases of dissociation an alternative personality state can emerge (i.e., alters) as frequently implicated in the dissociative identity disorder (DID).[14]

Loss of the assumptive world

The assumptive world refers to a core belief system reflecting that individuals perceive the world as secure and fair.[20] Janoff-Bulman (1992) identified three assumptions (e.g. the world as benevolent, meaningful, and worthy), which can be shattered by distortions in social behavior.[20] In the context of BTT, violations perpetrated by caregivers or close relationships have been implicated to impair views of the assumptive world and contribute to avoidance of the trauma experienced.[20]

Presence in psychopathology

Models of attachment-based dissociative disorders and trauma-related disorders involving betrayal trauma have been indicated in diagnostic groups such as posttraumatic stress disorder, personality disorders,[18] trauma and stress-related disorders,[21] dissociative disorders,[2] schizophrenia spectrum and other psychotic disorders[22] and substance-related and addictive disorders.[23] Many of these disorders can be disposed to experiencing betrayal trauma and betrayal trauma should be explored as a contributor to symptoms.[2]

Posttraumatic stress disorder

BTT includes an individual who may experience little or no conscious awareness of their trauma. If the trauma does have no conscious knowledge, the effects of the abuse instead can manifest with physical and psychological symptoms such as dissociation. Many have found that dissociation can be a predictor of developing posttraumatic stress disorder (PTSD) after the trauma has occurred.[24]

Dissociative identity disorder

Some trauma victims deploy a protective response such a dissociation or repression to block awareness of the trauma.[2] BTT indicates that childhood sexual abuse and other interpersonal injuries create the dissociative reaction. Dissociative identity disorder (DID) is commonly connected with prolonged overwhelming trauma such as childhood sexual abuse.[25] This trauma can create a disruption in identity where there are two or more distinct personalities in one person where perception, cognition, and sense of self and agency is different. The person may experience gaps in the recall of everyday events or traumatic events.[26]

Substance use disorders

There have been suggestions that interpersonal trauma such as betrayal trauma can in some cases have links to substance use.[23] This substance use may be episodic binge drinking or chronic substance use that can meet diagnostic criteria for substance use disorder.[27] Research found that childhood physical or sexual abuse is at increased risk for substance abuse. Some postulate that because betrayal trauma can create a loss of control that loss of control incorporates into substance use.[23] Others think substance use is a way to cope with posttraumatic negative affect traits such as avoidance, tension reduction or self-medication.[23]

Personality disorders

The development of borderline personality disorder (BPD) may have links to early maltreatment and attachment difficulties.[28] The maltreatment is sometimes because of the emotional, physical, verbal and/or sexual abuse by caregivers. BTT incorporates both attachment and damage from a caregiver in the definition of the theory. BTT includes dissociation as a diagnostic criterion for BPD. Some postulate that BTT may explain dissociation that BPD experience because dissociation is a defense mechanism against childhood trauma.[18] High betrayal traumas have been implicated in the development of traits indicative of borderline personality disorder (Kaehler, 2009).

Schizophrenia spectrum and other psychotic disorders

Dissociation is a severe symptom of betrayal trauma, and recently hallucinations have been linked to extreme cases of betrayal trauma.[22] Research found that childhood adversity such as interpersonal trauma like betrayal trauma, bullying, and a parent’s death is at increased risk for psychosis and hallucinations.[29] There is research suggesting that individually, the betrayal trauma of childhood abuse is related to hallucinations. The long-standing intervention for the treatment of hallucinations has been medication, but new research suggests that the treatment of betrayal trauma may reduce hallucinations when childhood sexual abuse is present in the person's past.[22]

Treatment

Betrayal assessments

To screen for BTT in patients, an inventory was created. This inventory is called Betrayal Trauma Inventory (BTI).[8] This inventory assesses physical, emotional and sexual abuse in childhood and/or adulthood traumas. Many of the questions have behaviorally defined events such as "did someone hold your head under water or tried to drown you before you were the age of 16". The response to these questions with "yes" can start the follow-up questions that may include age, relationship, the severity of injuries and memory of the event. These items were adapted from the Abuse and Perpetration Inventory (API). The BTI takes around 45-minutes to administer and only assesses trauma before age 16.[30]

The Brief Betrayal Trauma Survey (BBTS)[1] was adapted from the BTI in order to quickly assess for BTT. This survey includes 11 separate items for traumatic experiences such as sexual, physical and emotional abuse. It includes if the person was a someone close to them or an interpersonal event. This survey looks at events prior to age 18.[1]

Interventions

Treatment for betrayal trauma is relatively new to psychology. Many believe that the proper treatment is evidence-based treatments for a particular diagnosis others feel that betrayal trauma is unique and should be treated with an individual treatment. In an article by Jennifer M. Gómez in 2016[31] postulated that relational-cultural therapy is a match for treating betrayal trauma. This therapy established by Jean Miller following the emerging feminist therapies suggested that the therapist should focus on the relational disconnections a client is experiencing as opposed to symptoms.[31] Working through decontextualizing the betrayal trauma and separating self-decision making is postulated to work better for the treatment of betrayal trauma.

References

  1. ^ a b c d Goldsmith, Rachel E.; Freyd, Jennifer J.; DePrince, Anne P. (February 2012). "Betrayal trauma: associations with psychological and physical symptoms in young adults". Journal of Interpersonal Violence. 27 (3): 547–567. doi:10.1177/0886260511421672. ISSN 1552-6518. PMID 21987504.
  2. ^ a b c d e f g h i Freyd, Jennifer J. (1998-02-06). Betrayal Trauma: The Logic of Forgetting Childhood Abuse (Reprint ed.). Cambridge, Mass.; London: Harvard University Press. ASIN 0674068068. ISBN 978-0-674-06806-3. {{cite book}}: Check |asin= value (help)
  3. ^ a b GIESBRECHT, TIMO; MERCKELBACH, HARALD (2009). "Betrayal trauma theory of dissociative experiences: Stroop and directed forgetting findings". The American Journal of Psychology. 122 (3): 337–348. doi:10.2307/27784407 (inactive 2017-12-26). JSTOR 27784407.{{cite journal}}: CS1 maint: DOI inactive as of December 2017 (link)
  4. ^ Cosmides, Leda (1989-04-01). "The logic of social exchange: Has natural selection shaped how humans reason? Studies with the Wason selection task". Cognition. 31 (3): 187–276. doi:10.1016/0010-0277(89)90023-1. PMID 2743748.
  5. ^ McNally, Richard J. (April 2007). "Betrayal trauma theory: a critical appraisal". Memory (Hove, England). 15 (3): 280–294, discussion 295–311. doi:10.1080/09658210701256506. ISSN 0965-8211. PMID 17454665.
  6. ^ a b c DePrince, Anne P.; Brown, Laura S.; Cheit, Ross E.; Freyd, Jennifer J.; Gold, Steven N.; Pezdek, Kathy; Quina, Kathryn (2012). True and False Recovered Memories. Nebraska Symposium on Motivation. Springer, New York, NY. pp. 193–242. doi:10.1007/978-1-4614-1195-6_7. ISBN 978-1-4614-1194-9.
  7. ^ Freyd, Jennifer (1996). Betrayal Trauma: The Logic of Forgetting Childhood Abuse. Cambridge, MA: Harvard University Press.
  8. ^ a b PhD, Jennifer J. Freyd; PhD, Anne P. Deprince; PhD, Eileen L. Zurbriggen (2001-10-29). "Self-Reported Memory for Abuse Depends Upon Victim-Perpetrator Relationship". Journal of Trauma & Dissociation. 2 (3): 5–15. doi:10.1300/J229v02n03_02. ISSN 1529-9732.
  9. ^ a b c d Smith, Carly Parnitzke; Freyd, Jennifer J. (2013-02-01). "Dangerous Safe Havens: Institutional Betrayal Exacerbates Sexual Trauma". Journal of Traumatic Stress. 26 (1): 119–124. doi:10.1002/jts.21778. ISSN 1573-6598.
  10. ^ Smith, Carly Parnitzke; Freyd, Jennifer J. (2014). "Institutional betrayal". American Psychologist. 69 (6): 575–587. doi:10.1037/a0037564.
  11. ^ Scheinkman, Michele (2005-06-01). "Beyond the Trauma of Betrayal: Reconsidering Affairs in Couples Therapy". Family Process. 44 (2): 227–244. doi:10.1111/j.1545-5300.2005.00056.x. ISSN 1545-5300.
  12. ^ STARK, EVAN; BUZAWA, EVE (2009-06-08). Violence Against Women in Families and Relationships. ABC-CLIO. ISBN 978-0-275-99846-2.
  13. ^ Johnson, Susan M.; Makinen, Judy A.; Millikin, John W. (2001-04-01). "Attachment Injuries in Couple Relationships: A New Perspective on Impasses in Couples Therapy". Journal of Marital and Family Therapy. 27 (2): 145–155. doi:10.1111/j.1752-0606.2001.tb01152.x. ISSN 1752-0606.
  14. ^ a b PhD, Giovanni Liotti (2006-11-21). "A Model of Dissociation Based on Attachment Theory and Research". Journal of Trauma & Dissociation. 7 (4): 55–73. doi:10.1300/J229v07n04_04. ISSN 1529-9732. PMID 17182493.
  15. ^ a b c Schore, Allan N. (2002-02-01). "Dysregulation of the right brain: a fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorder". Australian and New Zealand Journal of Psychiatry. 36 (1): 9–30. doi:10.1046/j.1440-1614.2002.00996.x. ISSN 1440-1614. PMID 11929435.
  16. ^ Cassidy, Jude; Shaver, Phillip R. (2002-07-31). Handbook of Attachment: Theory, Research, and Clinical Applications. Rough Guides. ISBN 978-1-57230-826-8.
  17. ^ Padrón, Elena; Carlson, Elizabeth A.; Sroufe, L. Alan (2014). "Frightened Versus Not Frightened Disorganized Infant Attachment: Newborn Characteristics and Maternal Caregiving". The American journal of orthopsychiatry. 84 (2): 201–208. doi:10.1037/h0099390. ISSN 0002-9432. PMC 4085543. PMID 24826936.
  18. ^ a b c d Kaehler, Laura; Freyd, Jennifer (2009). "Borderline Personality Characteristics: A Betrayal Trauma Approach". Psychological Trauma: Theory, Research, Practice and Policy. 1 (4): 261–268.
  19. ^ a b Liotti, Giovanni (2006). "A Model of Dissociation Based on Attachment Theory and Research". Journal of Trauma & Dissociation. 7 (4): 55–73. doi:10.1300/j229v07n04_04.
  20. ^ a b c Beder, Joan (2005-06-01). "Loss of the Assumptive World—How We Deal with Death and Loss". OMEGA – Journal of Death and Dying. 50 (4): 255–265. doi:10.2190/GXH6-8VY6-BQ0R-GC04. ISSN 0030-2228.
  21. ^ Polusny, Melissa A.; Ries, Barry J.; Schultz, Jessica R.; Calhoun, Patrick; Clemensen, Lisa; Johnsen, Ingrid R. (February 2008). "PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster". Journal of Traumatic Stress. 21 (1): 75–82. doi:10.1002/jts.20281. ISSN 0894-9867. PMID 18302175.
  22. ^ a b c Gomez, Jennifer; Kaehler, Laura; Freyd, Jennifer (2014). "Are Hallucinations Related to Betrayal Trauma Exposure? A Three-Study Exploration". Psychological Trauma: Theory, Research, Practice, and Policy. 6 (6): 675–682.
  23. ^ a b c d Delker, Brianna; Freyd, Jennifer (2014). "From Betrayal to the Bottle: Investigating Possible Pathways from Trauma to Problematic Substance Use". Journal of Traumatic Stress. 27: 576–584.
  24. ^ Briere, John; Scott, Catherine; Weathers, Frank (2005-12-01). "Peritraumatic and Persistent Dissociation in the Presumed Etiology of PTSD". American Journal of Psychiatry. 162 (12): 2295–2301. doi:10.1176/appi.ajp.162.12.2295. ISSN 0002-953X.
  25. ^ Putnam, F. W.; Guroff, J. J.; Silberman, E. K.; Barban, L.; Post, R. M. (June 1986). "The clinical phenomenology of multiple personality disorder: review of 100 recent cases". The Journal of Clinical Psychiatry. 47 (6): 285–293. ISSN 0160-6689. PMID 3711025.
  26. ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-559-6.
  27. ^ Konkolÿ Thege, Barna; Horwood, Lewis; Slater, Linda; Tan, Maria C.; Hodgins, David C.; Wild, T. Cameron (2017-05-04). "Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review". BMC Psychiatry. 17 (1): 164. doi:10.1186/s12888-017-1323-1. ISSN 1471-244X. PMC 5418764. PMID 28472931.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  28. ^ "Child maltreatment and insecure attachment: A meta-analysis (PDF Download Available)". ResearchGate. Retrieved 2017-11-13.
  29. ^ Varese, Filippo; Smeets, Feikje; Drukker, Marjan; Lieverse, Ritsaert; Lataster, Tineke; Viechtbauer, Wolfgang; Read, John; van Os, Jim; Bentall, Richard P. (June 2012). "Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies". Schizophrenia Bulletin. 38 (4): 661–671. doi:10.1093/schbul/sbs050. ISSN 1745-1701. PMC 3406538. PMID 22461484.
  30. ^ Goldberg, Lewis; Freyd, Jennifer (2006). "Self-Reports of Potentially Traumatic Experiences in an Adult Community Sample: Gender Differences and Test-Retest Stabilities of the Items in a Brief Betrayal Trauma Survey". Journal of Trauma & Dissociation. 7 (3): 39–63.
  31. ^ a b Gómez, Jennifer M.; Lewis, Jenn K.; Noll, Laura K.; Smidt, Alec M.; Birrell, Pamela J. (2016). "Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care". Journal of trauma & dissociation: the official journal of the International Society for the Study of Dissociation (ISSD). 17 (2): 165–185. doi:10.1080/15299732.2016.1103104. ISSN 1529-9740. PMID 26460888.
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