Betrayal Trauma and Histrionic Personality Pathology.

Histrionic personality disorder is among the most common forms of personality pathology, and recent research on it has focused on its associations with trauma. This research has focused primarily on the types of traumatic experiences people endure, highlighting the role of sexual trauma in particular. However, recent research on the association between traumatic events and histrionic personality characteristics has not taken into account the role of traumatic experiences characterized by interpersonal betrayal, which research suggests is associated with personality pathology in general. In this study, we examine this, evaluating the association between traumatic experiences with varying degrees of betrayal on histrionic personality characteristics in a sample of men and women recruited online (N = 364). Results suggested that interpersonal trauma without a high degree of betrayal as well as non-interpersonal trauma had positive associations with histrionic personality characteristics, but interpersonal trauma with a high degree of betrayal did not. Further analysis indicated that sexual trauma both with and without a component of betrayal was associated with histrionic personality characteristics for women but not men. Study findings add to the research on the potential traumatogenic origins of histrionic personality characteristics and provide numerous directions for future research.

Association Between Betrayal Trauma and the PAI Traumatic Stress Scale.

The Personality Assessment Inventory (PAI) is among the most commonly used broadband inventories of psychological functioning. For the purposes of assessing trauma specifically, the most relevant aspect of the PAI is the Traumatic Stress subscale of the Anxiety-Related Disorders scale (ARD-T), which measures the degree to which a person feels wounded by something in their past. Research suggests that ARD-T is associated with exposure to a variety of different traumatic stressors. However, there is little research on the degree to which traumatic stressors that entail a component of interpersonal betrayal (i.e. betrayal trauma) are associated with higher scores on ARD-T relative to other stressors. In this study, we evaluated the relative associations between traumas with varying degrees of betrayal and scores on ARD-T in a secondary analysis of two non-clinical samples (college sample N = 494; crowdsourced sample N = 364) using a Bayesian approach to multiple regression. In both samples, traumas with both high and medium (but not low) degrees of betrayal were associated with elevated ARD-T scores. Findings suggest that ARD-T scores are associated with interpersonal trauma regardless of betrayal, which has implications for interpretation of the ARD-T scale in practice.

Influence of Betrayal Trauma on Schizoid Personality Pathology.

Schizoid personality pathology is among the most debilitating and enigmatic forms of personality pathology. Some have suggested that a potential etiological influence on schizoid pathology is trauma. Thus far, research on the association between trauma and schizoid pathology has focused primarily on type of trauma (e.g., abuse vs. neglect during childhood) rather than who perpetrated the trauma. This contrasts with recent research on trauma perpetrated by someone upon whom the survivor relies and/or trusts (i.e. betrayal trauma), which many studies show has a uniquely pernicious association with several forms of personality pathology. However, this has not yet been examined with respect to schizoid pathology specifically. In this study, we examined the relative associations between trauma varying degrees of betrayal and schizoid personality pathology in a sample recruited from Amazon's Mechanical Turk (N = 300) using a Bayesian approach to structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of schizoid pathology. Findings further indicate that for men but not women, trauma with a high degree of betrayal was uniquely associated with schizoid pathology. These findings contribute to the growing body of research suggesting the influence of interpersonal trauma in general and betrayal trauma in particular on personality pathology and have implications for future research on and intervention with people with high levels of schizoid pathology.

Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong.

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (ß = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.

"It Will Always Feel Worse Because it Comes with That Added 'Betrayal'": Intersectionality Praxis and Black Young Women Survivors' Perspectives on Cultural Betrayal Trauma Theory.

Because of interlocking oppressions of racism and sexism (e.g. intersectionality), Black women's experiences of high rates of sexual violence are often ignored. A critical Black feminist framework, cultural betrayal trauma theory (CBTT) examines within-group violence in the Black community, which has compounding harm due to inequality. Though quantitative research has found support for CBTT, Black young women survivors' perspectives have not been examined. Therefore, the purpose of the current exploratory study was to engage in intersectionality praxis to qualitatively examine Black young women survivors' perspectives on CBTT through structured thematic analysis and coding based on theory. Respondents (N = 37; 18-30 years), provided their thoughts on CBTT following participating in a quantitative study. With most survivors in agreement that cultural betrayal in trauma is harmful, a key theme was community orientation in understanding both the harm and healing of cultural betrayal trauma. Black young women survivors' resonance with CBTT, as well as their recommendations for community-level solidarity and healing have important implications.

Trust and betrayal in older adult financial exploitation.

OBJECTIVES: Although the knowledge base regarding the financial exploitation of older adults is expanding, work to understand the subpopulations of older adult financial exploitation victims and their experiences is greatly needed. This study uses betrayal trauma theory (BTT) as the foundation for conceptualizing the harm that arises from elder family financial exploitation. METHODS: The study uses a cross-sectional design to investigate group differences among a total sample of 95 community-dwelling older adults, 32 of the participants (33.7%) were older adult victims of family financial exploitation and the remaining 63 (66.3%) were victims of financial exploitation perpetrated by strangers. RESULTS: The group of older adults who were victims of elder family financial exploitation had significantly lower functional ability scores, higher stress and financial exploitation vulnerability scores and lost more money on average than those victimized by strangers. CONCLUSION: The present study provides support that BTT provides a valuable framework for understanding why older adult family financial exploitation victims are more vulnerable than victims of exploitation committed by strangers. Attention to this subgroup of financially exploited older adults will provide improved understanding of the unique challenges these victims face and inform prevention and intervention services.

Acquiring Psychopathy and Callousness Traits: Examining the Influence of Childhood Betrayal Trauma and Adult Dissociative Experiences in a Community Sample.

The study of psychopathy has largely centered on samples of incarcerated offenders with a focus on primary psychopathy traits. Less is known, however, about how experiences of childhood betrayal trauma and dissociation influence the development of these traits in non-institutionalized individuals. In the present study, we utilized structural equation modeling to investigate the relationships among childhood betrayal trauma, adult dissociation, and adult psychopathy traits and callous affect traits in a community sample (N = 746). Childhood betrayal trauma was associated with psychopathy and callous affect traits, and mediated by dissociative experiences. These results are consistent with theory and prior empirical findings associating childhood betrayal trauma with dissociation, psychopathy, and callous affect traits. The results will help influence the design of future studies that can further inform the developmental course of psychopathy.

An investigation of whether emotion regulation mediates the relationship between attachment insecurity and suicidal ideation and behaviour.

OBJECTIVE: The aim of this research was to examine relationships between attachment insecurity and suicidal ideation and behaviour. Secondary aims were to explore the mediating role of emotion dysregulation and the moderating role of betrayal trauma in explaining hypothesised relationships. METHOD: Sixty-five participants with experience of suicidal ideation completed questionnaire measures assessing attachment security, suicide ideation, emotion regulation, betrayal trauma, depressive symptoms and hopelessness. RESULTS: A direct relationship was found between avoidant attachment and suicide ideation after controlling for age and gender. Multiple suicide attempters had higher anxious attachment. Anxious and avoidant attachment, suicide ideation and betrayal trauma were associated with emotion dysregulation. The relationship between attachment insecurity and suicide ideation was not mediated by emotion dysregulation. In the mediation model, only anxious attachment remained a significant predictor of emotion regulation and there was no significant effect of emotion regulation nor betrayal trauma, on suicide ideation. CONCLUSION: Suicidal individuals may benefit from therapeutic intervention that explores attachment-related difficulties and therapies such as dialectical behavioural therapy, which support skills in emotional regulation. Future longitudinal research should identify other important mediators of the association between attachment and suicidality to develop more targeted psychological interventions for suicidality.

Incremental Influence of Betrayal Trauma and Personality Traits on PTSD Symptoms.

Symptoms of posttraumatic stress disorder (PTSD) are common reactions to trauma. One factor that influences the manifestation of PTSD symptoms is the type of trauma experienced. Traumas perpetrated by someone on whom the trauma survivor trusts and relies on for support (i.e., betrayal traumas) are especially predictive of PTSD symptoms. However, the degree to which this is true differs somewhat across men and women. Another factor that influences PTSD symptoms is personality, which is most often operationalized in terms of discrete personality traits. Among these traits, Neuroticism (the tendency to experience negative affect) is linked to a wide range of psychological dysfunction in general and to PTSD symptoms in particular. However, there is little research on how trauma type and personality differentially influence PTSD symptoms. To address this gap, in this study we examined the incremental effects of traumas with varying degrees of betrayal and personality traits on PTSD symptoms in a sample of college students (N = 276) using a Bayesian approach to multiple regression. Results suggest that Neuroticism and trauma at all levels of betrayal were associated with higher levels of PTSD symptoms, although this differed across sex. These results are consistent with previous research that identifies Neuroticism as a risk factor for a wide range of mental health problems and clarifies earlier findings on betrayal trauma.

Influence of Betrayal Trauma on Psychopathy.

Psychopathy is a virulent form of personality pathology that exerts a costly burden on society. Although there is a strong hereditary component to psychopathy, the environment also has an impact. One of the most salient environmental influences is trauma, although not all forms of trauma may be equally predictive of psychopathy. Many studies suggest that trauma perpetrated by someone whom the victim trusts and relies upon (i.e., betrayal trauma) has an especially robust influence on personality pathology. However, there has not yet been research examining this with respect to psychopathy specifically. In this study we examined the influence of traumas with varying degrees of betrayal on psychopathy in a sample of men and women working for Amazon's Mechanical Turk (N = 444) using partial least square structural equation modeling. Results suggest that interpersonal trauma in general was associated with psychopathy for both men and women, and that trauma high in betrayal was uniquely associated with psychopathy among men. These results clarify previous research on the association between betrayal trauma and personality pathology and on the traumatic antecedents of psychopathy in particular.

Influence of Betrayal Trauma on Schizotypal Personality Pathology.

Schizotypal personality pathology (SZP) is a persistent and debilitating problem for a substantial number of people. Research on SZP has typically emphasized its biological and more specifically genetic origins. However, recent research has highlighted the potential influence of trauma on SZP. This research is promising, although it has thus far focused primarily on type of trauma (e.g., different types of abuse vs. neglect in childhood) rather than who perpetrated the trauma. Previous studies on both personality pathology in general and psychotic-spectrum experiences characteristic of SZP in particular have highlighted the influence of trauma perpetrated by someone with whom the trauma survivor was close (i.e., betrayal trauma), although this has not yet been examined with respect to SZP specifically. In this study we examined this, evaluating the influence of trauma with varying degrees of betrayal on SZP in a sample of adults (N = 364) using structural equation modeling. Results suggest that interpersonal trauma in general was associated with higher levels of SZP. Findings further indicate that for women but not men, trauma with a high degree of betrayal was uniquely associated with SZP. These results underscore the potential role of trauma in SZP and have implications for future research on and intervention with people with high levels of SZP.

The Role of Anger in Traumatic Harm and Recovery for Sexual Violence Survivors.

Sexual violence is a strong predictor of posttraumatic stress disorder (PTSD). Sexual violence survivors presenting for PTSD treatment may experience and express a range of distressing emotions. An extensive body of research guides clinical conceptualization and targeting of fear responses in PTSD treatment. Models to guide clinicians in working with posttraumatic anger, in contrast, are scarce. To address this gap, we: 1) provide a review of the theoretical and empirical literature on sexual violence, anger, and trauma recovery among sexual violence survivors; 2) integrate this literature with social functionalist theories of anger; and 3) discuss implications of this integration for adaptively leveraging anger in psychological treatment.

Barriers to PTSD treatment-seeking by women veterans who experienced military sexual trauma decades ago: The role of institutional betrayal.

BACKGROUND: While some barriers to PTSD treatment engagement among veterans are well-identified, e.g., stigma, little is known about the barriers to VA PTSD treatment-seeking among women veterans who experienced military sexual trauma (MST) decades ago. PURPOSE: To explore the barriers to PTSD treatment-seeking of women veterans with PTSD related to MST experienced prior to 2000. METHOD: Data were collected from women veterans (n = 14) who had experienced MST and sought VA PTSD treatment. Data analyses utilized a constructivist grounded theory approach. FINDINGS: The context of the MST experience, including the military environment at the time, the era in which they experienced MST and the response of others to their reporting or disclosure of MST created decades-long barriers to PTSD treatment-seeking. DISCUSSION: Understanding institutional betrayal as a barrier to PTSD treatment-seeking among women veterans who experienced MST decades ago is necessary to develop effective targeted outreach and programs for this population.

Influence of Betrayal Trauma on Antisocial Personality Disorder Traits.

Antisocial personality disorder (ASPD) is linked to a number of social problems and accordingly is the focus of intensive empirical study. There is reason to believe that ASPD is influenced at least in part by exposure to trauma, but there has been minimal research on the association between trauma and ASPD traits. Specifically, research has not examined how traumatic experiences with different degrees of interpersonal betrayal differentially influence ASPD traits. This is notable in light of recent studies indicating that exposure to traumatic experiences high in betrayal (i.e., high betrayal trauma) is the primary predictor of borderline and narcissistic personality pathology. In this study, we examined the relative associations between high, medium, and low betrayal trauma and ASPD traits in a sample recruited from Amazon's Mechanical Turk (N = 363) using structural equation modeling. Results confirmed a strong association between trauma and ASPD traits in general, although the influence of specific forms of trauma differed depending on both sex and how trauma was calculated (i.e., in terms of severity vs. exposure). In general, high betrayal trauma was the most consistent predictor of ASPD traits for men, whereas medium and low betrayal traumas were more consistently associated with ASPD traits for women. Study findings extend research on betrayal trauma to more malevolent forms of personality pathology. Sex differences in the influence of trauma across ASPD traits suggest the possibility of sex-specific personality responses to trauma high in betrayal, a topic that can be addressed in the future research.

A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident.

BACKGROUND: To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation. OBJECTIVE: The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI. METHODS: A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base-indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI. RESULTS: The nurse empirical literature reviewed included qualitative (n = 10), quantitative (n = 7), and mixed-methods (n = 4) studies (total n = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual-existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self-harm, (19%), and social problems (48%). IMPLICATIONS: Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses' safety and retention in the aftermath of a PSI. CLINICAL RELEVANCE: By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath.

It Hurts When You're Close: High Betrayal Sexual Trauma, Dissociation, and Suicidal Ideation in Young Adults.

Sexual trauma (e.g., rape), is associated with dissociation and suicidal ideation (SI). Sexual trauma is additionally harmful when perpetrated by a person(s) who is close or trusted (known as high betrayal). With young adulthood as a high-risk period for mental instability, the purpose of the current study is to examine the roles of high betrayal sexual trauma and dissociation in SI among young adults. Participants (N = 192) were college students who completed the 30-minute online survey. A multivariate analysis of variance (MANOVA) found that high betrayal sexual trauma was associated with dissociation and SI. Moreover, there was an indirect effect of high betrayal sexual trauma on SI through dissociation. Empirical implications include examining these associations longitudinally, with a focus on the impact of revictimization over time.

Exploring an Emerging Measurement Issue in Older Adult Maltreatment: Exploitation of Older Adults' Residences.

Despite nationwide housing challenges that might lead to the exploitation of older adults' housing resources, exploitation of older adults' residences has not been a focus of measurement in the rapidly developing field of elder abuse and neglect. Rather, measures of older adult abuse and exploitation used in the research literature emphasize specific property, money, or resources being taken. Two composites are used to illustrate exploitation of older adults' residences by trusted others on whom the older adults depended with potentially serious implications for environmental safety and ultimately the older adults' housing stability. As part of a larger study on older adult maltreatment, police reports were coded for abuse and financial exploitation as well as misuse of the older adult's residence that threatened the older adult's housing security and/or exerted control over the older adult. Nearly one in ten (9.2%) police reports involving older adult victims and known/trusted perpetrators described exploitation of residences. Residence exploitation was separable from financial exploitation and less likely to co-occur with neglect. Considering the importance of housing stability to older adult well-being, consequences of maltreatment by a known/trusted other, and a national housing crisis, we propose that exploitation of older adults' residences warrants further measurement and practice attention. Findings are relevant to advancing theory in older adult maltreatment (e.g., application of white-collar crime versus betrayal trauma and family violence theories).

Considerations of Dissociation, Betrayal Trauma, and Complex Trauma in the Treatment of Incest.

Child sexual abuse committed by a parent (incest) is related to particularly severe physical and psychological symptoms across the life span. Incest is associated with low self-esteem, self-loathing, feelings of contamination, worthlessness, and helplessness, as well as somatization and low self-efficacy. A child's negative constructions often are attempts to derive some meaning that justifies the incest, such as, "it is because of my badness that it happens to me." Survival often involves voluntary or involuntary disconnection from self, others, and the environment, or compartmentalization of the traumatic experiences. Dissociation with survivors of child abuse, especially when the perpetrators are from within the child's caregiver system, can be accounted for by the concept of betrayal trauma. However, with few exceptions, little appears in the literature integrating dissociation, betrayal trauma, complex trauma, and incest for the purpose of treatment. Our purpose of this review to examine the relationship between trauma-related dissociation, betrayal trauma, and complex trauma, and how understanding these concepts and their relationship can inform the treatment of incest.

Trainee Perspectives on Relational Cultural Therapy and Cultural Competency in Supervision of Trauma Cases.

Supervision is a key part of training in clinical psychology. From my postdoctoral trainee perspective as a Black woman, I reflect on supervision in 1 of my predoctoral practicum at a community clinic where I worked with low-income women with trauma histories. With relational cultural therapy (e.g., Miller, 1976), my clinical supervision was in the feminist multicultural framework (Porter & Vasquez, 1997) and included the complexities of power in the supervisory relationship, openness, collaboration, and critical self-reflection (Arczynski & Morrow, 2017). Moreover, incorporating research perspectives (e.g., betrayal trauma theory, Freyd, 1996; cultural betrayal trauma theory, Gómez, 2018d; microaggressions, Sue, 2010) and cultural competency (Sue, 1978) created a rich learning environment. In this article, I detail 2 case studies to illustrate exchanges in supervision that positively impacted my professional development. In Case Study 1, my supervisor engendered identification of parallel processing through engaging in mutual empathy and relational reconnection regarding racial discrimination from a client. In Case Study 2, my supervisor used a collaborative approach in treatment planning for a Latina client who was in an abusive relationship. Based on these experiences, implications for supervisors include ongoing training in discrimination of diverse minorities and facilitating discussions in supervision about how trainees' and clients' respective societal statuses impact the therapeutic process (e.g., case conceptualizations, treatment planning). Implications for trainees include maintaining a processing journal, in which trainees reflect on their experiences including but not limited to cultural competency to be better prepared to discuss complex issues in supervision.

La supervisión es una parte clave de la formación en psicología clínica. Desde mi perspectiva de aprendiz postdoctoral como mujer negra, reflexiono sobre la supervisión en una de mis prácticas predoctorales en una clínica comunitaria donde trabajé con mujeres de bajos ingresos con antecedentes de trauma. Con la terapia cultural relacional (por ejemplo, Miller, 1976), mi supervisión clínica estaba en el marco multicultural feminista (Porter y Vásquez, 1997) e incluía las complejidades del poder en la relación de supervisión, apertura, colaboración y autorreflexión crítica (Arczynski & Morrow, 2017). Además, la incorporación de perspectivas de investigación (por ejemplo, la teoría del trauma de la traición, Freyd, 1996; la teoría del trauma de la traición cultural, Gómez, 2018c; las microagresiones, Sue, 2010) y la competencia cultural (Sue, 1978) crearon un rico ambiente de aprendizaje. En este manuscrito, detallo dos estudios de caso para ilustrar los intercambios en la supervisión que impactaron positivamente mi desarrollo profesional. En el Estudio de caso # 1, mi supervisor generó la identificación del procesamiento paralelo a través de la empatía mutua y la reconexión relacional con respecto a la discriminación racial de un cliente. En el Estudio de caso # 2, mi supervisor utilizó un enfoque colaborativo en la planificación del tratamiento para una cliente latina que estaba en una relación abusiva. En base a estas experiencias, las implicaciones para los supervisores incluyen capacitación continua en discriminación de minorías diversas y facilitar debates en supervisión sobre cómo los estados sociales respectivos de los alumnos y los clientes impactan el proceso terapéutico (por ejemplo, conceptualizaciones de casos; planificación del tratamiento). Las implicaciones para los alumnos incluyen mantener un diario de procesamiento, en el que los alumnos reflexionen sobre sus experiencias, incluidas, entre otras, la competencia cultural, para estar mejor preparados para debatir cuestiones complejas en la supervisión.

Influence of betrayal trauma on borderline personality disorder traits.

Recent research has linked traumatic experiences with a high degree of betrayal with symptoms of borderline personality disorder (BPD). Much of this research has operationalized BPD in terms of diagnostic symptoms, which contrasts with recent approaches to understanding personality disorders (PDs) in terms of maladaptive personality traits. In this study we examine the influence of traumatic experiences with varying levels of betrayal on BPD assessed via maladaptive personality traits in a sample of college students (N = 915) using a Bayesian approach to structural equation modeling. Results suggest that trauma with a high degree of betrayal (high betrayal trauma) was the only credible predictor of BPD traits when other traumatic experiences (medium and low betrayal trauma) were taken into account, and that this effect did not vary across sex. Future research directions and clinical implications are also discussed.