COVID-19 Mitigation Activities in Inpatient Psychiatry Were Associated With Patient-Reported Institutional Betrayal, Changes in Trust, and Fear of Getting Sick.

Institutional betrayal occurs when the institutions that people depend on fail to protect them from harm, which was exemplified by a failure to manage COVID-19 risks. Inpatient psychiatry provides a rich context for which to understand the effects of institutional betrayal, and this is amplified in the context of the COVID-19 pandemic. Using a retrospective cohort design, we administered an online survey to former patients (n = 172) of inpatient psychiatry hospitalized at the height of the COVID-19 pandemic (March 2020 to February 2021) to understand the relationship between facilities' use of COVID-19 mitigation activities (ie, offering or requiring face masks, keeping patients and staff 6 feet apart, access to hand sanitizer, use of telemedicine for clinical consults, and routine cleanliness of the unit) and former patients' reports of institutional betrayal, changes in their trust in mental healthcare providers, fear of getting sick, and having contracted or witnessed someone else contract COVID-19. The quantity of COVID-19 mitigation activities was monotonically negatively associated with the probability of reporting any betrayal, the probability of reduced trust in mental healthcare providers, and the probability of being afraid of getting sick always or most of the time while hospitalized. COVID-19 mitigation activities either directly affected these psychological outcomes, or facilities that engaged in robust mitigation had greater cultures of safety and care quality. Additional qualitative work is needed to understand these mechanisms.

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.

Critical Care Nurses' Moral Resilience, Moral Injury, Institutional Betrayal, and Traumatic Stress After COVID-19.

BACKGROUND: Traumatic stress and moral injury may contribute to burnout, but their relationship to institutional betrayal and moral resilience is poorly understood, leaving risk and protective factors understudied. OBJECTIVES: To examine traumatic stress symptoms, moral injury symptoms, moral resilience, and institutional betrayal experienced by critical care nurses and examine how moral injury and traumatic stress symptoms relate to moral resilience, institutional betrayal, and patient-related burnout. METHODS: This cross-sectional study included 121 critical care nurses and used an online survey. Validated instruments were used to measure key variables. Descriptive statistics, regression analyses, and group t tests were used to examine relationships among variables. RESULTS: Of participating nurses, 71.5% reported significant moral injury symptoms and/or traumatic stress. Both moral injury symptoms and traumatic stress were associated with burnout. Regression models showed that institutional betrayal was associated with increased likelihood of traumatic stress and moral injury. Increases in scores on Response to Moral Adversity subscale of moral resilience were associated with a lower likelihood of traumatic stress and moral injury symptoms. CONCLUSIONS: Moral resilience, especially response to difficult circumstances, may be protective in critical care environments, but system factors (eg, institutional betrayal) must also be addressed systemically rather than relying on individual-level interventions to address nurses' needs.

Emotional Betrayal From Child Sexual Abuse Measure (EBSCAM): A psychometric analysis.

OBJECTIVE: This study examined the psychometric properties of a new scale, the Emotional Betrayal from Child Sexual Abuse Measure (EBCSAM), which assesses feelings of betrayal in adult survivors of child sexual abuse (CSA). Emotional betrayal is examined with respect to the perpetrator as well as others in the survivor's immediate environment (i.e., family, friends, etc.) during the time of the abuse. METHOD: A sample of 342 CSA survivors were anonymously surveyed online in order to examine the psychometric properties of the EBCSAM. RESULTS: The original 16-item measure did not produce a good-fitting model, nor was it considered reliable or valid. Instead, a shortened six-item measure produced a successful model, was reliable (overall Cronbach's α = .85), and exploratory/confirmatory factor analyses suggested two valid latent subscales (Perpetrator Betrayal and Environmental Betrayal). CONCLUSION: This measure could be useful to clinicians treating survivors of child sexual abuse, as well as researchers, to reveal and evaluate aspects of emotional betrayal that impacted survivors.CSA). Emotional betrayal is examined with respect to the perpetrator as well as others in the survivor's immediate environment (i.e., family, friends, etc.) during the time of the abuse. METHOD: A sample of 342 CSA survivors were anonymously surveyed online in order to examine the psychometric properties of the (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Betrayal-Based Moral Injury and Mental Health Problems Among Healthcare and Hospital Workers Serving COVID-19 Patients.

One factor potentially driving healthcare and hospital worker (HHW)'s declining mental health during the COVID-19 pandemic is feeling betrayed by institutional leaders, coworkers, and/or others' pandemic-related responses and behaviors. We investigated whether HHWs' betrayal-based moral injury was associated with greater mental distress and post-traumatic stress disorder (PTSD) symptoms related to COVID-19. We also examined if these associations varied between clinical and non-clinical staff. From July 2020 to January 2021, cross-sectional online survey data were collected from 1,066 HHWs serving COVID-19 patients in a large urban US healthcare system. We measured betrayal-based moral injury in three groups: institutional leaders, coworkers/colleagues, and people outside of healthcare. Multivariate logistic regression analyses were performed to investigate whether betrayal-based moral injury was associated with mental distress and PTSD symptoms. Approximately one-third of HHWs reported feeling betrayed by institutional leaders, and/or people outside healthcare. Clinical staff were more likely to report feelings of betrayal than non-clinical staff. For all respondents, 49.5% reported mental distress and 38.2% reported PTSD symptoms. Having any feelings of betrayal increased the odds of mental distress and PTSD symptoms by 2.9 and 3.3 times, respectively. These associations were not significantly different between clinical and non-clinical staff. As health systems seek to enhance support of HHWs, they need to carefully examine institutional structures, accountability, communication, and decision-making patterns that can result in staff feelings of betrayal. Building trust and repairing ruptures with HHWs could prevent potential mental health problems, increase retention, and reduce burnout, while likely improving patient care.

THE IMPACT OF ETHNIC DISCRIMINATION AND INSTITUTIONAL BETRAYAL ON CANADIAN UNIVERSITY STUDENTS' MENTAL HEALTH.

The aims of this study were to understand associations among mental health symptoms, ethnic discrimination, and institutional betrayal, and explore the potential role of protective factors (e.g. ethnic identity and racial regard) in attenuating the detrimental effects of discrimination and betrayal. A total of 89 racialized Canadian university students were recruited for this study. Self-report measures investigated demographics, mental health symptoms, experiences of discrimination and institutional betrayal, racial regard, and ethnic identity. Experiencing ethnic discrimination was associated with increased symptoms of depression and PTSD, even when controlling for the buffering effects of protective factors. Marginally significant results suggested that institutional betrayal might play a role in this relationship. Experiencing ethnic discrimination is linked to significant posttraumatic consequences. Unhelpful institutional responses may further aggravate symptoms. Universities have a duty to protect victims, and prevent ethnic discrimination.

"It Made Me Feel Like Someone Wasn't Doing Their Job:" Sexual Assault Kit (SAK) Victim Notifications and Institutional Betrayal by the Criminal Legal System.

In the United States, sexual assault survivors are advised to have a medical forensic exam and the collection of a sexual assault kit (SAK) to preserve biological evidence (e.g. semen, blood, saliva, hair) if they are considering reporting the assault to the police. Law enforcement personnel are supposed to submit the SAK (also known as a "rape kit") to a crime laboratory for forensic DNA testing, which can help identify or confirm the identity of the offender. However, police do not routinely submit SAKs for testing, and large stockpiles of untested kits have been found in police storage throughout the United States. Public outrage has prompted many cities to submit these older rape kits for DNA analysis, and this testing has identified thousands of suspected perpetrators. Police and prosecutors are re-opening these older sexual assault cases, which requires reestablishing contact with survivors who made the initial report years ago - a process referred to as "victim notification." In this study, we conducted qualitative interviews with survivors who received a SAK victim notification and participated in the re-investigation and prosecution of their cases. We explored how survivors reacted to this de facto admission of an institutional betrayal and the emotions they felt during and after the notification. Participants experienced considerable emotional distress (e.g. PTSD, anxiety, fear), anger and betrayal, and hope after they were recontacted by the police. Implications for making victim notifications more trauma informed are discussed.

College Students' Trust, Betrayal, and Needs During and After Their Worst Nonassault-Related Healthcare Experiences Differ Based on Sexual Violence Exposure.

The BITTEN theoretical framework conceptually links patient's past healthcare betrayal and trauma experiences with their current and future healthcare interactions. BITTEN was used to examine whether healthcare experiences, behaviors, and needs differ between those with and without a history of sexual violence exposure. College students at two public universities in the southeastern United States (n = 1,381; 59.5% White, 61.0% women) completed measures about their self-selected worst or most frightening but nonassault-related healthcare experience. Multivariate general linear and mediation models were used to test theory-derived hypotheses. Participants exposed to sexual violence reported greater healthcare institutional betrayal, lower trust, and greater need for tangible aid and trauma-informed care during their worst nonassault-related healthcare experience. They also reported greater current healthcare avoidance alongside increased utilization of more physical and mental healthcare appointments, even after accounting for gender and race differences. These results suggest that, with minimal information about past sexual violence exposure, healthcare providers could be better poised to predict and address vulnerable patients' healthcare needs.

Modulation of Trust in Borderline Personality Disorder by Script-Based Imaginal Exposure to Betrayal.

Interpersonal and trust-related difficulties are central features of borderline personality disorder (BPD). In this study, we applied script-driven betrayal imagery to evoke mistrustful behavior in a social reinforcement learning task. In 21 BPD and 20 healthy control (HC) participants, we compared this approach to the standard confederate paradigm used in research studies. The script-driven imagery evoked a transient increase in negative affect and also decreased trusting behavior to a similar degree in both groups. Across conditions, we also replicated previously reported between-group differences in negative affect (increased in BPD) and task behavior (more sensitive to social cues in BPD). These results support the validity of script-driven imagery as an alternative social task stimulus. This script-driven imagery approach is appealing for clinical research studies on reinforcement learning because it eliminates deception, scales easily, and evokes disorder-specific states of social difficulty.

"A slap in the face": Institutional betrayal, burnout, and career choice regret among frontline health care workers serving COVID-19 patients.

The COVID-19 pandemic has exacted a physical and mental health toll on health care and hospital workers (HHWs). To provide COVID-19 care, HHWs expected health care institutions to support equipment and resources, ensure safety for patients and providers, and advocate for employees' needs. Failure to do these acts has been defined as institutional betrayal. Using a mixed-methods approach, this study aimed to explore the experience of institutional betrayal in HHWs serving COVID-19 patients and the associations between self-reported institutional betrayal and both burnout and career choice regret. Between July 2020 and January 2021, HHWs working in an urban U.S. health care system participated in an online survey (n = 1,189) and semistructured interview (n = 67). Among 1,075 quantitative participants, 57.8% endorsed institutional betrayal. Qualitative participants described frustration when the institution did not prioritize their safety while reporting they perceived receiving inadequate compensation from the system and felt that leadership did not sufficiently respond to their needs. Participants who endorsed prolonged breaches of trust reported more burnout and stronger intent to quit their job. Quantitatively, institutional betrayal endorsement was associated with 3-fold higher odds of burnout, aOR = 2.94, 95% CI [2.22, 3.89], and 4-fold higher odds of career choice regret, aOR = 4.31, 95% CI [3.15, 5.89], compared to no endorsement. Developing strategies to prevent, address, and repair institutional betrayal in HHWs may be critical to prevent and reduce burnout and increase motivation to work during and after public health emergencies.

Liebe am Nachmittag ­ Über dialogische Liebe und Verrat.

How easy should we take love? Does love call for exclusivity? Romantic non-exclusivity is widespread. One form thereof is the attempt to combine two or more loving relationships like modules that have nothing to do with each other. Bernard Schlink's short story «The night in Baden-Baden¼ beautifully exemplifies this modular kind of love. My main claim is that this form of romantic non-exclusivity amounts to betrayal and is therefore unethical. I argue for this claim on the basis of a dialogical understanding of love.

Secondary Institutional Betrayal: Implications for Observing Mistreatment of Sexual Assault Survivors Secondhand.

Institutional betrayal has been used to describe the experiences of sexual assault survivors who are harmed by institutions which they rely on for safety or survival. This concept has primarily been studied in the context of survivors' direct relationships with institutions they are members of (e.g., universities, churches, military) and how the said institutions either failed to protect them or were unsupportive following their disclosure. Institutional betrayal can exacerbate negative mental and physical health outcomes for survivors, highlighting a need to hold institutions accountable for harm they cause. A limitation to this conceptualization is that many adults in the general public are not proximally connected to institutions (as they have historically been defined), and the majority of survivors do not formally report. Drawing on semi-structured interviews conducted with young women survivors (n = 12), the present study aims to address this gap by abstracting the conceptualization to a more macro level, proposing the term secondary institutional betrayal. Secondary institutional betrayal refers to survivors' feelings of mistrust and disillusionment toward institutions they are distally connected to which are not directly involved in their own assault (e.g., the media, U.S. government, U.S. criminal legal system, their university), yet still have influence over their personal safety and survival. This sense of betrayal stems from secondhand observations, through the news media, of how other survivors are treated by these institutions. Many survivors in the present study reported their secondhand observations of institutional betrayal would likely deter them from reporting future assaults. Establishing research in this area is important to understand how survivors in the general public are impacted by news stories which highlight institutional betrayal, particularly in the context of ongoing social movements (e.g., #MeToo) which amplify public discourse about sexual assault.

COVID-19 and Lifetime Experiences of Trauma, Moral Injury, and Institutional Betrayal Among Healthcare Providers.

OBJECTIVE: The aim of the study is to increase understanding regarding healthcare provider experiences with psychological trauma, moral injury, and institutional betrayal, both over the lifetime and during the COVID-19 pandemic. METHODS: The study employed a cross-sectional design to understand traumatic experiences, moral injury, and institutional betrayal among medical and mental health providers. Participants were asked to identify an index trauma, and experiences were coded qualitatively using categories for traumatic events, moral injury, and institutional betrayal. RESULTS: Results revealed that experiences of trauma, moral injury, and institutional betrayal were common in relation to the pandemic, as were prepandemic histories of traumatic exposures. Findings indicate that trauma exposure was a work hazard for healthcare providers during the pandemic, which could result in negative long-term mental health outcomes. CONCLUSIONS: Future research is needed to explore potential long-term negative outcomes among healthcare providers.

Examining moral injury in clinical practice: A narrative literature review.

Healthcare workers experience moral injury (MI), a violation of their moral code due to circumstances beyond their control. MI threatens the healthcare workforce in all settings and leads to medical errors, depression/anxiety, and personal and occupational dysfunction, significantly affecting job satisfaction and retention. This article aims to differentiate concepts and define causes surrounding MI in healthcare. A narrative literature review was performed using SCOPUS, CINAHL, and PubMed for peer-reviewed journal articles published in English between 2017 and 2023. Search terms included "moral injury" and "moral distress," identifying 249 records. While individual risk factors predispose healthcare workers to MI, root causes stem from healthcare systems. Accumulation of moral stressors and potentially morally injurious events (PMIEs) (from administrative burden, institutional betrayal, lack of autonomy, corporatization of healthcare, and inadequate resources) result in MI. Individuals with MI develop moral resilience or residue, leading to burnout, job abandonment, and post-traumatic stress. Healthcare institutions should focus on administrative and climate interventions to prevent and address MI. Management should ensure autonomy, provide tangible support, reduce administrative burden, advocate for diversity of clinical healthcare roles in positions of interdisciplinary leadership, and communicate effectively. Strategies also exist for individuals to increase moral resilience, reducing the impact of moral stressors and PMIEs.

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.

A Qualitative Exploration of Institutional Betrayals in Rural Communities: An Emerging Typology.

To explore individuals' personal narratives of perceived betrayals and injustices committed by institutions, their representatives, or other authority figures and discern in what spheres of life they commonly manifest. 157 adults from largely rural, low-income communities in southern Appalachia participated in semi-structured qualitative interviews that asked them to describe key points in their life experiences, including high points, low points, and turning points. These were reviewed for episodes of institutional betrayals. Interview transcripts were analyzed using a grounded thematic analysis. Participants mentioned numerous instances of betrayals that occurred from interactions with institutions or their representatives. These were grouped into four categories: professional betrayals involving mistreatment from an employer, health care provider, or other authority figure; professional-organizational betrayals where a professional perpetrator was able to get support from a problematic organizational culture; corporate malfeasance involving misdeeds by business entities; and systemic injustices involving the sociopolitical architecture of society. The findings identified a range of institutional betrayal experiences that were unnecessary, unwanted, intentional, and harmful. They could be distinguished by the type of perpetrators and often led to notable harms, including unwanted system involvement and unemployment. Although participants seldom explicitly mentioned the rural setting in their descriptions of institutional betrayal, it is likely that limited options for health care providers, schools, and other institutions exacerbated some harms. Institutional betrayals need to be considered in people's trauma dosage, their cumulative lifetime burden of trauma.

Responses to autobiographical memories involving being a victim or perpetrator of betrayal in people with OCD and community controls.

Mental contamination in people with OCD has been linked to the perceived impact of being betrayed and betraying others. In this study, participants with OCD (N = 56) and community controls (N = 37) were randomised to an induction involving eliciting autobiographical memories of either being betrayed by someone they trusted or betraying someone that trusted them. The OCD group experienced greater increases in state mental contamination and anxiety than the control group, but no differences were observed between groups in urges to wash or drink. Both betrayal conditions elicited similar levels of mental contamination and anxiety. The results of this study suggest that people with OCD experience similar increases in mental contamination and anxiety not only when recalling memories of being a victim of betrayal but also when recalling being a perpetrator. People with OCD are therefore more sensitive to betrayal experiences than community controls. Clinical implications and implications for future research are discussed.

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.