Betrayal Trauma: Relationship to Physical Health ...

1 Betrayal Trauma: Relationship to Physical Health ,Psychological Distress,and a Written Disclosure InterventionJennifer J. Freyd, PhDBridget Klest, MACarolyn B. Allard, the current study we sought, first, to distinguish associ-ations with Health arising from types of trauma as indicated by betrayaltrauma theory (Freyd, 1996, 2001), and, second, to investigate the im-pact of disclosing a trauma history in survey form and/or writing essaysabout Betrayal traumas. We recruited 99 community adults reporting atleast 12 months of chronic medical illness or pain, 80 of whom com-pleted all four sessions of this six-month longitudinal intervention were randomly assigned to write about Betrayal traumas orneutral events, and they were randomly assigned to complete an exten-Jennifer J.

2 Freyd, Bridget Klest, and Carolyn B. Allard are affiliated with the De-partment of Psychology, University of correspondence to: Jennifer J. Freyd, PhD, Department of Psychology,1227 University of Oregon, Eugene, OR 97403-1227 (E-mail: research was supported by the Northwest Health Foundation Grant Number2001-255 Child Abuse and Health : An Intervention(Freyd, PI). The manuscript prepa-ration was also supported in part by the Trauma and Oppression Research Fund at theUniversity of Oregon Foundation. The authors are grateful to the numerous contribu-tions to this research made by Anne DePrince, Ann Yee, and from the members of theFreyd Dynamics Lab at the University of Oregon.)

3 The authors are also indebted to thereviewers and editors of this journal for helpful paper was submitted, reviewed, and accepted under the editorship of JamesChu, MD, and Jon Elhai, of Trauma & Dissociation, Vol. 6(3) 2005 Available online at 2005 by The Haworth Press, Inc. All rights trauma survey or a long personality inventory, producing fourgroups of participants. All 99 participants were assessed at their initialvisit for trauma history using the Brief Betrayal Trauma Survey (BBTS)and Physical and mental symptoms. The BBTS assesses exposure to bothtraumas high in Betrayal (such as abuse by a close other) and traumas lowin Betrayal but high in life-threat (such as an automobile accident).

4 Expo-sure to traumas with high Betrayal was significantly correlated with numberof Physical illness, anxiety, dissociation, and depression symptoms. Am-ount of exposure to other types of traumas (low Betrayal traumas) did notpredict symptoms over and above exposure to Betrayal trauma. Whileneither the survey manipulation nor the writing intervention led to maineffects on change in symptoms over time, there were interactions be-tween Betrayal trauma history and condition such that participants withmany Betrayal traumas fared better in the control conditions while par-ticipants with fewer Betrayal traumas had better outcomes if they wereplaced in the trauma writing and/or survey conditions.

5 We discuss ongo-ing and future research aimed at evaluating the role of increased struc-ture in writing assignments as beneficial for those with severe historiesof Betrayal trauma.[Article copies available for a fee from The Haworth Doc-ument Delivery Service: 1-800-HAWORTH. E-mail address: Website: < > 2005 by TheHaworth Press, Inc. All rights reserved.] trauma, mental Health , Physical Health , disclo-sure, writingThe phrase Betrayal trauma refers to those traumas in which indi-viduals or institutions that people depend on for survival harm or violatethem in some way (Freyd, 1996, 2001). Betrayal traumas involve thedepended-upon person or institution breaking an explicit or implied so-cial agreement, such that a violation of trust occurs.

6 Due to the depend-ent nature of the Relationship between perpetrator and victim, the victimof the violation is unable to confront or sever ties with the perpetrator,being forced to ignore or accept the violation in order to preserve an ap-parently necessary Relationship (Freyd, 1996, 2001). The victim thus islikely to remain in a position where future violations may traumas may not threaten death or Physical injury, but canbe damaging to well-being, relationships, self-concept, and beliefsabout others and the world. Such traumas represent a mismatch betweenwhat should be ( , people do not intentionally harm one another)and what is (you have been harmed by another person; DePrince &84 JOURNAL OF TRAUMA & DISSOCIATIONF reyd, 2002).

7 Freyd and colleagues have suggested that the most com-plete definition of trauma includes events evoking intense fear, socialbetrayal, or a combination of both (Freyd, 1999, 2001; Freyd, DePrince,& Zurbriggen, 2001). Both fear and Betrayal can be described either ascontinuous or categorical dimensions of trauma. A trauma can be said toeither involve Betrayal or not, but can also involve varying degrees ofbetrayal ( , abuse by a babysitter may be less betraying than abuse bya parent). The degree to which an event is traumatic may relate to the de-gree of fear and/or Betrayal involved. Because Betrayal is qualitativelydifferent from fear, traumas that include elements of Betrayal may leadto different outcomes than traumas that are only CONSEQUENCES OF TRAUMAT here have been many studies assessing the long-term consequencesof experiencing trauma.

8 The bulk of these studies have linked abuse inchildhood or adulthood with adult Physical and mental Health symp-toms and disorders (Felitti, 1991, 2002; Kendall-Tackett, 2000). Suchstudies have shown a strong Relationship between abuse traumas and anumber of Health problems. Although these researchers have not specif-ically sought to study the consequences of Betrayal trauma, most abusetraumas can be classified as Betrayal traumas. A national survey of childabuse prevalence and characteristics revealed that a great majority( ) of child abuse is perpetrated by caregivers (parents: 81%, legalguardians: , foster parents: , unmarried partners of , residential facility staff: , and daycare providers: ; Ad-ministration for Children and Families, 2002).

9 Therefore, although it islikely that not all the trauma reported in the following studies is betrayaltrauma, it is reasonable to assume that the bulk of it a study of 110 women drawn from a primary practice sample,childhood abuse and domestic abuse were positively correlated withpain symptoms (Kendall-Tackett, Marshall, & Ness, in press) and dia-betes symptoms (Kendall-Tackett & Marshall, 1999). Runtz (2002)found that university women with a history of childhood Physical abusewere more likely to experience a variety of Health symptoms, andRomans and colleagues (2002) found that women with childhood and/or adult abuse histories were more likely to experience chronic fatigue,bladder problems, pelvic pain, headache, chronic pain, asthma, diabe-tes, and heart problems.

10 In two studies of men and women from primarypractice samples, researchers found that those who had been victims ofFreyd, Klest, and Allard85abuse had had more surgeries and engaged in more behaviors that wereharmful to Health (Kendall-Tackett, Marshall, & Ness, 2000), weremore likely to be obese, to have chronic headaches, asthma, and gastro-intestinal symptoms, and were more likely to have high numbers of doc-tor office visits each year (Felitti, 1991). And in perhaps the mostcompelling piece of research linking trauma and Health , a study ofnearly 10,000 members of a Health maintenance organization (HMO)found positive correlations between adverse childhood experiences andmany of the leading causes of death in adults, including heart disease,cancer, and even skeletal fractures (Felitti et al.)