Betrayal trauma: relationship to physical health, psychological distress, and a written disclosure intervention

Abstract

In the current study we sought, first, to distinguish associations with health arising from types of trauma as indicated by betrayal trauma theory (Freyd, 1996, 2001), and, second, to investigate the impact of disclosing a trauma history in survey form and/or writing essays about betrayal traumas. We recruited 99 community adults reporting at least 12 months of chronic medical illness or pain, 80 of whom completed all four sessions of this six-month longitudinal intervention study. Participants were randomly assigned to write about betrayal traumas or neutral events, and they were randomly assigned to complete an extensive trauma survey or a long personality inventory, producing four groups of participants. All 99 participants were assessed at their initial visit for trauma history using the Brief Betrayal Trauma Survey (BBTS) and physical and mental symptoms. The BBTS assesses exposure to both traumas high in betrayal (such as abuse by a close other) and traumas low in betrayal but high in life-threat (such as an automobile accident). Exposure to traumas with high betrayal was significantly correlated with number of physical illness, anxiety, dissociation, and depression symptoms. Amount of exposure to other types of traumas (low betrayal traumas) did not predict symptoms over and above exposure to betrayal trauma. While neither the survey manipulation nor the writing intervention led to main effects on change in symptoms over time, there were interactions between betrayal trauma history and condition such that participants with many betrayal traumas fared better in the control conditions while participants with fewer betrayal traumas had better outcomes if they were placed in the trauma writing and/or survey conditions. We discuss ongoing and future research aimed at evaluating the role of increased structure in writing assignments as beneficial for those with severe histories of betrayal trauma.