Insult,then Injury: Interpersonal and Institutional Betrayal Linked to Health and Dissociation

Psychological trauma, particularly trauma involving betrayal, has been linked to health problems. Betrayal trauma is also characterized by dissociation and difficulty remembering as victims face conflicting demands presented by a harmful but important relationship. Institutional betrayal is related to, but distinct from, interpersonal betrayal and in need of research on its unique effects. The current study has two related goals. First, the association between institutional betrayal and health problems is examined. Second, the previously documented association between institutional betrayal and dissociative symptoms is re-examined, while controlling for betrayal trauma. This study utilizes a sample of 302 college students (70% female, 63% Caucasian) who reported their trauma history (Brief Betrayal Trauma Survey), institutional betrayal history (Institutional Betrayal Questionnaire), distress related to health problems (Patient Health Questionnaire), and dissociative symptoms (Wessex Dissociation Scale). We found that institutional betrayal is uniquely associated with both health problems and dissociative symptoms even when controlling for betrayal trauma exposure. Findings add to the understanding of how institutional betrayal is uniquely associated to trauma-related physical and mental health outcomes. Small effect sizes, likely due to low base rates of health problems and dissociative symptoms in college students, and problems generalizing these results to clinical samples are discussed.     

Frequency of Interpersonal Trauma Types,Avoidant Attachment,Self-Compassion,and Interpersonal Competence: A Model of Persisting Posttraumatic Symptoms

Given limited knowledge about how psychosocial factors interact to modulate posttraumatic stress symptoms, this study evaluated an integrative model proposing that experiencing more interpersonal trauma types (e.g., abuse, assault, rape, etc.) leads to greater avoidant attachment and lower self-compassion, which limits the development and use of effective interpersonal skills. In turn, lower levels of self-compassion and interpersonal competence perpetuate posttraumatic symptoms. Anonymous trauma-experienced adults (n = 132) completed self-report measures in an online study hyperlinked on trauma support websites. Data were subjected to confirmatory factor analysis and structural equation modeling, which provided support for the hypothesized model. Specifically, higher frequency of interpersonal trauma types experienced was linked to higher avoidant attachment and lower self-compassion, which in turn were associated with lower interpersonal competence, which correlated with greater posttraumatic stress symptoms. Although cross-sectional data cannot address directionality of associations, this study’s findings emphasize the potential utility of future longitudinal research designed to examine possible causal relationships among these specific psychosocial factors. For example, study findings suggest that those who experience more types of interpersonal trauma and who are characterized by avoidant attachment and lower self-compassion and interpersonal competence may be the most susceptible to experiencing severe posttraumatic symptoms. However, findings also suggest that efforts to increase self-compassion and interpersonal skills may help reduce symptoms.     

Health Outcomes by Closeness of Sexual Abuse Perpetrator: A Test of Betrayal Trauma Theory

Summary

In this chapter, practicing attorney Brooks Cooper illuminates how the legal tradition of applying different standards to the ad-missibility of expert and lay opinions as evidence in litigation complicates delayed-discovery sexual abuse cases. Admissibility standards have long been a source of controversy, and recent developments in law, such as the pre-trial evidentiary hearings that invoke the “gatekeeper” function of the judge under the standard enunciated in Daubert v. Mer-rell-Dow Pharmaceuticals, have become a favored strategy by the defense in an effort to bar delayed memory testimony by characterizing it as the product of unreliable science. To overcome this litigation hurdle, Mr. Cooper contextualizes the present controversy in the history of scientific evidence admissibility, tracing emerging trends in judicial opinion on scientific evidence from expert witnesses from the 1923 case Frye v. United States through the present, and offers strategies and techniques to maintain admissibility of the evidence before and during all phases of the trial.     

Institutional Betrayal in the Canadian Medical System: Reliability and Validity of a Self-Report Questionnaire

Institutional betrayal (IB), an institutional failure to either prevent or to respond supportively to a traumatic event, tends to cause trauma survivors further psychological distress. The medical system may exhibit significant levels of IB given the frequency of medical interactions and vulnerability of patients. The current study aimed to assess the reliability and validity of a new measure of IB in the medical system in a sample of 352 Canadian adults with chronic medical conditions. An exploratory factor analysis found 3 stable and reliable factors of IB: negative healthcare experiences, cognitive-affective reactions, and systemic responses to these experiences. Subsequent analyses found evidence supporting the validity of the IB questionnaire. As expected, IB predicted poorer mental health even after controlling for demographics, and traumatic experiences. Future studies should confirm that these factors hold in different populations, and should employ different experimental designs to better understand the causal factors of IB.     

When Home Is Where the Harm Is: Family Betrayal and Posttraumatic Outcomes in Young Adulthood

Research on institutional betrayal has found that institutional wrongdoing that fails to prevent or respond supportively to victims of abuse adds to the burden of trauma. In this two-study investigation with young adult university students, we demonstrated parallels between institutional betrayal and ways that families can fail to prevent or respond supportively to child abuse perpetrated by a trusted other, a phenomenon we call family betrayal (FB). In Study 1, psychometric analysis of a new FB questionnaire provided evidence of its internal consistency, unidimensionality, and convergent and discriminant validity. The majority (approximately 72%) of young adults abused in childhood reported a history of FB, with an average of 4.26 FB events (SD = 4.45, range 0–14). Consistent with betrayal trauma theory, Study 2 revealed that FB was 4× more likely to occur in relation to childhood abuse by someone very close to the victim (vs. non-interpersonal victimization), with a particularly strong effect for female participants. FB history predicted significant delay to disclosure of a self-identified worst traumatic event (η_p² = .017) and significant increases in dissociation (?R² = .05) and posttraumatic stress (?R² = .07) symptoms in young adulthood. Moreover, with FB in the regression models, only FB—not child abuse nor recent interpersonal victimization—predicted dissociation and clinically significant elevations in posttraumatic stress. Findings suggest that FB is a prevalent phenomenon among young adults abused as children and that it explains unique, clinically significant variance in posttraumatic distress, warranting increased attention from trauma researchers and clinicians.     

A Primer on Librarians Sabbaticals: A Case Study of a Six-Month Sabbatical at Home and Abroad

Sabbaticals have long been part of the research culture in American higher education and academic libraries. A review of the scholarly literature shows that sabbaticals serve a number of purposes for librarians. By providing time for reviewing best practices at other libraries, working at other libraries within and outside the United States, or pursuing post-graduate degrees, sabbaticals have allowed those in academic libraries to improve their skill sets and knowledge base to improve themselves and their libraries. A successful sabbatical takes planning and focus; the author of the article will use his sabbatical, which took place between July and December 2015 in Salt Lake City, Utah, and St. Stephen's House, an Anglican Theological College and Permanent Private Hall at Oxford University, as model for this primer on having a successful sabbatical.     

Intergenerational Transmission of Trauma-Related Distress: Maternal Betrayal Trauma,Parenting Attitudes,and Behaviors

The purpose of this study was to elucidate mechanisms involved in the intergenerational transmission of trauma-related distress. This study investigated whether betrayal trauma (BT; abuse by a person close to the victim) and specific parenting attitudes and behaviors among mothers with child abuse histories predicted internalizing and externalizing symptoms in their children. Mothers and children (ages 7–11) were recruited for a project on parenting and stress (N = 72). Maternal betrayal trauma predicted both internalizing (β = 0.33, p < .01) and externalizing symptoms (β = 0.25, p < .05) even when controlling for mothers’ trauma-related symptoms. Negative attitudes toward limit setting predicted externalizing symptoms (β = ?0.33, p < .05). Poorer communication (β = ?0.39, p < .05) but higher parenting satisfaction (β = 0.38, p < .01) predicted internalizing symptoms. These findings demonstrate the importance of assessing maternal trauma and parenting characteristics as part of interventions with symptomatic children.     

Therapeutic Alliance,Interpersonal Relations,and Trauma Symptoms: Examining a Mediation Model of Women With Childhood Abuse Histories

The current study explored the dimensions of the early therapeutic alliance (tasks, goals, bonds, and other-therapist [people important to clients who support their involvement in therapy]) as mediators between clients’ interpersonal relations problems and outcome measures of trauma symptoms (dissociation and total trauma symptoms). Seventy-six female participants who were receiving treatment for posttraumatic stress due to child abuse (CA), were recruited from a university training clinic. The bond and other subscales mediated the association between interpersonal relations problems and dissociation. The element of client trust associated with the alliance bond, as well as clients’ sense that people who are important to them support their involvement in therapy, should be focal in treating CA survivors. Clinical implications revolve around developing, maintaining, and repairing the therapeutic relationship, especially the bond, within the context of dissociation, as well as exploring clients’ views of important others and its impact on their therapy.     

Emotional Reactions During and After Trauma: A Comparison of Trauma Types

Peri- and posttraumatic emotional responses have been understudied, and furthermore, have rarely been compared among trauma types. The current study compared college students' retrospective self-reports of peri- and posttraumatic responses of fear, shame, guilt, anger, and sadness among four types of traumatic events: sexual assault, physical assault, transportation accident, and illness/injury. Overall emotional responding was generally high for all trauma types, and for those in the sexual assault group, emotion increased sharply from the peri- to posttraumatic time point. Generally, fear was higher during the trauma compared to after the trauma, whereas the other emotions tended to remain stable or increase posttrauma. The sexual assault group tended to report higher levels of posttrauma emotion than the other trauma type groups.     

Betrayal Trauma,Health Care Relationships,and Health in Patients with a Chronic Neurovascular Condition

Individuals who have been exposed to trauma are at a greater risk of developing a chronic physical health condition and use health services more frequently than individuals who have not experienced trauma. The mechanism by which trauma affects health is not fully understood, but relationships with health care providers could be important in understanding this association. The purpose of this study was to explore the relationships among betrayal trauma, health care relationships, and physical and mental health in a chronic medical population. Participants (N = 272) diagnosed with a chronic neurovascular condition (cavernous malformation) completed an online survey. Questionnaires assessed self-rated health, instances of betrayal trauma, posttraumatic stress disorder (PTSD) and depression symptoms, income, and other demographic factors, and health care relationships. Level of income and the experience of betrayal trauma predicted mental health symptoms (depression, PTSD, or both) and also predicted health care relationships. After controlling for income and previous trauma, mental health symptoms significantly predicted health care relationships. Finally, mental health symptoms, health care relationships, and income predicted self-rated health, although the associations were not straightforward. These results suggest complex interrelations among trauma, mental health, income, health care relationships, and physical health, and a model is proposed for explaining these associations.     

Perceptions of Dating Violence Following a Sexualor Nonsexual Betrayal of Trust: Effects of Gender, Sexism, Acceptance of Rape Myths, and Vengeance Motivation

College womens (N = 220) and mens (N = 208) perceptions of violence following a betrayal by a romantic partner were studied in an independent groups design that varied gender of the participant, type of betrayal (sexual or nonsexual), and gender of the betrayed individual. Participants read one of four brief vignettes in which the betrayed person slapped his/her partner and made his/her lip bleed. Justification of this action was rated on 10 items. Factor analysis of these items indicated the presence of three factors for men and four for women. Both men and women indicated that hitting the partner, getting even, and being angry were more justifiable following a sexual betrayal. The hitting of a male partner by a betrayed woman was perceived as more justified than the hitting of a female partner by a betrayed man. In absolute terms, hitting and getting even by both women and men were generally viewed as unjustifiable, whereas being angry was viewed as justifiable. For both women and men, scores on the Vengeance Scale (Stuckless & Goranson, 1992) and Rape Myth Acceptance Scale (Lonsway & Fitzgerald, 1995) were related to getting even. For men, the Hostile Sexism Scale (Glick & Fiske, 2001) was related to getting even or being angry and breaking up. Results indicated that perceptions of reactions to betrayal are related to type of betrayal and to the dispositional characteristics of the perceiver.     

Interpersonal Trauma and Physical Health Symptoms in College Students: Mediating Effects of Substance Use and Self-Blame

The present study examined the mediating effect of two coping mechanisms (substance use and self-blame) on the relationship between interpersonal trauma (IPT) exposure and self-reported physical health symptoms in college students. Participants included 365 trauma-exposed college students. We used multigroup structural equation modeling to test our hypothesized model and to determine whether the hypothesized relationships were moderated by gender. Results indicated that IPT exposure was associated with increased substance-use coping and self-blame. These two coping mechanisms, in turn, predicted increased physical health symptoms. The results of the moderation analysis indicated no significant gender differences in the hypothesized relationships.     

Responses to the September 11, 2001, Terrorist Attacks: Experience of an Indirect Traumatic Event and Its Relationship With Perceived Benefits

Little is known about how people might benefit from an indirectly experienced traumatic event. The authors examined the relationship between perception of benefit and trauma symptoms in response to a relatively severe, but indirectly experienced, traumatic event. The authors sampled from 2 colleges located in the southeastern United States (N = 136). Individuals responded to questionnaires that assessed perceived benefits and trauma symptoms 1-2 weeks after the terrorist attacks of September 11, 2001, and again approximately 10 weeks later. Participants did perceive benefits from witnessing this event, although their perception of benefit declined over time. Level of trauma symptoms correlated positively with perception of benefit, and experiencing a previous trauma also correlated positively with perceived benefits. Additional analysis indicated that level of trauma symptoms mediated the relationship between previous trauma and perception of benefit. These findings help to elucidate understanding of the development of perceived benefits in response to indirectly experienced events.     

Vicarious Trauma in Social Workers: The Role of Trauma History,Social Support,and Years of Experience

Vicarious trauma, a disruption in schemas and worldview often accompanied by symptoms similar to those of posttraumatic stress disorder, occurs as a result of chronic secondary exposure to traumatic material. The aim of this study was to examine the role of personal trauma history, social support, and experience level in the development of vicarious trauma among licensed social workers in Maryland (N = 160). Results indicated an increase in social support and in experience level of social workers predicted less severe vicarious trauma. In addition, an interaction effect between trauma history and social support trending on significance indicated higher levels of social support might help protect those without a trauma history but not those with a trauma history against vicarious trauma. Research and clinical implications are discussed.     

Trauma in the Lives of Older Men: Findings from the Normative Aging Study

Research on the prevalence of traumatic exposure has tended to focus on younger populations, limiting our knowledge about trauma and its effects in older adults. In this study, lifetime trauma exposure was assessed in a sample of 436 male military veterans of World War II and the Korean Conflict (age 59–92). A clinician-administered screening measure, the Brief Trauma Interview, was developed to assess lifetime exposure to 10 categories of trauma using DSM-IV criteria. PTSD was assessed in interview and questionnaires. Despite a high prevalence of trauma exposure, symptom levels were relatively low. Few men met criteria for current or lifetime PTSD. Secondary analyses found that lifetime symptom severity was higher in men who met the DSM-IV A.2 criterion, in contrast with men who did not meet A.2. Findings indicate that trauma is highly prevalent among older men, although many may be asymptomatic.     

Inverting the Object of Study: Recalibrating the Frame of Reference in Study Abroad Experiences

This essay is concerned with study abroad experiences as opportunities for student cognitive development, using the interpretive lens of educational psychologist William G. Perry. A standard and often valuable assignment in courses on world religions is a site visit to a religious institution in one's local area. This may concretize otherwise abstract materials and help students reflect on ways in which the lived experience of religion differs from its presentation in course texts and other academic materials. Increasingly, study abroad trips are being offered as extended and more intensive ways of bringing this material to life, offering students opportunity to see lived religion within another cultural framework. At the heart of this paper is the contention that such study abroad experiences function not simply as longer, more intense versions of site visits but, rather, as experiences that invert the subject and object of study. The worldview of the student becomes a primary object of study, which is examined, as it were, by the particulars of the religion(s) under investigation and the cultures of which said religion(s) are a part. Where site visits offer students an opportunity to visit the strange amidst the familiar, study abroad trips provide opportunities for students to become the strange within a recalibrated familiar. The subject becomes the object and is interrogated by the context of study. While local, stateside site visits can offer a degree of such dislocation, their brevity, together with some degree of assimilation to the larger culture flows on the part of the local religious institution being visited, most often mitigates any significant inversion. Students generally see such institutions as either mildly or wildly exotic, but always within their frame of reference, which constitutes the norm. When abroad, the normative experience of students is often subverted in ways that lay bare the assumptions behind such views and makes possible another world in which to live. Simply put, the subject and object of study change places. If this inversion is carefully attended to, it can provide rich insight into not only the topics nominally being studied but also occasion opportunity for real cognitive development on the part of the student. This essay is published alongside of six other essays, including a response from John Barbour, comprising a special section of the journal (see Teaching Theology and Religion 18:1, January 2015).     

儿童期创伤与有留守经历大学生负性情绪：心理韧性的调节作用

本研究旨在考察有留守经历的大学生儿童期创伤与负性情绪关系,以及心理韧性在其间的调节作用。对391名有留守经历的大学生进行间隔3个月的两次问卷调查。结果:(1)相较于没有儿童期创伤的个体,有儿童期创伤的个体心理韧性更低,抑郁、焦虑、压力水平更高;(2)在控制性别、城乡来源、是否独生、年龄与T1时间点负性情绪的作用后,T1时间点的儿童期创伤、心理韧性均能显著预测T2时间点的负性情绪;(3)低心理韧性水平下,儿童期创伤显著预测留守经历大学生的负性情绪;高心理韧性水平下,预测作用不再显著。表明儿童期创伤是有留守经历的大学生负性情绪的风险因素,心理韧性可以调节儿童期创伤对有留守经历大学生的负性情绪的预测。     

Therapeutic Work with Trauma,Revictimization, and Perpetration: Bearing Witness,Offering Hope,Embracing Despair

ABSTRACT

This paper offers a case study of a survivor of childhood incest who in adulthood has become a victim of violence in her relationships with chosen partners and is concerned that she herself may be a perpetrator of sexual abuse. It examines selected literature on attachment, dissociation, transference/countertransference, role responsiveness and sadomasochistic therapeutic enactments, the two-system superego model, and the triadic self. The paper focuses on long-term treatment dynamics with survivors of cumulative trauma and explores such psychodynamic psychotherapy issues as the therapist as a perpetrator of violence, the development of sacred space, authenticity, and the importance of both offering hope and embracing despair in this work.     

Spirituality and Trauma: The Role of Clergy in the Treatment of Posttraumatic Stress Disorder

An increased awareness of the spiritual aspects of health and illness has recently led to changes in psychiatry residency training as well as hospital accreditation requirements. The spiritual impact of trauma has been an area of particular interest, as trauma evokes certain existential questions and crises. It is estimated that from 5–11% of trauma survivors will go on to develop posttraumatic stress disorder (PTSD). Given the spiritual challenges of the experience of trauma, patients with PTSD could benefit from spiritual assessment and intervention as part of their overall treatment plan, and clergy can be utilized to perform this. The literature exploring the spiritual impact of trauma and the use of clergy in the treatment of trauma survivors is reviewed. The methods used by three chaplains in a residential treatment program for PTSD at one facility are described and discussed. Both the literature and the experiences of the clergy suggest that exploration of trauma-related existential conflicts in patients with PTSD is beneficial. However, there is a notable dearth of controlled scientific studies evaluating the effectiveness of spiritual interventions with this treatment population. The need for controlled studies to verify the usefulness of spiritual assessment and intervention in patients with PTSD is noted, and a more rigorous analysis of how clergy can best serve this treatment population is encouraged.     

Emotional Constriction and Risk for Posttraumatic Stress: The Roles of Trauma History and Gender

Research suggests there are qualitative differences in emotionality across gender, with men being more emotionally constrictive than women. Constrictive emotionality has consistently been linked to posttraumatic stress disorder (PTSD) and because men are generally more emotionally constrictive, one could infer they are at increased risk for PTSD. However, research demonstrates that twice as many women are diagnosed with PTSD than men. In an undergraduate sample, men reported significantly greater emotional constriction, but significantly less posttraumatic stress severity in comparison to women. The gender differences in emotional constriction disappeared in a subsample of students who endorsed experiencing an upsetting event. Emotional constriction mediated the relationship between trauma and posttraumatic stress severity, although it was a stronger mediator for women than men.