What happens when you are betrayed by someone close to you?
For a child dealing with sexual abuse or a spouse dealing with domestic abuse, the trauma becomes far worse when it involves someone with whom they share an intimate relationship. When you depend on another person for food, shelter, emotional, or financial support, the sense of being betrayed adds a new dimension to being abused.
Along with the sense of violation comes a basic shattering of the trust that victims once had with their abusers. Coping with that abuse often leads to a form of betrayal blindness, or deliberate unawareness of what is happening. Whether through simple denial or, in more extreme cases, active repression of the memory of that betrayal, the psychological costs can last a lifetime.
According to the betrayal trauma theory first proposed by Jennifer Freyd of the University of Oregon, the extent of trauma associated with abuse is often linked to the level of perceived betrayal involved. Due to a fear of confrontation with the abuser and the potential loss of the abuser's support, abuse victims are far more likely to shut out conscious recall of the abuse, even years later. Various other symptoms associated with betrayal trauma include alexithymia (inability to recognize emotions), depression, anxiety, panic attacks, suicidal behavior, anger, and physical health complaints.
Another common problem linked to the suppression of memories surrounding betrayal trauma is dissociation. Defined by Freyd and her colleagues as, "“the lack of integration of thoughts, feelings, and experiences into the stream of consciousness," dissociation can range from mild detachment from immediate reality (such as daydreaming) to more severe symptoms including loss of memory, fragmenting of identity, and complex posttraumatic disorder (C-PTSD).
In some cases, betrayal trauma can also lead to visual and auditory hallucinations such as victims hearing the voice of their abuser. At least one study has found that 73 percent of people reporting psychotic symptoms, including hallucinations, have a history of childhood trauma. Other studies have also linked psychosis to childhood trauma, including bullying, parental death, and interpersonal crises.
But is there a clear link between betrayal trauma and developing later problems such as hallucinations? While betrayal blindness can be considered a form of dissociation which can lead to more serious psychiatric symptoms, there has been little research to date looking at the kind of psychiatric symptoms that can arise due to violation of trust and abuse.
A new article published in Psychological Trauma presents the results of three studies looking at the impact of low, medium, and high betrayal trauma on dissociation and hallucination. Conducted by Jennifer Gomez, Laura Kaehler, and Jennifer Freyd of the University of Oregon, the three studies were conducted on hundreds of university undergraduates with an average age of 19.68 years. The majority of the participants were female.
Along with self-report inventories measuring specific trauma symptoms, history of abuse, and psychiatric symptoms, the participants were also questioned about whether they experienced high betrayal trauma (made to have some form of sexual contact, such as touching or penetration, by someone with whom you were very close), medium betrayal (you were made to have such sexual contact by someone with whom you were not close), or low betrayal trauma (involving natural disasters or similar trauma without an interpersonal element.)
The first study looked at symptoms of dissociation specifically while the second study focused on hallucinations. In the third study, the researchers looked at type of hallucination, i.e., visual, auditory, or tactile hallucinations. Overall, about 28 percent of the participants in the different studies reported experiencing at least one high-betrayal trauma with up to 48 percent reporting trauma of any type. According to the results of the first study, high betrayal trauma was significantly related to symptoms of dissociation while medium betrayal trauma was not. This reflects previous research in suggesting that level of dissociation resulting from childhood abuse can depend on the degree of betrayal involved.
In the second study, experiencing high and medium betrayal trauma significantly predicted later experiencing of hallucinations though low-betrayal trauma did not. Taking those results further in the third study, high-betrayal trauma was significantly related to tactile hallucinations (sensation of physical contact that wasn't there). Both medium and high-betrayal trauma was linked to auditory and visual hallucinations.
The researchers noted that hallucinations were only linked to sexual experiences occuring during childhood (younger than thirteen years). Participants experiencing betrayal trauma as adolescents or adults appear better able to cope without developing extreme symptoms such as hallucinations.
So what can we learn from these studies? Though the authors recognize that their study results are limited by the use of self-report questionnaires and needs to be repeated with a more diverse population, their findings have some important implications. While childhood trauma can have a lasting impact, the nature of that trauma is important as well. Dealing with betrayal along with the trauma of physical or sexual abuse appears to increase the likelihood of survivors developing symptoms such as hallucinations and severe dissociation. These study findings also have important treatment implications for people reporting serious psychiatric symptoms.
At present, treatment for hallucinations usually involves medication which psychiatrists may often prescribe as an alternative to psychological treatment. Understanding the potential role of betrayal trauma in developing psychotic symptoms may lead to greater use of PTSD treatment for these patients. Along with treating PTSD symptoms, it is also important to focus on helping them deal with trust issues and repair their ability to form relationships. While recent research shows that trauma treatment can be useful for patients reporting psychosis, there is much more that can be done.
The most important lesson that Gomez, Kaehler, and Freyd feel can be learned from their study findings is that betrayal trauma can be prevented through proper programming and greater vigilance on the part of family members and caregivers. Dealing with betrayal trauma as it occurs can significantly reduce the likelihood of later psychiatric problems developing.
While there are no simple answers for dealing with complex issues such as betrayal trauma, helping victims move on and learn to trust again can be the key to true recovery.