Betrayal trauma

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. BTT posits that in the context of abusive relationships in which escape is not a viable option, the cheater-detecting mechanism may be suppressed for the higher goal of survival. Thus, betrayal trauma offers 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. 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 human ethics. Notably, the degree to which one is violated by a caregiver or close relationship can influence the nature of and response to trauma. BTT suggests that CSA is closely linked with psychogenic amnesia or other dissociative processes occurring as a means to maintain an attachment with the caregiver and promote survival. 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 to address their wrongs they risk disbelief, blame, and refusal of help. Priorities of the institution, such as protecting their reputation, may increase the likelihood that institutions fail to respond appropriately. Institutions may strenuously attempt to prevent knowledge of said assaults from surfacing, which can take the form of attempting to silence the individual. Similarly, sexual assault committed by close others in the context that the betrayal is implicit, and challenging to detect, Military In an effort to directly measure institutional betrayal, results from comparisons of female veterans who experienced civilian sexual assault and those who experienced sexual assault in the United States military indicated that institutional betrayal was higher in military contexts when members were highly dependent upon the military for safety, protection, and employment. Although research investigating military sexual trauma (MST) is still in its infancy, literature has identified the perpetrator-victim relationship as a primary impediment to reporting the assault which could impact job status and contribute to disruptions in unit cohesion, ostracization, inability to leave or transfer duty stations. Evidence evaluating the impact of assault or harassment during military service, and medical care is 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. However, recent deaths suspected to be the result of police officers using excessive force (e.g., shooting of Stephon Clark, shooting of Philando Castile) have shone light upon the issue of police brutality as a form of institutional betrayal. Research has identified that cultural minorities tend to experience police brutality more frequently than their European American counterparts due to stereotypes associating criminal activity with race/ethnicity, particularly in urban areas where crime rates are high and the presence of cultural minorities is more prevalent. Healthcare system Emerging literature has articulated a need for furthering research that evaluates the prevalence and impact of institutional betrayal in healthcare settings, with an emphasis on understanding the relationship between the level of trust patients place in physicians, associated expectations that physicians will prioritize protections to patients' welfare, and incurred adverse medical experiences which are conceptualized as institutional betrayal. 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. More recent literature exploring BTT in romantic partnerships has focused on the inclusion of domestic violence (DV). DV involves a betrayal of trust when one partner is repeatedly beaten, degraded, and violated and 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 which have been linked to deep feelings of shame and anxiety in the victim. 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. In the context of intimate partner violence (IPV), vulnerability/fear, relationship expectations, shame/low self-esteem, and communication issues are suggested to be ways exposure to betrayal trauma manifests and subsequently serves as a barrier to forming new romantic relationships. == 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 which such content can be segregated into one's unconscious awareness. 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 are likely to have detrimental effects on a child's attachment security, stress responses, coping strategies, and sense of self. 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. 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. 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. Research suggests that the level of betrayal trauma experienced (e.g., high, moderate, low) can influence the degree of dissociation. Additionally, consolidated empirical evidence has indicated that exposure to HBT is linked to increased levels of dissociation and impaired memory of trauma-related words as compared to low dissociators. Janoff-Bulman (1992) identified three assumptions (e.g. the world as benevolent, meaningful, and worthy), which can be shattered by distortions in social behavior. 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. == Presence in psychopathology ==

Models of attachment-based dissociative disorders and trauma-related disorders involving betrayal trauma have been indicated in diagnostic groups such as post-traumatic stress disorder, personality disorders, dissociative disorders, and substance-related and addictive disorders. Many of these disorders can result from betrayal trauma, and such trauma should be explored as a possible contributor to symptoms. Dissociative identity disorder Some trauma victims deploy a protective response such as dissociation or repression to block awareness of the trauma. 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. Substance use disorders There have been suggestions that interpersonal trauma such as betrayal trauma can in some cases have links to substance use. 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. The maltreatment is sometimes because of the emotional, physical, verbal 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. Pathological Narcissism is another personality disorder in which betrayal trauma may have an impact as narcissism is functionally similar to BPD. High betrayal trauma significantly predicted both grandiose and vulnerable narcissistic dimensions. 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. == Treatment ==

Betrayal assessments The Betrayal Trauma Inventory (BTI) was created to assess for BTT in patients. The 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. The Brief Betrayal Trauma Survey (BBTS) 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. == References ==