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Hujing CL, Yalch MM, Levendosky AA. Association Between Betrayal Trauma and the PAI Traumatic Stress Scale. J Trauma Dissociation 2024; 25:408-418. [PMID: 38385573 DOI: 10.1080/15299732.2024.2320873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/30/2023] [Indexed: 02/23/2024]
Abstract
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.
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Affiliation(s)
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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2
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Walsh C, Cunningham T. THE PAINS OF PARAMILITARISM: The Latent Criminogenic Effects of Exposure to Paramilitary Violence Among Young Men in a Post-Conflict Society. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:547-558. [PMID: 37593052 PMCID: PMC10427590 DOI: 10.1007/s40653-023-00516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 08/19/2023]
Abstract
Purpose: Whilst most people who experience adversity recover, there is a cumulative body of evidence that illustrates that the effects can be long lasting, and can even become debilitating over time. Links have been made between traumatic distress, mental health disorders and disturbances in behavioural and emotional regulatory systems that may in context elevate the risk of offending. Despite the burgeoning evidence around the criminogenic effects of adversity, few studies have examined the traumatic effects of paramilitary related adversity in the context of post-conflict Northern Ireland. Methods: With reference to DSM-V PTSD diagnostic clusters, the aim of this study was to explore the latent impact of adversity and latent trauma among justice involved young men and identify potential criminogenic effects of exposure to paramilitary related adversity. Results and conclusions: This study found that across the sample, young men had self-reported to have experienced significant adversity, including violent victimisation. Exposure to paramilitary adversity often began during early adolescence. The participants described symptoms that were consistent with clinically diagnosable disorders such as Post-Traumatic Stress Disorder. Despite this, there appears to be a paucity of trauma screening and assessment, and few supports that victim could benefit from. In the absence of appropriate and evidence-based supports, many young men appear to find other (and more maladaptive) ways to cope. This exacerbates the risk of interfacing with the justice system and may even contribute towards a deterioration in wider psycho-social outcomes. Implications for practice are discussed.
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Affiliation(s)
- Colm Walsh
- Queen’s University Belfast, Belfast, United Kingdom
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Russell B, Mussap AJ. Rumination and threat-biased interpretation mediate posttraumatic stress and growth responses to military stressors. MILITARY PSYCHOLOGY 2023; 35:451-466. [PMID: 37615560 PMCID: PMC10453989 DOI: 10.1080/08995605.2022.2127618] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
We examined the role of rumination and threat-biased interpretation in stress and growth responses to military stressors. Two online surveys were completed by 183 (survey 1) and 393 (survey 2) currently serving or retired military personnel. The surveys measured exposure to potential military stressors (exposure to combat, witnessing the consequences of war, and perceived moral injury), posttraumatic stress symptomatology (PTSS), posttraumatic growth (PTG), and personal wellbeing, with survey 1 including measures of rumination, and survey 2 including a measure of threat-biased interpretation. Path analyses revealed that indirect paths from both witnessing the consequences of war and experiencing betrayal to PTSS were mediated by intrusive rumination and threat-biased interpretation, and that indirect paths from both betrayal and transgressions by others to PTG were mediated by deliberate rumination and threat-biased interpretation. The results reveal the idiosyncratic nature of military stressors, their differential involvement with cognitions that underpin rumination about past events and interpretation of current events, and their relevance to posttraumatic stress and growth in military personnel.
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Affiliation(s)
- Brenton Russell
- School of Psychology, Deakin University, Melbourne, Australia
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4
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Kidwell MC, Kerig PK. To Trust is to Survive: Toward a Developmental Model of Moral Injury. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:459-475. [PMID: 37234829 PMCID: PMC10205960 DOI: 10.1007/s40653-021-00399-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 05/28/2023]
Abstract
Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration. Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths' potentially heightened susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research.
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Affiliation(s)
- Mallory C. Kidwell
- Department of Psychology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112 USA
| | - Patricia K. Kerig
- Department of Psychology, University of Utah, 380 S 1530 E, Salt Lake City, UT 84112 USA
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5
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Wallick A, Ward RN, Levendosky AA, Brown LM, Yalch MM. Incremental Influence of Betrayal Trauma and Personality Traits on PTSD Symptoms. J Trauma Dissociation 2022; 23:356-365. [PMID: 34651565 DOI: 10.1080/15299732.2021.1989119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Amanda Wallick
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
| | - Rachel N Ward
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
| | - Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Minnesota, United States
| | - Lisa M Brown
- Department of Psychology, Palo Alto University, Palo Alto, California, United States.,Department of Psychology, Stanford University, Palo Alto, United States
| | - Matthew M Yalch
- Department of Psychology, Palo Alto University, Palo Alto, California, United States
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6
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Gómez JM. When solidarity hurts: (Intra)cultural trust, cultural betrayal sexual trauma, and PTSD in culturally diverse minoritized youth transitioning to adulthood. Transcult Psychiatry 2022; 59:292-301. [PMID: 34913370 PMCID: PMC9149028 DOI: 10.1177/13634615211062970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sexual trauma is associated with PTSD, with perpetrators putting women and girls more at risk than men and boys. Young adulthood is a time where risk of victimization and susceptibility to mental health problems increase. Certain contributors of costly trauma outcomes may be affected by the larger context of societal inequality. Cultural betrayal trauma theory (CBTT) highlights cultural betrayal in within-group trauma in minoritized populations as a dimension of harm that affects outcomes. In CBTT, within-group trauma violates the (intra)cultural trust-solidarity, love, loyalty, connection, responsibility-that is developed between group members to buffer against societal inequality. This violation, termed a cultural betrayal, can contribute to poorer mental health. The purpose of the current study is to address a gap in the CBTT literature by examining the role of (intra)cultural trust on the association between cultural betrayal sexual trauma and symptoms of PTSD among diverse minoritized youth transitioning to adulthood. Participants (N = 173) were diverse minoritized college students, who completed a 30-min online questionnaire at a location of their own choosing. Participants received course credit and could decline to answer any question without penalty. The results reveal that the interaction between cultural betrayal sexual trauma and (intra)cultural trust predicted clinically significant symptoms of PTSD. These findings have implications for increased cultural and contextual specificity in trauma research in minoritized populations, which can aid in the development and implementation of culturally competent interventions for diverse minoritized youth survivors of sexual trauma.
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Howard Valdivia RL, Ahrens CE, Gómez JM. Violence victimization in Latina/o/x young adults: The multiplicative effects of cultural and high betrayal trauma. JOURNAL OF FAMILY TRAUMA, CHILD CUSTODY & CHILD DEVELOPMENT 2022; 20:216-238. [PMID: 37554581 PMCID: PMC10406453 DOI: 10.1080/26904586.2022.2066596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/08/2022] [Indexed: 08/10/2023]
Abstract
Latinas/os/xs experience pervasive rates of interpersonal violence victimization while also experiencing frequent discrimination and societal trauma (e.g., hate crimes). Betrayal trauma theory and cultural betrayal trauma theory provide frameworks for examining the distinct harm of violence perpetrated by a close other and by a member of the same marginalized group(s), respectively. However, no known research has examined the concurrent impacts of both forms of betrayal among Latina/o/x young adults. The current study examined the unique and multiplicative effects of high betrayal trauma (i.e., violence perpetrated by a close other) and cultural betrayal trauma (i.e., violence perpetrated by someone of the same marginalized group(s)) on psychological and physical health symptoms in Latina/o/x young adults. Latina/o/x undergraduate students (N = 208) participated in a 60-minute online survey assessing violence victimization, psychological symptoms, and physical health. Rates of victimization (91.35%, n = 190) were high across differing forms of violence. Interactions of high betrayal trauma and cultural betrayal trauma were significant for psychological, physical, and anxiety symptoms. Although there were no significant simple effects, the pattern of results suggested that being assaulted by someone who shares one's Latina/o/x identity was more strongly associated with psychological and physical symptoms when participants had not been assaulted by someone with whom they were close. The current study highlights the importance of culturally competent therapy for Latina/o/x survivors that incorporates the interpersonal and cultural contexts of victimization.
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Affiliation(s)
| | - Courtney E. Ahrens
- Psychology, California State University Long Beach, Long Beach, California, USA
| | - Jennifer M. Gómez
- Psychology, Wayne State University, Detroit, Michigan, USA
- Center for Institutional Courage, Wayne State University, Detroit, Michigan, USA
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8
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Timmer-Murillo SC, Schramm A, deRoon-Cassini TA. Life threat during assaultive trauma: Critical posttraumatic stress disorder risk factors for injured patients. J Trauma Acute Care Surg 2022; 92:848-854. [PMID: 35468115 PMCID: PMC9181289 DOI: 10.1097/ta.0000000000003543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) among injury survivors are higher relative to the general population, supporting the need to identify those most at risk for PTSD following injury given negative impact of PTSD on recovery. Perceived life threat and assaultive trauma are consistent risk factors for subsequent PTSD development, although less work has explored them in combination. The current study evaluated whether trauma type (assaultive vs. nonassaultive) and perceived life threat, together, led to greater PTSD symptoms 1 month and 6 months postinjury. METHODS Participants included adult injured trauma survivors admitted to a level 1 trauma center. While hospitalized, perceived life threat during trauma was assessed and mechanism of injury was collected via record review and was collapsed into two categories: assaultive and nonassaultive. The Clinician-Administered PTSD Scale (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) was administered at 1 month (N = 137) and 6 months (N = 220) after injury. RESULTS The four symptoms clusters of PTSD (intrusions, avoidance, hyperarousal, and negative mood/cognitions) were examined using four 2 (time) × 2 (life threat) × 2 (trauma type) mixed methods analyses of variance to assess differences based on risk factors and time. Results showed significant interaction effects of life threat, trauma type, and time for intrusive symptoms and avoidance symptoms. Individuals with life threat during assaultive traumas maintained heightened intrusive symptoms across time and increased avoidance at 6 months. On the other hand, participants with either life threat or assaultive traumas had decreased symptoms at 6 months. CONCLUSION Experiencing assaultive trauma and life threat led to greater symptoms of PTSD. Individuals with assaultive traumas who experienced life threat may represent a specific at-risk group following injury. Avoidance can protract functional impairment and impede access to care, negatively impacting recovery. This study highlights a need to assess for these peritrauma factors during hospitalization and supports early intervention targeting avoidance and intrusive symptoms in this group. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level IV.
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Affiliation(s)
- Sydney C Timmer-Murillo
- From the Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin
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9
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Newton TL. In Their Own Words: Women'S Memories of Felt Emotions During Worst Incidents of Intimate Partner Abuse. J Trauma Dissociation 2021; 22:563-580. [PMID: 33460364 PMCID: PMC8286265 DOI: 10.1080/15299732.2020.1869649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Peritraumatic emotions are implicated in the elevated health risks associated with interpersonal trauma, but they have not been widely studied in the context of intimate partner abuse (IPA). To address this, community women with divorce histories completed IPA measures, along with an interview to assess posttraumatic stress symptoms and both DSM-IV A2 emotions (yes/no) and other emotions (free response) experienced during worst incidents of IPA. Anxiety/fright, helplessness, and horror were highly prevalent. Lexical analysis of the words women used to describe their other emotions revealed that anger and shame were the most prevalent, followed by dissociation and sadness. As predicted, chronicity of direct assault and frequency of verbal/emotional abuse showed significant, positive correlations with peritraumatic dissociation, and peritraumatic shame showed significant, positive correlations with current symptoms of effortful avoidance. Also, a negative correlation between frequency of dominance/isolation abuse - an indicator of coercive control - and peritraumatic anger approached statistical significance. Although limited by the cross-sectional, retrospective design, results contribute to the understanding of peritraumatic emotions in the context of IPA, and motivate continued efforts to examine their roles in the elevated health risks of interpersonal trauma.
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Affiliation(s)
- Tamara L Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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10
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Gómez JM. Cultural Betrayal as a Dimension of Traumatic Harm: Violence and PTSS among Ethnic Minority Emerging Adults. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:347-356. [PMID: 34471453 PMCID: PMC8357871 DOI: 10.1007/s40653-020-00314-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
According to cultural betrayal trauma theory, within-group violence confers a cultural betrayal that contributes to outcomes, including symptoms of posttraumatic stress disorder (PTSS). Close relationship with the perpetrator, known as high betrayal, also impacts PTSS. The purpose of the current study is to examine cultural betrayal trauma, high betrayal trauma, and PTSS in a sample of diverse ethnic minority emerging adults. Participants (N = 296) completed the one-hour questionnaire online. Hierarchical linear regression analyses revealed that when controlling for gender, ethnicity, and interracial trauma, high betrayal trauma and cultural betrayal trauma were associated with PTSS. Clinical interventions can include assessments of the relationship with and in-group status of the perpetrator(s) in order to guide treatment planning with diverse survivors.
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Affiliation(s)
- Jennifer M. Gómez
- Department of Psychology and Merrill Palmer Skillman Institute for Child & Family Development (MPSI), Wayne State University, 71 East Ferry St, Detroit, MI 48202 USA
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Eslinger PJ, Anders S, Ballarini T, Boutros S, Krach S, Mayer AV, Moll J, Newton TL, Schroeter ML, de Oliveira-Souza R, Raber J, Sullivan GB, Swain JE, Lowe L, Zahn R. The neuroscience of social feelings: mechanisms of adaptive social functioning. Neurosci Biobehav Rev 2021; 128:592-620. [PMID: 34089764 PMCID: PMC8388127 DOI: 10.1016/j.neubiorev.2021.05.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/31/2021] [Accepted: 05/10/2021] [Indexed: 01/10/2023]
Abstract
Social feelings have conceptual and empirical connections with affect and emotion. In this review, we discuss how they relate to cognition, emotion, behavior and well-being. We examine the functional neuroanatomy and neurobiology of social feelings and their role in adaptive social functioning. Existing neuroscience literature is reviewed to identify concepts, methods and challenges that might be addressed by social feelings research. Specific topic areas highlight the influence and modulation of social feelings on interpersonal affiliation, parent-child attachments, moral sentiments, interpersonal stressors, and emotional communication. Brain regions involved in social feelings were confirmed by meta-analysis using the Neurosynth platform for large-scale, automated synthesis of functional magnetic resonance imaging data. Words that relate specifically to social feelings were identfied as potential research variables. Topical inquiries into social media behaviors, loneliness, trauma, and social sensitivity, especially with recent physical distancing for guarding public and personal health, underscored the increasing importance of social feelings for affective and second person neuroscience research with implications for brain development, physical and mental health, and lifelong adaptive functioning.
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Affiliation(s)
- Paul J Eslinger
- Departments of Neurology, Neural & Behavioral Sciences, Pediatrics, and Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
| | - Silke Anders
- Social and Affective Neuroscience, Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Tommaso Ballarini
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Sydney Boutros
- Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, OR, USA
| | - Sören Krach
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Annalina V Mayer
- Social Neuroscience Lab, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany
| | - Jorge Moll
- Cognitive Neuroscience Unit, D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Tamara L Newton
- University of Louisville, Department of Psychological and Brain Sciences, Louisville, KY, USA
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Ricardo de Oliveira-Souza
- Cognitive Neuroscience Unit, D'Or Institute for Research and Education (IDOR), BR Hospital Universitario, Universidade do Rio de Janeiro, Brazil
| | - Jacob Raber
- Departments of Behavioral Neuroscience, Neurology, and Radiation Medicine, Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, USA
| | - Gavin B Sullivan
- International Psychoanalytic University, Berlin, Germany, Centre for Trust, Peace and Social Relations, Coventry University, UK
| | - James E Swain
- Department of Psychiatry and Behavioral Health, Psychology and Obstetrics and Gynecology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | | | - Roland Zahn
- Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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12
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Lee JY, Micol RL, Davis JL. Intimate Partner Violence and Psychological Maladjustment: Examining the Role of Institutional Betrayal Among Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:7505-7522. [PMID: 30879384 DOI: 10.1177/0886260519836783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Research has found that a majority of individuals, irrespective of gender, experienced their first intimate partner violence (IPV) victimization between the ages of 18 and 24 years. Indeed, researchers have found that college students' experiences of IPV are comparable if not higher than that of the general population. IPV victimization also places individuals at a higher risk for developing psychological conditions. In addition, when IPV experiences occur on college campuses, there are a variety of institutional factors that may impact the outcome of the traumatic event for the survivor. The present study seeks to examine whether institutional betrayal moderates the relationship between IPV and different psychological outcomes (i.e., depression, posttraumatic stress, anxiety). The study analyzed survey responses from a sample of 316 undergraduate students attending a Midwestern University. Three separate hierarchical regression analyses were conducted for each of the maladaptive psychological outcomes. Results showed that institutional betrayal was positively correlated with depressive symptoms, posttraumatic stress symptoms, and anxiety symptoms. Interestingly, institutional betrayal was a significant predictor of depressive symptoms, posttraumatic stress symptoms, and anxiety symptoms when controlling for the effects of physical violence, sexual violence, and psychological aggression. The present study highlights the significance of the impact of institutional betrayal, independent of interpersonal betrayal, on mental health.
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13
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Tirone V, Orlowska D, Lofgreen AM, Blais RK, Stevens NR, Klassen B, Held P, Zalta AK. The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis. Eur J Psychotraumatol 2021; 12:1883925. [PMID: 33968319 PMCID: PMC8075088 DOI: 10.1080/20008198.2021.1883925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Betrayal traumas have a particularly deleterious effect on mental health. Although social support is a robust predictor of posttraumatic stress disorder (PTSD) symptom severity, it is not clear what factors may impact this relationship among betrayal trauma survivors. Objective: This study sought to describe the association between social support and PTSD symptom severity among survivors of betrayal trauma and examine whether methodological, sample, trauma, and social support characteristics moderated this association. Method: A comprehensive search identified 29 studies that assessed the cross-sectional association between PTSD symptom severity and social support among 6,510 adult betrayal trauma survivors. Results: The average effect size (r = -.25; 95% CI: -.30, -.20) was small to medium, with significant heterogeneity between studies (I2 = 71.86). The association between PTSD and social support was stronger when the trauma was perpetrated by a romantic partner compared to mixed perpetrators, even after accounting for covariates. There was also a significant effect of support type depending on whether the support was provided in the context of trauma disclosure. Specifically, positive reactions to trauma disclosure were not associated with PTSD symptoms whereas general positive social support (not disclosure focused) was associated with fewer PTSD symptoms. Negative reactions to trauma disclosure were associated with more PTSD symptoms. None of the included studies measured general negative social support outside of trauma disclosure. Conclusions: Our findings suggest that social support may be a particularly important buffer against PTSD symptoms when experiencing traumatic betrayal by an intimate partner. Additionally, our results suggest that social support interventions for those experiencing betrayal trauma should focus on reducing negative responses to disclosure and bolstering general satisfaction with social support.
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Affiliation(s)
- Vanessa Tirone
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Daria Orlowska
- University Libraries, Western Michigan University, Kalamazoo, MI, USA
| | - Ashton M Lofgreen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rebecca K Blais
- Department of Psychology, Utah State University, Logan, UT, USA
| | - Natalie R Stevens
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Brian Klassen
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Philip Held
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Alyson K Zalta
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Psychological Science, University of California, Irvine, CA, USA
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14
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Gómez JM. It Hurts When You're Close: High Betrayal Sexual Trauma, Dissociation, and Suicidal Ideation in Young Adults. VIOLENCE AND VICTIMS 2020; 35:712-723. [PMID: 33060252 DOI: 10.1891/vv-d-19-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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15
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Gómez JM. Gendered Sexual Violence: Betrayal Trauma, Dissociation, and PTSD in Diverse College Students. JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 2020; 30:625-640. [PMID: 35527804 PMCID: PMC9075698 DOI: 10.1080/10926771.2020.1783737] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/27/2020] [Accepted: 05/19/2020] [Indexed: 06/14/2023]
Abstract
Young adults' transition into college includes risk for onset of mental health problems and sexual violence, particularly for women. Compared to men and boys, women and girls across the lifespan are more likely to be sexually abused, with the perpetrators often being someone close to them. High betrayal trauma is linked to varied mental health outcomes. Despite literature depth, many samples are not ethnically diverse, which results in uncertainty about the generalizability of these findings outside of majority White American populations. The purpose of the current study is to assess gender and high betrayal in sexual violence and mental health outcomes among ethnically diverse college students in the U.S. Participants (N = 368) were ethnically diverse college students attending a public university in the Pacific Northwest, who completed online measures assessing sexual violence and mental health outcomes. When controlling for medium betrayal sexual trauma (perpetrator: unclose other), the associations between high betrayal sexual trauma and dissociation and anxiety, respectively, were moderated by the female gender. The findings point to the utility of relational cultural therapy as a feminist framework that can identify sexism as a contributing factor to young women's increased risk for sexual violence and associated mental health problems.
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Affiliation(s)
- Jennifer M Gómez
- Department of Psychology, Wayne State University, Detroit, MI, USA
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Boals A, Trost Z, Warren AM, McShan EE. Injustice is Served: Injustice Mediates the Effects of Interpersonal Physical Trauma on Posttraumatic Stress Symptoms and Depression Following Traumatic Injury. J Trauma Stress 2020; 33:201-207. [PMID: 32216147 DOI: 10.1002/jts.22495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 08/05/2019] [Accepted: 08/09/2019] [Indexed: 11/11/2022]
Abstract
Previous research has consistently found that traumas of an interpersonal nature are associated with elevated levels of posttraumatic stress symptoms (PTSS). In the current study, we examined whether feelings of injustice related to sustained physical trauma mediate the association between the interpersonal nature of a traumatic injury and two outcomes: PTSS and depressive symptoms. The sample consisted of 176 patients admitted to a Level 1 trauma center for traumatic injuries. Participants completed measures of PTSS, depressive symptoms, and injury-related injustice perception at baseline and again at 3- and 6-month postinjury follow-ups. The results revealed that, compared to noninterpersonal injuries, interpersonal injuries were related to significantly higher levels of perceived injustice, PTSS, and depressive symptoms at all three assessment points, except for PTSS at baseline, ds = 0.47-1.23. These associations remained significant after accounting for injury severity. It is important to note that higher levels of perceived injustice 3-month postinjury follow-up mediated the association between the interpersonal nature of the trauma and higher levels of PTSS and depressive symptoms at 6 months postinjury. Our results suggest injustice may be an important factor that helps explain why interpersonal traumas are associated with poorer mental health outcomes than noninterpersonal traumas. Additionally, the current study provides some of the first prospective analyses of injustice perception and trauma outcomes.
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Affiliation(s)
- Adriel Boals
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Zina Trost
- Department of Psychology, University of Alabama-Birmingham, Birmingham, Alabama, USA
| | - Ann Marie Warren
- Neuropsychology and Rehabilitation Psychology for Baylor Scott & White Health Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas, USA
| | - Evan E McShan
- Neuropsychology and Rehabilitation Psychology for Baylor Scott & White Health Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas, USA
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Gómez JM. Group dynamics as a predictor of dissociation for Black victims of violence: An exploratory study of cultural betrayal trauma theory. Transcult Psychiatry 2019; 56:878-894. [PMID: 31046633 DOI: 10.1177/1363461519847300] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Violence victimization is prevalent in the US and is linked to costly mental health outcomes, including dissociation and posttraumatic stress disorder (PTSD). Black Americans are at increased risk for violence victimization, while additionally enduring racism that impacts mental health. Moreover, discrimination affects outcomes of violence. Cultural betrayal trauma theory (CBTT) is a new framework for examining the impact of within-group violence victimization (termed cultural betrayal trauma) and minority status on outcomes. Furthermore, CBTT examines posttraumatic group dynamics, such as (intra)cultural pressure. As pressure to protect the minority in-group by not disclosing cultural betrayal trauma, (intra)cultural pressure may impact outcomes. The purpose of the exploratory study was to examine the impact of cultural betrayal trauma and (intra)cultural pressure on dissociation and posttraumatic stress symptoms (PTSS). Participants (N = 43) were Black/African American university students who completed online measures assessing violence victimization and outcomes. Linear regression analyses revealed that cultural betrayal trauma predicted PTSS, whereas (intra)cultural pressure predicted dissociation. The current study has implications for examining the impact of group dynamics, such as (intra)cultural pressure, in clinical interventions for Black victims of cultural betrayal trauma. Such cultural competency in mental health care treatment may help reduce mental health disparities.
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Gómez JM. Isn't It All About Victimization? (Intra)cultural Pressure and Cutural Betrayal Trauma in Ethnic Minority College Women. Violence Against Women 2019; 25:1211-1225. [PMID: 30497342 DOI: 10.1177/1077801218811682] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cultural betrayal trauma theory proposes that intraracial trauma in ethnic minority populations includes a cultural betrayal that contributes to outcomes, such as symptoms of PTSD (posttraumatic stress disorder; posttraumatic stress symptoms [PTSS]), dissociation, and (intra)cultural pressure. Participants (n = 179) were ethnic minority female college students, who completed online questionnaires. The results revealed that when controlling for age, ethnicity, and interracial trauma, intraracial trauma and (intra)cultural pressure affected PTSS and dissociation. There were also indirect effects of cultural betrayal trauma on outcomes through (intra)cultural pressure. The current study can contribute to clinical interventions that address trauma-related mental health in ethnic minority college women.
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Holliday R, Monteith LL. Seeking help for the health sequelae of military sexual trauma: a theory-driven model of the role of institutional betrayal. J Trauma Dissociation 2019; 20:340-356. [PMID: 30714879 DOI: 10.1080/15299732.2019.1571888] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although rates vary, approximately 38.4% of women and 3.9% of men report experiencing military sexual trauma (MST). MST is associated with numerous psychosocial consequences, increased propensity for physical and mental health diagnoses, suicide, and an elevated likelihood of revictimization. Consequently, medical and mental health care for MST-related health sequelae is often warranted for individuals who have experienced MST; however, many MST survivors forgo or delay MST-related care, despite the fact that the Veterans Health Administration (VHA) provides free healthcare for MST-related health conditions. One potential explanation for this phenomenon is that survivors of MST feel betrayed by the military institution that they served when the MST occurred due to the institutional response to MST or perceptions that the institution failed to prevent MST from occurring. Perceptions of institutional betrayal may, in turn, decrease survivors' likelihood of disclosing MST and utilizing necessary treatment through VHA or affiliated institutions. A theoretical model of the role of institutional betrayal on help-seeking is proposed in which institutional betrayal serves as a potential barrier to utilizing MST-related healthcare. Potential mediators of this association (e.g., distrust, beliefs about safety) are also posited. This model offers utility in conceptualizing institutional factors that may influence helping-seeking following MST. By testing and refining such models, institutions and providers may be better-equipped to support MST survivors in obtaining necessary healthcare.
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Affiliation(s)
- Ryan Holliday
- a Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, USA.,b Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
| | - Lindsey L Monteith
- a Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, USA.,b Department of Psychiatry, University of Colorado Anschutz Medical Campus, USA
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Aggarwal SK. Cannabis Fear Deconditioning: An Autobiological Marijuana Memoir of a South Asian-Oklahoman Physician-Scientist. J ETHNOBIOL 2018. [DOI: 10.2993/0278-0771-38.4.489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sunil Kumar Aggarwal
- University of Washington, Departments of Geography, Rehabilitation Medicine; Advanced Integrative Medical Science Institute; MultiCare Health System; National Family Medicine Residency, 2825 Eastlake Ave E #115, Seattle, WA 98102
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Parnell D, Ram V, Cazares P, Webb-Murphy J, Roberson M, Ghaed S. Sexual Assault and Disabling PTSD in Active Duty Service Women. Mil Med 2018; 183:e481-e488. [PMID: 29660018 DOI: 10.1093/milmed/usy048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/01/2017] [Accepted: 03/06/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Sexual assault in the military is a major concern and may result in significant health problems, such as post-traumatic stress disorder (PTSD). Those developing disabling PTSD symptoms may require a disability evaluation. We examined disability evaluation trends for service women with PTSD to better understand characteristics associated with inability to continue Active Duty service. METHODS This is a retrospective review of disability reports and electronic medical records for 322 Active Duty women diagnosed with and treated for PTSD by psychiatrists and psychologists at a large military treatment facility between 2011 and 2014. Service women requiring medical disability evaluation for PTSD (n = 159) were included in the study as "IDES cases" (Integrated Disability Evaluation System - IDES). A similar number of women, randomly selected from those seeking care for PTSD but not requiring disability evaluation during the same period, were included in the "control" group (n = 163). Analyzes done to evaluate differences between groups (IDES cases vs. controls) included demographic and service-related characteristics, history of chronic pain, and PTSD index trauma types, such as pre-military trauma and military sexual trauma (MST). Logistic regression was performed to identify the factors associated with inclusion in IDES. RESULTS MST was the most frequent PTSD index trauma in the IDES group (73.6% vs. 44.8% of control group) and the most significant factor associated with IDES inclusion (OR 2.6, p = 0.032). Those in the IDES group had significantly greater number of mental health visits for PTSD (IDES: m = 68.6 vs. controls: m = 29.6) and more frequent chronic pain history (IDES 40.9% vs. controls 19.6%) than those in the control group. Approximately 65% of women in both groups had a history of childhood abuse, but childhood abuse, as a PTSD index trauma, was negatively associated with IDES inclusion (OR 0.293, p = 0.006). CONCLUSIONS Active Duty service women with PTSD and a MST index trauma are much more likely to require disability evaluation (IDES) than those with PTSD due to other trauma types. IDES evaluation for conditions such as PTSD may result in early termination of military service and is a potential downstream consequence of MST. Service women requiring greater numbers of mental health visits for PTSD treatment may benefit from a multidisciplinary approach to treating concurrent health conditions, such as chronic pain. Those providing care for service women should evaluate for MST, chronic pain and pre-military trauma, such as childhood abuse; and aggressively treat these conditions to prevent PTSD and disability.
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Affiliation(s)
- Denise Parnell
- Naval Medical Center San Diego, Medical Evaluation Board Office, Directorate for Administration and Internal Medicine Department, 34800 Bob Wilson Drive, San Diego, CA
| | - Vasudha Ram
- Naval Center for Combat & Operational Stress Control, 34800 Bob Wilson Drive, San Diego, CA
| | - Paulette Cazares
- Naval Medical Center San Diego, Directorate for Mental Health, 34800 Bob Wilson Drive, San Diego, CA
| | - Jennifer Webb-Murphy
- Naval Center for Combat & Operational Stress Control, 34800 Bob Wilson Drive, San Diego, CA
| | - Melanie Roberson
- Naval Hospital Pensacola, Department of Mental Health, 6000W Highway 98, Pensacola, FL
| | - Shiva Ghaed
- Naval Medical Center San Diego, Directorate for Mental Health, 34800 Bob Wilson Drive, San Diego, CA
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Gómez JM, Freyd JJ. Psychological Outcomes of Within-Group Sexual Violence: Evidence of Cultural Betrayal. J Immigr Minor Health 2017; 20:1458-1467. [DOI: 10.1007/s10903-017-0687-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Gómez JM, Lewis JK, Noll LK, Smidt AM, Birrell PJ. Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care. J Trauma Dissociation 2016; 17:165-85. [PMID: 26460888 DOI: 10.1080/15299732.2016.1103104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller & Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.
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Bryan CJ, Bryan AO, Anestis MD, Anestis JC, Green BA, Etienne N, Morrow CE, Ray-Sannerud B. Measuring Moral Injury: Psychometric Properties of the Moral Injury Events Scale in Two Military Samples. Assessment 2015; 23:557-70. [PMID: 26092043 DOI: 10.1177/1073191115590855] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the construct of moral injury has gained increased conceptual and empirical attention among military personnel and veterans, preliminary attempts to operationalize and measure the construct have emerged. One such measure is the Moral Injury Event Scale (MIES). The aim of the current study was to further evaluate the MIES's psychometric properties in two military samples: a clinical sample of Air Force personnel and a nonclinical sample of Army National Guard personnel. Exploratory and confirmatory factor analyses across both samples supported a three-factor solution: transgressions by others, transgressions by self, and betrayal. Transgressions-Others was most strongly associated with posttraumatic stress; Transgressions-Self was most strongly associated with hopelessness, pessimism, and anger; and Betrayal was most strongly associated with posttraumatic stress and anger. Results support the construct validity of the MIES, although areas for improvement are indicated and discussed.
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Affiliation(s)
- Craig J Bryan
- The University of Utah, Salt Lake City, UT, USA National Center for Veterans Studies, UT, USA
| | - AnnaBelle O Bryan
- The University of Utah, Salt Lake City, UT, USA National Center for Veterans Studies, UT, USA
| | | | - Joye C Anestis
- University of Southern Mississippi, Hattiesburg, MS, USA
| | | | | | | | - Bobbie Ray-Sannerud
- The University of Utah, Salt Lake City, UT, USA National Center for Veterans Studies, UT, USA
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Why some patients are unhappy: part 1. Relationship of preoperative nasal deformity to number of operations and a history of abuse or neglect. Plast Reconstr Surg 2014; 134:823-835. [PMID: 25357039 DOI: 10.1097/prs.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma (neglect or abuse) can create body shame (different from body dissatisfaction), driving some patients to seek aesthetic surgery. We hypothesized that a trauma history would be related to the severity of the original deformity and the drive to undergo repeated operations. METHODS Descriptive statistics were computed for 100 secondary rhinoplasty patients, 50 of whom originally had dorsal humps, 21 of whom had straight, functional noses, and 29 of whom had subjectively normal noses but underwent multiple rhinoplasties. This latter group fulfills criteria for body dysmorphic disorder. RESULTS Compared with patients with hump noses, patients with normal primary noses were 2.9 times more likely to be demanding 2.5 times more likely to be depressed, had undergone 3.0 times more rhinoplasties and other aesthetic operations, and were 3.8 times more likely to have confirmed trauma histories. Patients who had undergone more than three operations were 92.7 percent women; 85 percent originally had straight noses and had undergone an average of 7.56 rhinoplasties and 5.78 aesthetic operations; 85.4 percent had histories of abuse or neglect. CONCLUSIONS Secondary rhinoplasty patients with normal preoperative noses, who fulfill the criteria for body dysmorphic disorder, had significantly higher prevalences of depression, demanding conduct, previous rhinoplasties and other aesthetic operations, and confirmed trauma histories than patients who originally had dorsal deformities or straight noses with functional symptoms. To the authors' knowledge, this is the first report of such associations. A history of childhood trauma may impact adult patient behavior and therefore the surgical experience.
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Constantian MB, Lin CP. Why some patients are unhappy: part 2. Relationship of nasal shape and trauma history to surgical success. Plast Reconstr Surg 2014; 134:836-851. [PMID: 25357040 DOI: 10.1097/prs.0000000000000552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A previous report indicated that secondary rhinoplasty patients with normal preoperative noses displayed significantly higher prevalences of depression, demanding behavior, previous aesthetic operations, and confirmed trauma (abuse/neglect) histories than patients who originally had dorsal deformities or straight noses with functional symptoms. The authors hypothesized that abuse or neglect might also influence patient satisfaction and suggest screening criteria. METHODS One hundred secondary rhinoplasty patients stratified by their original nasal shapes were examined by bivariate analysis to determine the characteristics associated with surgical satisfaction. Mediation analysis established intervening factors between total surgery number and patients' perceived success. Random forests identified important patient attributes that predicted surgical success; logistic regression confirmed these effects. RESULTS Satisfied patients originally had dorsal humps, three or fewer previous operations, were not demanding or depressed, were not looking for perfect noses, and had no trauma histories. Dissatisfied patients originally had subjectively normal noses, more than three operations, were depressed, had demanding personalities, and had trauma histories. Patients who had undergone the most operations were most likely to request more surgery and least likely to be satisfied. A trauma (abuse/neglect) history was the most significant mediator between patient satisfaction and number of operations and the most prominent factor driving surgery in patients with milder deformities. CONCLUSIONS Potentially causative links exist between trauma (abuse/neglect), body image disorders, and obsessive plastic surgery. Body dysmorphic disorder may be a model of the disordered adaptation to abuse or neglect, a variant of posttraumatic stress disorder. Our satisfied and dissatisfied patients shared common characteristics and therefore may be identifiable preoperatively.
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Affiliation(s)
- Mark B Constantian
- Nashua, N.H.; and Madison, Wis. From the Department of Surgery (Plastic Surgery), St. Joseph Hospital; and the Division of Plastic Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison
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Delker BC, Freyd JJ. From betrayal to the bottle: investigating possible pathways from trauma to problematic substance use. J Trauma Stress 2014; 27:576-84. [PMID: 25322887 DOI: 10.1002/jts.21959] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 04/04/2014] [Accepted: 04/16/2014] [Indexed: 11/08/2022]
Abstract
Research in both community and clinical settings has found that exposure to cumulative interpersonal trauma predicts substance use problems. Less is known about betrayal as a dimension of trauma exposure that predicts substance use, and about the behavioral and psychological pathways that explain the relation between trauma and substance use. In a sample of 362 young adults, this study evaluated three intervening pathways between betrayal trauma exposure prior to age 18 years and problematic substance use: (a) substance use to cope with negative affect, (b) difficulty discerning and/or heeding risk, and (c) self-destructiveness. In addition, exposure to trauma low in betrayal (e.g., earthquake) was included in the model. Bootstrap tests of indirect effects revealed that betrayal trauma prior to age 18 years was associated with problematic substance use via posttraumatic stress and two intervening pathways: difficulty discerning/heeding risk (β = .07, p < .001), and self-destructiveness (β = .12, p < .001). Exposure to lower betrayal trauma was not associated with posttraumatic stress or problematic substance use. Results contribute to a trauma-informed understanding of substance use that persists despite potentially harmful consequences.
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Affiliation(s)
- Brianna C Delker
- Department of Psychology, University of Oregon, Eugene, Oregon, USA
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