Betrayal trauma: associations with psychological and physical symptoms in young adults

The well-being of young adults: The implications of multi-type child maltreatment and the mediating role of betrayal trauma

BACKGROUND

Research indicates that the nature of the relationship between a victim-survivor and perpetrator of child maltreatment can influence well-being experienced during young adulthood. However, further research is required to substantiate the possible mediating role of betrayal trauma following child maltreatment.

OBJECTIVE

To explore the relationship between child maltreatment and psychological well-being experienced during young adulthood by examining the extent of maltreatment, the importance of the type of perpetrator, and the potential mediating role of betrayal trauma following child maltreatment.

PARTICIPANTS AND SETTING

The self-selected sample comprised 468 young adults (aged 18-25 years; M = 21.74 years, SD = 2.47) from Australia and internationally.

METHOD

Information regarding participants' current well-being, the extent of enduring five types of maltreatment (witnessing family violence, neglect, physical abuse, psychological abuse, and sexual abuse) by their mother, father and other adults during childhood, multi-type maltreatment, and severity of betrayal trauma were obtained via an online survey.

RESULTS

Using multiple regression analysis, it was found that higher levels of multi-type maltreatment were associated with poorer current well-being. Maltreatment by one's mother or father predicted poorer well-being, maltreatment by another adult did not. Hierarchical regressions revealed young adults' sense of betrayal trauma in close relationships partially mediated the relationship between current well-being and child maltreatment by one's mother, father, and another adult.

CONCLUSION

Findings show that the extent of child maltreatment experienced, one's sense of betrayal, and the relationship of the child/adolescent to the perpetrator can influence well-being experienced during young adulthood. These findings highlight the therapeutic benefit of clinicians supporting young adults who have endured child maltreatment to process betrayal trauma, to improve their well-being.

Understanding College Students' Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences

Understanding healthcare avoidance among college students is critical. In this study, we consider two broad cognitive contributors to greater healthcare avoidance: specific early maladaptive schema and negative appraisals of students' prior worst healthcare experiences. From schema theory, we proposed college students holding greater levels of two early maladaptive schema (disconnection/rejection and impaired autonomy/performance EMS) would be more likely to appraise their problematic healthcare experience as both containing healthcare institutional betrayal (HIB) behaviors and as traumatic and betrayal-inducing; both EMS and these appraisals would predict healthcare avoidance. Using a cross-sectional survey in a large, diverse college student sample (n = 1383, 61.1% female, 18.9% African American, 7.2% Asian, 6.4% Hispanic/Latino), as predicted, both EMS were significantly related to healthcare avoidance. Furthermore, a sequential mediation model was supported, indicating students holding greater EMS of disconnection/rejection or impaired autonomy/rejection reported more HIB in their worst healthcare experience, and appraised that experience as more betraying. Taken altogether, this model accounted for 23% of the variance in students' reports of healthcare avoidance. Core beliefs formed early in life may be a foundational lens through which potentially traumatic healthcare experiences are processed in ways that can impact emerging adults' future healthcare engagement. Findings also support the importance of addressing HIB actions and repairing trauma appraisals accrued during problematic healthcare experiences to prevent healthcare avoidance by emerging adults.

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

The elephant in the room: Is betrayal trauma associated with borderline personality disorder?

Background

Borderline personality disorder (BPD) has been found to be closely linked to childhood trauma, particularly betrayal trauma.

Aim

In our study, we aimed to investigate the association between betrayal trauma and anxiety among young adults.

Methods

We assessed a total of 305 young adults using a Google form utilizing three assessment tools: the 10-item McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the 12-item Brief Betrayal Trauma Survey (BBTS), and the 7-item Generalized Anxiety Disorder (GAD-7) to evaluate borderline personality traits, betrayal trauma experiences, and anxiety level.

Results

Our findings revealed that 22% [95% confidence interval (CI) 17.7 to 26.9] of the participants screened positive for BPD on MSI-BPD assessment; self-reported anxiety as reported by GAD-7 was observed in 27.9% (95% CI 23.1 to 33.2), while 82% (95% CI 77.3 to 85.9) reported experiencing betrayal trauma. A significantly higher proportion of individuals with BPD (97%) reported experiencing betrayal trauma compared to those without the disorder. High betrayal trauma [odds ratio (OR) 8.14, 95% CI 3.06 to 21.67] and medium betrayal trauma (OR 7.06, 95% CI 2.64 to 18.92) were significantly associated with the diagnosis of BPD. The associations held true across genders, although they were stronger in females.

Conclusions

Our study highlights the strong relationship between betrayal trauma and BPD, with significant implications for the development of anxiety in young adults. These findings underscore the importance of recognizing and addressing childhood trauma, particularly betrayal trauma, in individuals at risk for BPD.

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

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

When Institutions Harm Those Who Depend on Them: A Scoping Review of Institutional Betrayal

The term institutional betrayal (Smith and Freyd, 2014) builds on the conceptual framework of betrayal trauma theory (see Freyd, 1996) to describe the ways that institutions (e.g., universities, workplaces) fail to take appropriate steps to prevent and/or respond appropriately to interpersonal trauma. A nascent literature has begun to describe individual costs associated with institutional betrayal throughout the United States (U.S.), with implications for public policy and institutional practice. A scoping review was conducted to quantify existing study characteristics and key findings to guide research and practice going forward. Multiple academic databases were searched for keywords (i.e., "institutional betrayal" and "organizational betrayal"). Thirty-seven articles met inclusion criteria (i.e., peer-reviewed empirical studies of institutional betrayal) and were included in analyses. Results identified research approaches, populations and settings, and predictor and outcome variables frequently studied in relation to institutional betrayal. This scoping review describes a strong foundation of published studies and provides recommendations for future research, including longitudinal research with diverse individuals across diverse institutional settings. The growing evidence for action has broad implications for research-informed policy and institutional practice.

Trust and betrayal in older adult financial exploitation

OBJECTIVES

Although the knowledge base regarding the financial exploitation of older adults is expanding, work to understand the subpopulations of older adult financial exploitation victims and their experiences is greatly needed. This study uses betrayal trauma theory (BTT) as the foundation for conceptualizing the harm that arises from elder family financial exploitation.

METHODS

The study uses a cross-sectional design to investigate group differences among a total sample of 95 community-dwelling older adults, 32 of the participants (33.7%) were older adult victims of family financial exploitation and the remaining 63 (66.3%) were victims of financial exploitation perpetrated by strangers.

RESULTS

The group of older adults who were victims of elder family financial exploitation had significantly lower functional ability scores, higher stress and financial exploitation vulnerability scores and lost more money on average than those victimized by strangers.

CONCLUSION

The present study provides support that BTT provides a valuable framework for understanding why older adult family financial exploitation victims are more vulnerable than victims of exploitation committed by strangers. Attention to this subgroup of financially exploited older adults will provide improved understanding of the unique challenges these victims face and inform prevention and intervention services.

Is teacher violence a form of betrayal trauma? Relationship with mental health problems among young adults

BACKGROUND

Childhood trauma is one of the most preventable risk factors for mental health problems. Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health.

OBJECTIVES

This study examined the relationship between exposure to teacher violence and mental health problems.

PARTICIPANTS AND SETTING

An international sample of young adults aged 18 to 24 (N = 283).

METHODS

Participants completed self-report measures of childhood trauma, exposure to teacher violence, depressive symptoms, post-traumatic stress, and alcohol misuse.

RESULTS

Exposure to teacher violence could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems - including depressive symptoms, post-traumatic stress, and alcohol misuse - were associated with exposure to teacher violence during high school years, but not with childhood non-betrayal trauma.

CONCLUSIONS

Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence. It is important to provide more support and training to teachers and enhance monitoring measures in schools. More research on the prevalence and correlates of exposure to teacher violence is needed. We also provided first evidence supporting the reliability and validity of the English version of the TVS to facilitate future research.

Risk factors for traumatic bonding and associations with PTSD symptoms: A moderated mediation

BACKGROUND

Traumatic bonding, defined as attachment to a perpetrator of intimate partner violence (IPV), offers one explanation as to why many people with abusive romantic partners do not break off these relationships. But what individual-level risk factors make some victims of IPV more likely than others to develop traumatic bonding toward their partners? What is the nature of the potential association between traumatic bonding and PTSD symptoms?

PARTICIPANTS

A path model tested the potential roles of childhood maltreatment and attachment insecurity as risk factors for traumatic bonding, as well as the potential association between traumatic bonding and PTSD symptoms, in a high-risk sample of 354 participants in current abusive relationships.

RESULTS

As hypothesized, childhood maltreatment and attachment insecurity significantly predicted traumatic bonding over and above the effects of age, gender, and romantic love. In addition, attachment insecurity moderated the association between childhood maltreatment and traumatic bonding, such that at higher levels of attachment insecurity, the association between childhood maltreatment and traumatic bonding was stronger than at mean or lower levels of attachment insecurity. Traumatic bonding was positively associated with PTSD symptoms.

CONCLUSIONS

Overall, the results support the role of childhood maltreatment as a risk factor for both traumatic bonding and PTSD symptoms and highlight the importance of attachment insecurity in these associations. This was the first study to examine a complex model of risk factors for traumatic bonding. Theoretical and clinical implications are discussed.

Do adverse experiences predict unemployment and need of psychiatric help after treatment for drug use disorders?

Background: This study prospectively examined the association between adverse experiences (physical abuse, sexual abuse and parental substance use problems [SUPs]), not being employed, in education or training (NEET) and being in need of acute psychiatric help among patients receiving treatment for substance use disorders. Methods: A total of 580 adolescents and early adults aged 15-25 years enrolled in treatment for drug use disorders were included in the analyses. Treatment data were linked to participants' register data on employment, education and acute contact to psychiatric services for the following two years. Multivariable logistic regression models were used to examine associations between the three adverse experiences, NEET and need of acute psychiatric help, adjusting for confounders such as age, gender, ethnicity, treatment response and treatment condition. Results: More than half of the participants were NEET two years after treatment enrolment. After controlling for demographics and treatment conditions, NEET was predicted by parental substance use problems (odds ratio [OR] = 1.89, 95% confidence interval [CI] 1.31- 2.70), exposure to physical abuse (OR = 1.48, 95% CI 1.03-2.13) and non-abstinence (abstinence was negatively associated with NEET, OR = 0.53, 95% CI 0.37-0.76). Being exposed to two (OR = 3.17, 95% CI 1.93-5.21) and three types of adverse experiences (OR = 3.14, 95% CI = 1.47-6.70) predicted NEET more strongly than exposure to one type. One out of 10 participants sought acute care from psychiatric services at least once within two years after treatment. Only sex and ethnic minority status were associated with contacting psychiatric services acutely. Conclusion: The present study suggests that adverse experiences, such as being exposed to parental problematic substance use and physical abuse, may be important predictors for NEET after treatment for SUDs.

Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network analysis

ABSTRACT

Urologic chronic pelvic pain syndrome (UCPPS) is a complex, debilitating condition in which patients often report nonpelvic pain in addition to localized pelvic pain. Understanding differential predictors of pelvic pain only vs widespread pain may provide novel pathways for intervention. This study leveraged baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network's Symptom Pattern Study to investigate the impact of childhood sexual and nonsexual violent trauma on pelvic and nonpelvic pain sensitivity among adult patients with UCPPS, as well as potential mediators of this association. Study participants who met inclusion criteria for UCPPS completed questionnaires assessing childhood and recent trauma, affective distress, cognitive dysfunction, and generalized sensory sensitivity. Experimental pain sensitivity was also evaluated using standardized pressure pain applied to the pubic region and the arm. Bivariate analyses showed that childhood violent trauma was associated with more nonviolent childhood trauma, more recent trauma, poorer adult functioning, and greater pain sensitivity at the pubic region, but not pain sensitivity at the arm. Path analysis suggested that childhood violent trauma was indirectly associated with pain sensitivity at both sites and that this indirect association was primarily mediated by generalized sensory sensitivity. More experiences of recent trauma also contributed to these indirect effects. The findings suggest that, among participants with UCPPS, childhood violent trauma may be associated with heightened pain sensitivity to the extent that trauma history is associated with a subsequent increase in generalized sensory sensitivity.

The roles and impacts of worldviews in the context of meditation-related challenges

Previous research has shown that worldviews can serve as a coping response to periods of difficulty or struggle, and worldviews can also change on account of difficulty. This paper investigates the impacts worldviews have on the nature and trajectory of meditation-related challenges, as well as how worldviews change or are impacted by such challenges. The context of meditation-related challenges provided by data from the Varieties of Contemplative Experience research project offers a unique insight into the dynamics between worldviews and meditation. Buddhist meditation practitioners and meditation experts interviewed for the study report how, for some, worldviews can serve as a risk factor impacting the onset and trajectory of meditation-related challenges, while, for others, worldviews (e.g., being given a worldview, applying a worldview, or changing a worldview) were reported as a remedy for mitigating challenging experiences and/or their associated distress. Buddhist meditation practitioners and teachers in the contemporary West are also situated in a cultural context in which religious and scientific worldviews and explanatory frameworks are dually available. Furthermore, the context of "Buddhist modernism" has also promoted a unique configuration in which the theory and practice of Buddhism is presented as being closely compatible with science. We identify and discuss the various impacts that religious and scientific worldviews have on meditation practitioners and meditation teachers who navigate periods of challenge associated with the practice.

Childhood adversity and developmental trajectories of alcohol and cannabis co-use

OBJECTIVE

A large body of literature has noted detrimental effects of childhood adversity on young adult behavioral health, yet few studies have assessed how early childhood adversity influences the development of alcohol and cannabis co-use.

METHOD

In the present study we use data from an ongoing longitudinal cohort (N = 2507) to understand how early childhood adversity influences transitions into alcohol and cannabis co-use trajectories. We also explore how sex, depression, and anxiety are associated with transition probabilities. We used latent transition analysis to examine transitions from emergent childhood adversity classes to classes of parallel alcohol and cannabis co-use from ages 17 to 24 years.

RESULTS

Those who reported high levels of childhood adversity were more likely to transition into classes with relatively chronic and rapidly increasing alcohol and cannabis co-use during young adulthood. Young adults who both experienced high levels of childhood adversity and transitioned into increasing alcohol and cannabis co- use trajectories were more likely to be male and meet clinical cutoff for depression.

CONCLUSION

Our results indicate an incrementally more nuanced set of risk profiles, with differential risk of alcohol and cannabis co-use trajectories, dependent on one's experience of childhood adversity.

PUBLIC HEALTH SIGNIFICANCE

Results of the present study note important heterogeneity in alcohol and cannabis co-use throughout young adulthood, with general trends showing increases in co-use. The present study also shows differential risk of alcohol and cannabis co-use dependent on prior experience of childhood adversity.

Institutional courage buffers against institutional betrayal, protects employee health, and fosters organizational commitment following workplace sexual harassment

Workplace sexual harassment is associated with negative psychological and physical outcomes. Recent research suggests that harmful institutional responses to reports of wrongdoing-called institutional betrayal-are associated with additional psychological and physical harm. It has been theorized that supportive responses and an institutional climate characterized by transparency and proactiveness-called institutional courage-may buffer against these negative effects. The current study examined the association of institutional betrayal and institutional courage with workplace outcomes and psychological and physical health among employees reporting exposure to workplace sexual harassment. Adults who were employed full-time for at least six months were recruited through Amazon's Mechanical Turk platform and completed an online survey (N = 805). Of the full sample, 317 participants reported experiences with workplace sexual harassment, and only this subset of participants were included in analyses. We used existing survey instruments and developed the Institutional Courage Questionnaire-Specific to assess individual experiences of institutional courage within the context of workplace sexual harassment. Of participants who experienced workplace sexual harassment, nearly 55% also experienced institutional betrayal, and 76% experienced institutional courage. Results of correlational analyses indicated that institutional betrayal was associated with decreased job satisfaction, organizational commitment, and increased somatic symptoms. Institutional courage was associated with the reverse. Furthermore, results of multiple regression analyses indicated that institutional courage appeared to attenuate negative outcomes. Overall, our results suggest that institutional courage is important in the context of workplace sexual harassment. These results are in line with previous research on institutional betrayal, may inform policies and procedures related to workplace sexual harassment, and provide a starting point for research on institutional courage.

Impact of childhood maltreatment on psychosomatic outcomes among men and women with disabilities

PURPOSE

This project examined the impact of childhood maltreatment types on psychosomatic outcomes among adults with a range of self-reported disabilities.

MATERIALS AND METHODS

Participants (n = 643) were recruited using Amazon Mechanical Turk and Cloud Research. Single-item questions assessed sociodemographic information. The Childhood Trauma Questionnaire measured childhood maltreatment types (emotional, physical, and sexual abuse, and emotional and physical neglect) and the RAND-36 Item Health Survey evaluated physical functioning, pain, and energy/fatigue. Logistic regressions determined associations between childhood trauma and psychosomatic outcomes; stratified models compared men and women.

RESULTS

Multivariate-adjusted models indicated physical abuse was positively associated with poor physical functioning (OR: 2.03; 95%CI: 1.35-3.06) with this relationship being stronger for men (OR: 3.25; 95%CI: 1.42-7.43) than women (OR: 1.91; 95%CI: 1.17-3.13). Adjusted models showed that physical neglect was protective against fatigue (OR: 0.58; 95% CI: 0.36-0.94), while emotional neglect increased the risk of fatigue (OR: 1.74; 95%CI: 1.02-2.95). Lastly, physical abuse was positively associated with pain (OR: 1.53; 95%CI: 1.01-2.33). This relationship was stronger in men (OR: 4.99; 95%CI: 1.91-12.99).

CONCLUSIONS

Results improve our understanding of risk factors for poor physical health outcomes and can guide the development of trauma-sensitive rehabilitation services.Implications for RehabilitationIndividuals with disabilities who report childhood maltreatment may experience poor psychosomatic outcomes in adulthood.Consequences of experiencing childhood maltreatment may manifest differently between men and women over the course of the lifespan.It is essential to integrate trauma-informed principles into treatment plans for individuals with poor psychosomatic health.Rehabilitation professionals should screen for abuse and refer individuals to the appropriate mental and physical health services.

Moral injury and chronic pain in veterans

Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.

A meta-analysis of the association between shame and dissociation

Shame and dissociation have been implicated theoretically and empirically in trauma exposure and its sequelae, with shame understood as an intense negative emotion and dissociation as a reaction to intense negative emotions. Understanding the connection between shame and dissociation is important for theory and practice; however, the strength of this association remains unclear. For example, in therapy, both shame and dissociation serve as a barrier to engaging with emotion. Theoretically, these two states should be distinct, as one (dissociation) confers low affective intensity and the other (shame) high intensity. The present meta-analysis focused on the magnitude of the association between these two phenomena and investigated the extent to which gender, trauma exposure, psychiatric comorbidities, and demographic characteristics influence this association given their independent links to shame and dissociation. An initial search of six databases identified 151,844 articles. Duplicates were removed, and additional articles were excluded based on abstract and title screening. After contacting authors for missing data, a full-text screen yielded 25 articles for the present analysis. The results indicate that shame and dissociation were moderately correlated (k = 33, n = 4,705), r = .42, 95% CI [.35, .48], p < .001, but no clear clinical moderators emerged. Despite this association, very few studies utilized experimental designs to examine the association between these constructs. Future research should focus on experimental study designs to investigate the extent to which shame induces dissociation or vice versa.

The Effects of a Multi-Family Group Trauma Intervention on Caregiver Posttraumatic Stress Symptom Clusters

Strengthening Family Coping Resources (SFCR), a multi-family group intervention tailored to families experiencing traumatic stress, is associated with improved post-traumatic stress disorder (PTSD) symptoms and family functioning. To further SFCR research, we examined (1) SFCR's effects on caregiver PTSD symptom clusters (intrusions, avoidance, negative alterations in cognitions and mood [NACM], alterations in arousal and reactivity); and (2) whether effects differed by caregiver trauma type (interpersonal versus non-interpersonal; intrafamilial versus extrafamilial). Forty-two caregivers of primarily low socioeconomic status reporting trauma histories completed SFCR treatment. Significant decreases in PTSD intrusion, avoidance, and NACM subscale scores emerged from pre- to post-SFCR; there were no differences in subscale score changes by trauma type categorization. Findings support SFCR as a promising treatment for reducing PTSD severity among caregivers reporting diverse traumas.

Distinguishing everyday evil: Towards a clinical inventory of extreme and outrageous behaviors, actions and attitudes

Everyday evil is seen in a broad range of scenarios of intended behaviors that are often not violations of criminal law, but nevertheless cause significant and enduring personal and emotional harm. For this reason, the manifestations of everyday evil have pressing psychiatric import. Here, we propose the Welner Inventory of Everyday Extreme and Outrageous (WIEEO) for use as a screening inventory in clinical settings. The WIEEO contains 14 items within four categories: Physical and Emotional Damage, Exploitation, Extending Damage, and Extinguishing Goodness. Five items of "Physical and Emotional Damage" account for enduring life impact from said damage, and material effects that amplify emotional impact as well. Three items of "Exploitation" highlight the significance of not merely the actor's exploitation itself, but also the defenseless vulnerability of the victim. Four items that comprise the "Extending Suffering" category lengthen the impact, involve unusual dimensions, reflect creative social deviance in intent, or extend to additional parties. The two items of "Extinguishing Goodness" focus on the impact of decaying the otherwise prosocial or benevolent character of another and spawning everyday outrageousness in someone who would not have otherwise acted as such. These items have assumed relevance to the WIEEO through research and clinical settings that reveal their significant impact and psychological morbidity. The WIEEO serves as a marker for behaviors that warrant closer clinical attention to intervene, treat and detoxify such situations and the motivations of such malignant behavior before it further traumatizes or damages others.

Childhood betrayal trauma, dissociation, and shame impact health-related quality of life among individuals with chronic pelvic pain

BACKGROUND

High betrayal trauma (HBT), or interpersonal trauma perpetrated by someone close, is linked to dissociation and shame, while trauma perpetrated by someone less close, low betrayal trauma (LBT) is associated with post-traumatic stress disorder (PTSD).

OBJECTIVE

Child interpersonal trauma is common among women with chronic pelvic pain (CPP) and can negatively impact physical and mental health-related quality of life (HRQOL). Our study investigates unexplored connections between these variables.

PARTICIPANTS & SETTING

Survey data were analyzed from 96 English-speaking female patients with CPP at a women's health clinic (mean age = 33, 59 % White non-Hispanic, 62 % married or cohabitating, 61.5 % completed post-high school degree); prevalence of HBT and LBT were 65.2 % and 45.6 %, respectively.

METHODS

Multiple regression analyzed relationships between mental and physical HRQOL and dissociation, shame, and PTSD. Parallel mediation analyses examined indirect relationships between mental and physical HRQOL and exposure to childhood HBT and LBT.

RESULTS

Dissociation was related to worse physical HRQOL, while shame was related to worse physical and mental HRQOL. Dissociation and shame mediated relationships between childhood HBT and current mental (R² = 0.08, p = .01) and physical (R² = 0.11, p = .002) HRQOL. Shame, but not PTSD, mediated relationships between childhood LBT and current mental (R² = 0.14, p < .001) and physical (R² = 0.16, p < .001) HRQOL.

CONCLUSIONS

Our study provides preliminary evidence that dissociation and shame negatively impact HRQOL among individuals with CPP in the context of exposure to different types of childhood betrayal trauma. Replication studies to validate our results with larger samples and longitudinal designs are encouraged.

Association between post-traumatic stress symptoms and functional health among internally displaced people in Myanmar

WHAT IS KNOWN ON THE SUBJECT?: Internally displaced persons (IDPs) in Myanmar have been exposed to conflict and violence for a long time and experience physical, psychological and social problems. Post-traumatic stress symptoms (PTSS) are more prevalent among IDPs than among general populations and refugees, and limited research is available on this topic among IDPs in Myanmar. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: More than one-third of the IDPs in our sample from Myanmar camps had a high PTSS score. More than two-thirds experienced traumatic events and left home after age 18. The overall functional health of IDPs was poor, and the presence or absence of PTSS led to differences in the factors associated with functional health in each group. Resilience and PTSS were associated with the functional health of IDPs in Myanmar. Further, functional health was positively correlated with levels of resilience among those relatively low in PTSS. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to assess IDPs' health status and PTSS by first performing health screening at camps in Myanmar. Subsequently, tailored interventions can be provided according to individual health conditions and PTSS severity. IDPs in Myanmar need psychological first aid to cope with the ongoing conflict and violence, and further mental health nurse training is necessary to implement this aid and tailored interventions for PTSS.

ABSTRACT

INTRODUCTION: Internally displaced persons (IDPs) are individuals forced to leave their homes and move within their country. Post-traumatic stress symptoms (PTSS) are prevalent in this population.

AIM

To investigate trauma symptoms and functional health of IDPs in Myanmar and identify the factors associated with their functional health according to the presence/absence of PTSS.

METHOD

This cross-sectional study included 201 IDPs who completed a questionnaire on functional health, PTSS, resilience, social support and hope. The analysis included descriptive statistics, t-tests, Pearson's correlation coefficients and multiple linear regression with interaction analyses.

RESULTS

Over one-third of the participants had PTSS, with low functional health scores. The greater the resilience, the better the functional health. The higher participants' PTSS, the poorer their functional health. There was a significant interaction between resilience and PTSS.

DISCUSSION

Tailored resilience-building programs, as well as health policies and services, are needed to enhance IDPs' functional health and help them overcome PTSS.

IMPLICATIONS FOR PRACTICE

Psychological first aid should be provided to minimize PTSS experienced in situations of ongoing conflict and violence. Mental health nurses should be trained to assess IDPs' health status and tailor interventions accordingly.

Violence victimization in Latina/o/x young adults: The multiplicative effects of cultural and high betrayal trauma

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.

Anne’s Secret: Teaching Children to Protect Themselves from Child Sexual Abuse Using Animated Cartoons

This paper presents an innovative methodology for the prevention of child sexual abuse (CSA): animated cartoons. CSA is a political, social, educational, and psychological problem that affects many children according to the World Health Organization (WHO). That is why prevention becomes an essential tool for the protection of children. Children are increasingly accustomed to the use of digital media, both for learning and for entertainment. In response to this evolution on how information is transmitted and according to the tradition that cartoons have always had of transmitting values such as friendship, ecology, or solidarity, a 15-minute long video was developed. This video is an animated cartoon, presenting a story. It is composed of music, six friends, and three fantasy characters, and it was designed for children to learn resources to ask for help in case they are suffering CSA. The video is accompanied by a workbook through which both children and adults reinforce what they have learned in the cartoons and learn additional keys for their protection. Data from the first pilot studies carried out to test the effectiveness of this methodology are also presented, with promising results.

Bitten by the System that Cared for them: Towards a Trauma-Informed Understanding of Patients' Healthcare Engagement

The BITTEN theoretical framework of trauma-informed healthcare proposes that each patient presents to a healthcare encounter with a baseline level of historical institutional Betrayal and trauma exposure that interacts with their Indicator for healthcare engagement to potentially Trigger trauma symptoms, impacting patients' Trust in healthcare providers and shaping their current and future Expectations of and Needs for healthcare. The current study sought to test and extend components of the BITTEN theoretical framework to better understand the link between trauma exposure (childhood trauma and institutional betrayal) and healthcare engagement. Results largely supported the propositions of the BITTEN theoretical framework: childhood trauma was directly related to healthcare avoidance behaviors. The relation between childhood trauma and healthcare avoidance was partially mediated by patients' reduced trust in healthcare providers. Further, the relation between childhood trauma and reduced trust in healthcare providers was potentiated by experiences of institutional betrayal. Interpreting patients' interactions with healthcare providers and the healthcare system as a whole in light of their interpersonal and institutional trauma histories is needed to more fully embody trauma-informed healthcare. The BITTEN theoretical framework of trauma-informed healthcare appears to be a viable foundation for developing a trauma-informed understanding of patients' healthcare engagement.

Cultural Betrayal as a Dimension of Traumatic Harm: Violence and PTSS among Ethnic Minority Emerging Adults

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.

Posttraumatic Stress Symptom Severity Mediates the Relationship Between Military Sexual Trauma and Tension Reduction Behaviors in Male and Female Veterans

Numerous studies attest to the prevalence and complex negative consequences associated with military sexual trauma (MST). However, relatively less is known about male survivors and about the interaction of psychological problems such as posttraumatic stress disorder (PTSD) symptoms and emotion management difficulties following MST. The current study examined the path of psychological distress following MST in both male and female veterans. We predicted that (a) history of MST would predict more severe PTSD symptoms, which in turn would predict greater use of dysfunctional emotion management strategies (specifically, tension reduction behaviors) and that (b) PTSD symptoms would mediate the relationship between history of MST and tension reduction behaviors. Finally, we explored whether the indirect (i.e., mediating) effect was moderated by gender. Data were obtained from pretreatment paper and pencil assessments administered as part of standard clinical care from 338 veterans seeking treatment at a Veterans Affairs (VA) mental health specialty clinic. Veterans who endorsed MST experienced more severe PTSD symptoms and greater reported use of tension reduction behaviors. Bootstrapping testing the indirect effect revealed that PTSD symptoms mediated the relationship between history of MST and tension reduction behaviors. An exploratory moderated mediation analysis found that the indirect effect did not differ as a function of gender. PTSD symptoms appear to mediate the relationship between MST and tension reduction behaviors in veterans, regardless of gender. While previous research has suggested that civilian men report a greater number of tension reduction behaviors following a sexual assault compared to civilian women, we did not find the same gender differences among veterans. These results may provide support for using trauma-focused treatment even when MST survivors are reporting high-risk tension reduction behaviors.

Sexual violence and Australian women: A longitudinal analysis of psychosocial and behavioral outcomes

RATIONALE

Sexual violence (SV) is associated with adverse psychosocial and behavioural outcomes with revictimization likely. However, there are significant gaps in the current literature in regard to (a) whether over time women's levels of distress/behaviour change, and (b) whether social support mediates the relationship between SV and adverse outcomes.

METHODS AND RESULTS

This study aimed to address these two issues by analysing data from the Australian Longitudinal Women's Health Survey, surveys 4 (2006) to 8 (2018). Using repeated-measures data analytic procedures we found that women who had suffered SV, in comparison to women with no SV history, had greater anxiety, depression, stress, a lower mental health-related quality of life and less life satisfaction. Moreover, their level of distress remained higher at all time points, in comparison to the other group. Women with a SV history were also more likely to suffer re-victimization, consume more cigarettes and illicit drugs than other women. Moreover, SV predicted all psychosocial outcomes (except life satisfaction) 12 years later, with social support mediating these relationships. SV predicted drug status; however social support did not mediate this relationship.

CONCLUSIONS

These findings suggest that for women who have experienced SV their distress levels remain elevated. The findings also provide additional insights into the long-term impact of SV in Australian women with social support being identified as a resource that may assist in reducing some of the negative psychological outcomes associated with SV.

Association between relational trauma and empathy among male offenders in China

BACKGROUND

Offenders are more likely than the general population to have experienced relationship trauma. They are also more likely to have lower empathy. To date, relationships between historical trauma and later empathic states have not been examined among offenders.

AIMS

To explore the association between history of trauma in close personal relationships and empathy among offenders. Our research question is: Is such relational trauma associated with self-rated impairments in empathy?

METHODS

All men with a primary school education and above at a single all-male prison in Jiangsu Province in China were invited to participate. The self-reported Interpersonal Reactivity Index was used to evaluate empathy, and the Brief Betrayal Trauma Survey was to explore interpersonal trauma and classify such experiences.

RESULTS

Interpersonal trauma was associated with higher personal distress and lower empathic concern among men reporting relational trauma in adulthood, but only higher personal distress when the trauma reported was in childhood. Non-relational trauma was associated with higher empathic concern. Cognitive aspects of empathy varied little between groups.

CONCLUSIONS

Our findings add to the existing literature by making distinctions between the types of trauma and the age of key experience in its relationship to self-reported empathy. The differences found suggest that it may be helpful to consider planning any trauma-related interventions differently according to the type and age of trauma experiences.

A Developmental Framework for Embodiment Research: The Next Step Toward Integrating Concepts and Methods

Embodiment research is at a turning point. There is an increasing amount of data and studies investigating embodiment phenomena and their role in mental processing and functions from across a wide range of disciplines and theoretical schools within the life sciences. However, the integration of behavioral data with data from different biological levels is challenging for the involved research fields such as movement psychology, social and developmental neuroscience, computational psychosomatics, social and behavioral epigenetics, human-centered robotics, and many more. This highlights the need for an interdisciplinary framework of embodiment research. In addition, there is a growing need for a cross-disciplinary consensus on level-specific criteria of embodiment. We propose that a developmental perspective on embodiment is able to provide a framework for overcoming such pressing issues, providing analytical tools to link timescales and levels of embodiment specific to the function under study, uncovering the underlying developmental processes, clarifying level-specific embodiment criteria, and providing a matrix and platform to bridge disciplinary boundaries among the involved research fields.

Psychological Distress, Somatic Complaints, and Their Relation to Negative Psychosocial Factors in a Sample of Swedish High School Students

Background: Adolescence is a period in life characterized by major neurobiological, physiological, and psychological changes. Those changes may give rise to worsened mental health and an increased prevalence of somatic complaints combined with a negative psychosocial environment. Rapid changes in society, which may also affect young people in several ways, call for a renewed screening of today's adolescents' mental and somatic well-being. Aim: The present study's primary aim was to measure the level of self-rated psychological distress and the prevalence of somatic complaints in a sample of Swedish high school students. As a secondary aim, it identifies gender-specific patterns and examines mental and somatic health in relation to negative psychosocial factors (such as parental alcohol use problems or the experience of physical or psychological abuse). Method: Two hundred and eighty-seven Swedish high school students completed a survey including the Brief Symptom Inventory (BSI) and a questionnaire about the presence of defined somatic complaints. In order to examine the relationship between negative psychosocial factors and mental and somatic health, three groups were formed: those reporting (i) parental substance use problems, (ii) previous experience of abuse, (iii) none of these problems. Results: The majority of the Swedish high-school students (>80%) reported no or only a few problems with psychological distress and no or only one somatic complaint. Female students disclosed a significantly higher psychological distress level captured by each BSI domain. The number of somatic complaints was similarly distributed between the genders. The students rarely reported parental substance use problems, but almost 40% of the male and 50% of the female students indicated the experience of physical and/or psychological abuse. Such negative psychosocial circumstances were related to an increased level of anxiety in the male and an increased general level of psychological distress in female students. Conclusions: The study confirmed female students' higher psychological distress level. Gender differences in the type of somatic complaints, but not in the number were detected. The experience of physical and/or psychological abuse was found to significantly worsen psychological distress in students of both genders.

Child Sexual Abuse in Mexican Women: Type of Experience, Age, Perpetrator, and Disclosure

Child sexual abuse (CSA) is a type of maltreatment that occurs in practically all countries and social statuses. Due to the taboo and shame that surrounds it, CSA is a problem universally silenced despite the important consequences (both physical and psychological) that it has for the victim and their family. This work aimed to study the correlates of CSA in Mexican women. Our sample comprised 1058 women ranged from 18 to 73 years (M = 40.19; SD = 10.24). They completed an anonymous online survey including questions about all the different types of abuse, questions about who perpetrated it, at what age it happened, and whether the victim disclosed the abuse. Our results showed that, depending on the type of abuse, from 13.9% to 65.8% of the participants had suffered at least one episode of CSA throughout their childhood. The first episode typically occurred between 6 and 12 years old, with the perpetrator being a male. The youngest women reported higher rates of being shown pornography by a family member, whereas the oldest ones reported higher rates of exhibitionism by a stranger. Only 31.3% of the sample disclosed the abuse, usually to their mother or a peer. Differences among the correlates of the different types of abuse, the age of the victims, and the relationship with the perpetrator are discussed as well as the victims’ feelings of being believed when they disclosed the abuse.

The association between social support and posttraumatic stress symptoms among survivors of betrayal trauma: a meta-analysis

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.

The "3 Es" of trauma-informed care in a federally qualified health center: Traumatic Event- and Experience-related predictors of physical and mental health Effects among female patients

Federally Qualified Health Centers (FQHCs) are a fast-growing source of healthcare for women with intersectional identities, or those most frequently exposed to and negatively impacted by interpersonal trauma. According to the "3 E" conceptualization of trauma, certain Event- and Experience-related characteristics of a trauma predict victims' physical and mental health Effects. The "3 Es" have yet to be studied in female FQHC patients. The current study examined the prevalence of interpersonal trauma and interrelationships among traumatic Event-related factors (e.g., cumulative trauma by victim-perpetrator relationship), Experience-related factors (e.g., betrayal, resilience), and Effects (e.g., somatic symptoms, posttraumatic stress (PTS), anxiety/depression, mistrust, reduced sense of safety) among 138 predominantly Black (89.1%) women receiving care at an FQHC in the southeastern U.S. Roughly 65% of participants (n = 86) endorsed exposure to at least one type of interpersonal trauma. More cumulative trauma was significantly correlated with more somatic, PTS, and anxious/depressive symptoms, and a reduced sense of safety. Experiences of betrayal and/or resilience were better predictors of PTS and anxious/depressive symptoms and lack of safety than Event-related factors. Findings support the need for the implementation of trauma-informed care within community-based health centers. Healthcare providers should consider women's subjective experience of trauma when screening for exposure and providing trauma-sensitive care.

Effect of HIV and Interpersonal Trauma on Cortical Thickness, Cognition, and Daily Functioning

BACKGROUND

Interpersonal trauma (IPT) is highly prevalent among HIV-positive (HIV+) individuals, but its relationship with brain morphology and function is poorly understood.

SETTING

This cross-sectional analysis evaluated the associations of IPT with cognitive task performance, daily functioning, magnetic resonance imaging (MRI) brain cortical thickness, and bilateral volumes of 4 selected basal ganglia regions in a US-based cohort of aviremic HIV+ individuals, with (HIV+ IPT+) and without IPT exposure (HIV+ IPT-), and sociodemographically matched HIV-negative controls with (HIV- IPT+) and without IPT exposure (HIV- IPT-).

METHODS

Enrollees completed brain MRI scans, a semistructured psychiatric interview, a neurocognitive battery, and 3 measures of daily functioning. Demographic and clinical characteristics of the 4 groups were described, and pairwise between-group comparisons performed using χ tests, analysis of variance, or t-tests. Linear or Poisson regressions evaluated relationships between group status and the outcomes of interest, in 6 pairwise comparisons, using Bonferroni correction for statistical significance.

RESULTS

Among 187 participants (mean age 50.0 years, 63% male, 64% non-white), 102 were HIV+ IPT+, 35 were HIV+ IPT-, 26 were HIV- IPT-, and 24 were HIV- IPT+. Compared with the remaining 3 groups, the HIV+ IPT+ group had more activities of daily living declines, higher number of impaired Patient's Assessment of Own Functioning Inventory scores, and lower cortical thickness in multiple cerebral regions. Attention/working memory test performances were significantly better in HIV- IPT- compared with the HIV+ IPT+ and HIV+ IPT- groups. Basal ganglia MRI volumes were not significantly different in any between-group comparisons.

CONCLUSION

IPT exposure and HIV infection have a synergistic effect on daily functioning and cortical thickness in aviremic HIV+ individuals.

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

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

Polyvictimization and psychopathology among children and adolescents: A systematic review of studies using the Juvenile Victimization Questionnaire

BACKGROUND

Exposure to child abuse can lead to lasting mental health problems. Extant research has found that different types of child abuse tend to co-occur and overlap, which merits the investigation of the effects of exposure to multiple types of childhood mistreatment.

OBJECTIVE

The aim of this study was to systematically review the evidence on the associations between multiple different types of interpersonal victimization or polyvictimization, and indicators of psychopathology among children ages 0-17.

METHODS

The review included studies across all economic strata and research on nationally representative, community, and at-risk samples, using the same standardized assessment tool (i.e. the Juvenile Victimization Questionnaire or JVQ). The review was conducted using peer-reviewed evidence published up until August 2019 from Scopus, EMBASE, PsycINFO, Medline, CINAHL, and ERIC. Out of 4998 relevant references screened, 255 met the inclusion criteria, 22 of which aimed to address childhood polyvictimization and psychopathology.

RESULTS

A total of 21 of the 22 included studies identified a significant positive association between polyvictimization and various indicators of psychopathology comprising both externalizing (e.g. anger), internalizing problems (e.g. depression) and total psychological distress. A range of studies demonstrated that polyvictimization was a stronger risk factor for psychopathology than individual (sub)types of victimization. Based on the study findings, we provide a set of recommendations for future research on polyvictimization and psychopathology.

CONCLUSION

The present systematic review was the first to review the evidence on the associations between polyvictimization (as measured by the JVQ) and child and adolescent psychopathology in the global research literature. As a novel approach, the present review included both normative and high-risk samples. The results showed that polyvictimization is a substantial risk factor for mental health problems spanning both inner-directed and outer-directed mental health difficulties. However, the inconsistency in methods of defining and measuring polyvictimization severely undermines the scientific impact of this body of work. Additional well-designed, longitudinal studies that take account of the context-specific nature of polyvictimization are required to better establish the causal relationships between childhood polyvictimization and psychopathology so as to improve prevention and intervention efforts.

Gendered Sexual Violence: Betrayal Trauma, Dissociation, and PTSD in Diverse College Students

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.

Exploring the impact of trauma type and extent of exposure on posttraumatic alterations in 5-HT1A expression

The long-term behavioral, psychological, and neurobiological effects of exposure to potentially traumatic events vary within the human population. Studies conducted on trauma-exposed human subjects suggest that differences in trauma type and extent of exposure combine to affect development, maintenance, and treatment of a variety of psychiatric syndromes. The serotonin 1-A receptor (5-HT1A) is an inhibitory G protein-coupled serotonin receptor encoded by the HTR1A gene that plays a role in regulating serotonin release, physiological stress responding, and emotional behavior. Studies from the preclinical and human literature suggest that dysfunctional expression of 5-HT1A is associated with a multitude of psychiatric symptoms commonly seen in trauma-exposed individuals. Here, we synthesize the literature, including numerous preclinical studies, examining differences in alterations in 5-HT1A expression following trauma exposure. Collectively, these findings suggest that the impact of trauma exposure on 5-HT1A expression is dependent, in part, on trauma type and extent of exposure. Furthermore, preclinical and human studies suggest that this observation likely applies to additional molecular targets and may help explain variation in trauma-induced changes in behavior and treatment responsivity. In order to understand the neurobiological impact of trauma, including the impact on 5-HT1A expression, it is crucial to consider both trauma type and extent of exposure.

Injustice is Served: Injustice Mediates the Effects of Interpersonal Physical Trauma on Posttraumatic Stress Symptoms and Depression Following Traumatic Injury

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.

Interpersonal Violence Exposure and Chronic Pain in Adult Sickle Cell Patients

Almost half of sickle cell disease (SCD) patients develop chronic, debilitating physical pain with uncertain genesis for which they primarily receive opiate-based palliative treatment. Psychological trauma exposure, especially interpersonal victimization, has been linked to the perception of pain in several medical diseases, but has yet to be examined in SCD patients. This study examines self-reported chronicity of pain and use of prescribed opiates in 50 adult SCD patients with and without a history of interpersonal violence exposure. We conducted a retrospective chart review of 50 consecutive SCD patients seen for medical care in an adult subspecialty hematology clinic. Data collected included demographics, opiate use, pain chronicity, and measures of anxiety, depression, and interpersonal violence exposure. Sixty-eight percent of patients reported past interpersonal violence exposure. The mean number of types of interpersonal violence exposure, including physical, sexual, or emotional abuse, was 2.76 (SD = 1.63). SCD patients with a history of interpersonal violence exposure were almost five times more likely to report chronic pain and more than six times more likely to report use of opiate-based medications on a daily basis compared with SCD patients with no history of violence exposure. Depression and anxiety symptoms were associated with violence exposure, but did not account for the relationship between violence exposure and chronic pain or prescribed opiate use. Screening and assessment of exposure to interpersonal violence may be useful in addition to screening for mental health problems in the management of chronic pain with adults diagnosed with SCD. Such screening may contribute to addressing health care disparities given the preponderance of SCD patients who are of African American ethnoracial background.

Understanding trauma as a system of psycho-social harm: Contributions from the Australian royal commission into child sex abuse

This article examines how particular understandings of trauma as a systemic form of psychosocial harm framed the establishment of the Australian Royal Commission into Institutional Responses to Child Sexual Abuse, informed its successful investigatory process, and shaped its recommendations and outcomes. In so doing, the Royal Commission makes an important contribution to the field of trauma studies, which has been characterized by contested histories and is subject to continuing debate in clinical and academic research. For much of the twentieth century, trauma and its impacts have been typically articulated through a bio-medical discourse of individual harm and health outcomes. We argue that the establishment of the Royal Commission reflected an expanded understanding of trauma, constitutive of moral, political and psychological arenas as evidenced in its methodology, conceptual approach and treatment of survivor testimony. We also argue that the institutionalization of an historically situated and politically engaged approach to trauma within the Royal Commission itself was effective in contesting narrow psychological or juridical concepts of harm by developing approaches to trauma as a system of harm with complex impacts on families, communities and indeed the nation. We evaluate the implications and consequences of this shift in the work of the Royal Commission, with particular attention to the development of an interdisciplinary relational approach to the study of trauma as a key principle in the emergence of a trauma-informed culture.

Psychopathology among adult survivors of child pornography

BACKGROUND

The majority of studies investigating child pornography have focused on conceptualizing the problem and the harm of the crime, evaluating the risk for child pornography offending, or discuss preventive measures. Little is known about survivors of this type of crime.

OBJECTIVE

This research explores the relationship between child pornography victimization and psychopathology in adulthood. Specifically, we examined the contribution of emotional reactions at the time of the crime and shortly after (guilt, embarrassment and avoidance) on psychopathology among adult survivors of child pornography.

PARTICIPANTS AND SETTING

The study was conducted among 107 child pornography adult survivors, aged 18-63 (M = 39.48, SD = 12.31). All participants were sexually molested during the crime.

METHODS

An online survey was completed by a convenience sample of adult survivors of child pornography.

RESULTS

Findings indicate survivor's current age predicted current psychopathology symptoms. Survivor's emotional reactions of guilt and embarrassment at the time of the crime and shortly after were significantly associated with elevated psychopathology, above and beyond demographic characteristics and features of the crime.

CONCLUSIONS

The present results suggest the way survivors of child pornography react to the crime might shape their mental health in the long term.

Resilience and psychological trauma among Filipino American women

AIMS

To explore the types of traumatic exposure, prevalence of posttraumatic stress disorder (PTSD), and level of resilience in a community sample of Filipino American women (FAW), as well as to investigate the relationships between their PTSD symptoms, history of traumatic exposure, and resilience.

METHOD

A cross-sectional study with a total of 188 adult FAW.

RESULTS

We observed high levels of resilience and low levels of PTSD symptom severity. The most common form of traumatic exposure was non-interpersonal trauma occurring after the age of 18 years old. We also found a significant correlation between history of traumatic exposure and PTSD and between resilience and PTSD. Resilience was found to have a significant moderating effect on the relationship between traumatic exposure and PTSD.

CONCLUSIONS

The results provide preliminary evidence on the buffering and protective properties of FAW's resilience to PTSD despite traumatic exposure.

Post-traumatic stress and psychological health following infidelity in unmarried young adults

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity-related post-traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity-related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post-traumatic cognitions mediated the associations between infidelity-related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity-related PTSD. Whether used as continuous or categorical predictor, infidelity-related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post-traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post-traumatic cognitions.

Do dialectical self-beliefs moderate the indirect effect of betrayal traumas on posttraumatic stress through self-compassion?

BACKGROUND

Traumatic events experienced in childhood, particularly those that are perpetrated by someone whom the child trusts or depends upon (i.e., high betrayal traumas [HBTs], such as abuse by a parent) can lead to long-term negative consequences, including a tendency to see oneself in a negative light, low self-compassion, and posttraumatic stress disorder. Although negative psychological consequences of HBTs are well-documented in the literature, little is known surrounding the protective factors that may reduce the effects of HBTs on individuals' functioning. The present study focused on one potential protective factor, dialectical self-beliefs, that may moderate the negative effects of HBTs experienced in childhood on self-compassion, and hence reduce posttraumatic stress (PTS).

OBJECTIVE

The present study is aimed at determining whether dialectical self-beliefs moderate the indirect effect of HBTs on PTS via self-compassion.

PARTICIPANTS AND SETTING

Data of the present study were collected from 747 college students attending a university in the Northeast region of the United States.

METHOD

Using a correlational study design, the data of this study were collected from college students through an online survey.

RESULTS

The results of a moderated mediation analysis indicated that the hypothesized model explained 25% of the variance in PTS. After controlling for low betrayal traumas, the indirect effect of HBTs on PTS through self-compassion was moderated by dialectical self-beliefs. These findings provide support for our hypotheses and suggest that having a dialectical self-view may enhance the adjustment of individuals with a history of HBTs by reducing the negative effect of HBTs on self-compassion.

The risk of Telling: A Dyadic Perspective on Romantic Partners' Responses to Child Sexual Abuse Disclosure and Their Associations with Sexual and Relationship Satisfaction

Among 70 community couples who reported childhood sexual abuse (CSA) and disclosure to their partner, this study examined associations between survivors' perception of partner responses to their disclosure, and both partners' sexual and relationship satisfaction. Participants completed self-report questionnaires online. Results of path analyses within an actor-partner interdependence model indicated that survivors' perceived partner responses of emotional support to disclosure were associated with their own and their partners' higher sexual satisfaction. Survivors' perceived responses of being stigmatized/treated differently by the partner were associated with their own and their partners' poorer relationship satisfaction. Findings suggest that survivor-perceived partner responses to the disclosure of CSA can have a positive and a negative impact on the sexual and relationship satisfaction of both partners.

High Betrayal Adolescent Sexual Abuse and Nonsuicidal Self-Injury: The Role of Depersonalization in Emerging Adults

Adolescent sexual abuse can interfere with healthy development. Sexual abuse that is perpetrated by close other(s)-high betrayal-can be additionally harmful, with sexual abuse being linked with dissociation and nonsuicidal self-injury (NSSI). Depersonalization, a dissociative subtype characterized by disconnection between oneself and one's body and/or thoughts, may further explain the role of dissociation in NSSI. The purpose of the current study was to: 1) isolate the impact of adolescent sexual abuse on NSSI; and 2) examine depersonalization as a pathway between high betrayal adolescent sexual abuse and NSSI. Participants (N = 192) were college students who completed online measures assessing sexual abuse, dissociation, and NSSI. While controlling for child sexual abuse and adult sexual abuse, adolescent sexual abuse predicted NSSI. Moreover, there was an indirect effect of high betrayal adolescent sexual abuse on NSSI through depersonalization, while controlling for child sexual abuse, adult sexual abuse, and medium betrayal (perpetrator: unclose other) adolescent sexual abuse. Findings from the current study have implications for relational cultural therapy as an evidence-informed treatment that highlights the relational harm of interpersonal trauma, while incorporating contextual elements, such as development of maladaptive coping strategies, into therapy.

Extending poly-victimization theory: Differential effects of adolescents' experiences of victimization on substance use disorder diagnoses upon treatment entry

BACKGROUND

Although victimization is a known contributor to the development of substance use disorders, no research has simultaneously examined how characteristics of victimization experienced over time, such as the type of abuse, the presence of poly-victimization, closeness to perpetrator(s), life threat or fear, and negative social reactions to disclosing victimization, cluster into profiles that predict substance use disorders.

OBJECTIVE

The aim of the current study is to assess how profiles of victimization and trauma characteristics are associated with substance use disorders and assess potential gender differences.

PARTICIPANTS AND SETTING

Participants were 20,092 adolescents entering substance use treatment.

METHODS

We used latent class and multi-group latent class analysis to extract classes of victimization and associated characteristics. Emergent classes were used to predicted substance use disorder status at treatment intake.

RESULTS

Five classes were extracted: poly-victimization + high harmful trauma characteristics, sexual abuse + negative social reaction and perceived life threat, emotional abuse + trusted perpetrator, physical abuse and low all. Similar classes were found for the multi-group model. In both the overall and female-specific models, the poly-victimization + high harmful trauma characteristics class was more severe than all other classes in terms of opioid use disorder, tobacco use disorder, and dual diagnosis. Other class differences were found across gender.

CONCLUSIONS

Adolescents entering treatment can be distinguished by their profiles of victimization experiences and associated characteristics, and these profiles evidence different associations with substance use disorder diagnoses. Results point to a need for more nuanced assessment of victimization experiences and gender-specific interventions.

Japanese Students Do See the Value of Asking About Child Abuse and Trauma in the Research Setting

Despite evidence regarding the impact of childhood abuse perpetrated by close others, or high betrayal trauma, a number of barriers continue to impede research efforts, including concerns that research may do more harm than good. Research conducted with Western samples has indicated that contrary to such concerns, participants rate the benefit of participating in trauma research as outweighing costs, even when they have a history of high betrayal trauma. Certain non-Western values, such as interpersonal harmony, could play a role in perceptions regarding trauma research participation. The current study evaluated perceptions of 79 Japanese undergraduate students who participated in an online study of child abuse. Japanese students rated the importance of participating in trauma research as greater than any immediate distress it caused. Interpersonal harmony was not related to perceptions of participating in trauma research, nor was a history of high betrayal child trauma. Taken together, these findings support continued research on childhood abuse in non-Western samples.