Bridget Klest

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.

Military Sexual Trauma Research: A Proposed Agenda

Military sexual trauma (MST) is a widespread problem associated with negative psychological and physical health problems. This article presents the current state of MST research and highlights specific areas in need of more focused study. Areas that have produced the greatest body of knowledge include MST prevalence and psychological and physical health correlates. We propose a research agenda based on gaps noted in our research review and empirical and theoretical evidence of issues relevant to but not studied directly in MST populations. We present evidence that MST is qualitatively distinct from other forms of sexual maltreatment in terms of its relational and vocational context as well as the severity of associated psychological distress, examine underexplored gender and sexual issues in MST, and discuss the lack of treatment and prevention studies specific to MST. Specific recommendations are made throughout in an attempt to guide and advance the field.

Causal Mechanisms and Multidirectional Pathways Between Trauma, Dissociation, and Health

Do traumatic events increase the risk of health problems? Over the past decade, researchers in a number of fields—health psychology, medicine, nursing, epidemiology, and public health—have found that they do. In the early stages of this work, researchers worked independently and did not communicate with one another, which limited the application of their findings. For example, researchers in nursing and several fields of medicine— gynecology, gastroenterology, rheumatology—began to notice, quite independently, that patients with pain often had a history of child or domestic abuse (Kendall-Tackett, Marshall & Ness, 2003; Sachs-Ericsson, Cromer, Hernandez, & Kendall-Tackett, this issue). Unfortunately, for many years these findings were discounted because the pain syndromes were usually so-called functional conditions (such as irritable bowel syndrome or fibromyalgia), meaning that lab or radiologic findings rarely matched a patient’s level of pain or impairment from that pain. Because these findings were not placed in a broader context, symptoms were viewed as idiosyncratic, written off as primarily psychological in origin, and were generally not of interest to health care providers.

Trauma, socioeconomic resources, and self-rated health in an ethnically diverse adult cohort

Objectives. To evaluate ethnic group differences in the association between trauma exposure and health status among an ethnically diverse sample originating in Hawai‘i. Design. Across a 10-year period (1998–2008), participants (N=833) completed five waves of questionnaire assessments. Trauma exposure was measured retrospectively at the most recent assessment (wave 5), socioeconomic resources (educational attainment and employment status) were measured at wave 1, and self-rated health was measured at each of the five waves. Results. Results indicated that greater exposure to trauma was associated with poorer self-rated health, as were lower educational attainment and lower work status. In addition, there was ethnic group variation in health ratings, as well as in how strongly trauma exposure predicted health status. Specifically, within Filipino American and Native Hawaiian ethnic groups, there was a stronger negative association between trauma exposure and self-rated health. Conclusion. These results suggest complex interrelations among trauma, ethnicity, socioeconomic status, and physical health. Further understanding these relations may have implications for medical and behavioral interventions in vulnerable populations.