Jennifer M. Gómez

The Relationship of Psychological Trauma and Dissociative and Posttraumatic Stress Disorders to Nonsuicidal Self-Injury and Suicidality: A Review

We reviewed research on the relationship between (a) exposure to psychological trauma and (b) nonsuicidal self-injury (NSSI) and suicidality (suicidal ideation [SI] and suicide attempts [SA]) in individuals with dissociative disorders and posttraumatic stress disorder (PTSD). The review provides a context for the special issue of the Journal of Trauma & Dissociation on these topics. Exposure to childhood sexual abuse is the most consistent traumatic antecedent of self-harm, although traumatic violence in childhood (particularly physical abuse) and adulthood (particularly domestic violence) and exposure to multiple types of traumatic stressors also are associated with NSSI and SI/SA. Dissociative disorders and PTSD are consistently associated with increased NSSI and SA/SI. There is preliminary cross-sectional evidence that dissociation and posttraumatic stress disorders may mediate the relationship between psychological trauma and NSSI and SI/SA. Research on emotion dysregulation as a potential cross-cutting mechanism linking dissociation, PTSD, and self-harm is also reviewed. We conclude with a discussion of implications for clinical practice and future directions for scientific research.

Microaggressions and the Enduring Mental Health Disparity Black Americans at Risk for Institutional Betrayal

Despite federal focus on reducing mental health disparities for Black Americans, mental health disparities persist, resulting in reduced access to and benefit from mental health care. Amid calls for deeper examination of etiology, the current literature review introduces discrimination in the form of microaggressions at the institutional level as one changeable systemic cause for mental health disparities. In combining the mental health disparity and microaggression literatures, I first review the evidence regarding prevalence and contributing factors for current mental health disparities and microaggressions. Next, I examine the potential contributing role that microaggressions as a form of institutional betrayal within mental health care may play in perpetuating these disparities. Finally, I review implications regarding the particular role of mental health care systems, the field of psychology in general, and Black American psychologists specifically in systematically reducing mental health disparities for Black Americans.

Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care

ABSTRACT As the diagnosis and treatment of mental disorders has become increasingly medicalized (Conrad & Slodden, 2013), consideration for the relational nature of trauma has been minimized in the healing process. As psychiatrist R. D. Laing (1971) outlined in his essays, the medical model is an approach to pathology that seeks to find medical treatments for symptoms and syndromes based on categorized diagnoses. We argue that such a model implicitly locates the pathology of trauma within the individual instead of within the person(s) who perpetrated the harm or the social and societal contexts in which it took place. In this article, we argue that this framework is pathologizing insofar as it both prioritizes symptom reduction as the goal of treatment and minimizes the significance of relational harm. After providing a brief overview of betrayal trauma (Freyd, 1996) and the importance of relational processes in healing, we describe standard treatments for betrayal trauma that are grounded in the medical model. In discussing the limitations of this framework, we offer an alternative to the medicalization of trauma-related distress: relational cultural therapy (e.g., Miller & Stiver, 1997). Within this nonpathologizing framework, we highlight the importance of attending to contextual, societal, and cultural influences of trauma as well as how these influences might impact the therapeutic relationship. We then detail extratherapeutic options as additional nonpathologizing avenues for healing, as freedom to choose among a variety of options may be particularly liberating for people who have experienced trauma. Finally, we discuss the complex process of truly healing from betrayal trauma.

Self-Injury and Suicidality: The Impact of Trauma and Dissociation

In the growing research literature on nonsuicidal self-injury (NSSI) and suicidality (SA), there are many questions still unresolved about the role played by exposure to traumatic stressors (including but not limited to childhood maltreatment) and posttraumatic disorders (including dissociative features and disorders). In this special issue of the Journal of Trauma & Dissociation, a review article and 4 empirical studies attempt to provide additional insight into the relationship of traumatization and dissociation to NSSI and SA. The review article describes similarities and differences in the relationships that have been empirically documented between trauma exposure and posttraumatic stress or dissociative symptoms with NSSI versus SA and highlights the need for research to identify and test integrative clinical constructs, such as emotion dysregulation, in order to develop systematic risk, assessment, and intervention models. The empirical reports provide illustrative examples of conceptually and clinically integrated research on traumatic stress, dissociation, and NSSI and SA. Their findings offer a more nuanced picture of the potential role of different forms and degrees of dissociation in SA and NSSI and suggest that dissociation and emotion dysregulation may play a mediating role linking childhood maltreatment and adult or adolescent NSSI. In this introduction, we briefly summarize key points from the special issue articles and point out directions that their findings suggest for future research, including incorporating multiple predictors in studies of NSSI and SA, utilizing longitudinal studies to assess the etiology and course of NSSI and SA, and sampling diverse populations.

A Brief Report on Predicting Self-Harm: Is It Gender or Abuse that Matters?

Self-harm, which consists of nonsuicidal self-injury and attempted suicide, is a public health problem that is not well understood. There is conflicting evidence on the role of gender in predicting self-harm. Abuse history also is a potentially relevant factor to explore, as it is related to both gender and self-harm. In this study, we hypothesized that abuse history, as opposed to gender, would predict self-harm. Three hundred and ninety-seven undergraduates completed a self-report survey that assessed abuse history, nonsuicidal self-injury, and attempted suicide. The results suggested that abuse history predicted nonsuicidal self-injury and attempted suicide. These findings can inform clinical interventions as they reinforce the importance of including abuse history in the conceptualizations and treatment of self-harm.

Collusion, torture, and inequality: understanding the actions of the American Psychological Association as institutional betrayal

ABSTRACT The Hoffman Report (Hoffman et al., 2015) documented devastating information about the American Psychological Association (APA) and the profession of psychology in the United States, prompting a public apology and a formal commitment by APA to correct its mistakes (APA, 2015). In the current article, we utilize betrayal trauma theory (Freyd, 1997), including betrayal blindness (e.g., Freyd, 1996; Tang, 2015) and institutional betrayal (Smith & Freyd, 2014b), to understand and learn from APA’s behaviors. We further situate this discussion in the context of inequality, both within APA and in American society generally. We detail how the impact of APA’s institutional betrayals extended beyond the organization, its members, and the psychology profession, highlighting the potential for disproportionate harm to minorities, including those who were tortured; Muslims, Middle Easterners, Afghans, and non-Americans who were not tortured; and other minority individuals (Gómez, 2015d). Acknowledging, understanding, and addressing its institutional betrayals offers APA the opportunity to take meaningful corrective and preventive measures. We propose several institutional reparations, including making concrete changes with transparency and conducting self-assessments to inform further needed changes (Freyd & Birrell, 2013). By engaging in institutional courage, APA has the potential to grow into an ethical governing body that fulfills its mission to “advance the creation, communication and application of psychological knowledge to benefit society and improve people’s lives” (APA, 2016).

High betrayal child sexual abuse and hallucinations: a test of an indirect effect of dissociation

ABSTRACT Though hallucinations traditionally have been conceptualized as a central feature of psychosis, some hallucinations may be dissociative, with dissociation potentially contributing to hallucinations. Childhood trauma has been linked with dissociation and hallucinations. Betrayal trauma theory distinguishes abusive experiences based on closeness to the perpetrator. In the current study, we examined the indirect effect of dissociation on the relationship between high betrayal child sexual abuse (perpetrated by a close other) and hallucinations. Participants (N = 192) from a northwestern university in the United States completed self-report measures online assessing history of high betrayal child sexual abuse and current dissociation and hallucinations. Bootstrapping analyses indicated a significant indirect effect of high betrayal child sexual abuse on hallucinations through dissociation, 95% Confidence Interval (.16, .66). Through betrayal trauma theory, this study provides a non-pathologizing framework for understanding how dissociation and hallucinations may develop as natural reactions to the harm inherent in child sexual abuse perpetrated by a close other. These findings have clinical implications for relational models of healing for trauma survivors who are distressed by dissociation and hallucinations.

Does Gender Matter? An Exploratory Study of Cultural Betrayal Trauma and Hallucinations in Latino Undergraduates at a Predominantly White University:

Violence victimization, such as physical, sexual, and emotional abuse, has been linked with hallucinations. How abuse-related distress manifests is dependent on a host of factors, including gender, ethnicity, and societal inequality. Cultural betrayal trauma theory may provide insight into hallucinatory experiences for Latinos in the United States, as it is a contextualized framework that identifies societal trauma (e.g., discrimination) as a contributor to the harm of within-group interpersonal violence victimization in minority populations. Though men may experience higher rates of hallucinations, there is little work on gender differences in the predictive power of violence victimization on hallucinations, particularly in Latino populations. Therefore, with cultural betrayal trauma theory as a guide, the purpose of the current exploratory study is to examine gender differences in the association of ethno-cultural betrayal trauma (within-group violence victimization) on tactile, visual, and auditory hallucinations in a sample of Latino undergraduate students at a predominantly White university in the United States. Participants ( N = 80) completed online self-report measures on ethno-cultural betrayal trauma and hallucinatory experiences. Sizable proportions of the sample reported experiencing ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations. Controlling for between-group trauma, the link between ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations was moderated by male gender. With cultural betrayal trauma theory as its framework, these preliminary results suggest that gender differences in hallucinatory experiences may be affected by the way trauma-related distress is expressed in Latino undergraduate students in the United States.

Does ethno-cultural betrayal in trauma affect Asian American/Pacific Islander college students' mental health outcomes? An exploratory study

ABSTRACT Objectives: Interpersonal trauma has deleterious effects on mental health, with college students experiencing relatively high rates of lifetime trauma. Asian American/Pacific Islanders (AAPIs) have the lowest rate of mental healthcare utilization. According to cultural betrayal trauma theory, societal inequality may impact within-group violence in minority populations, thus having implications for mental health. In the current exploratory study, between-group (interracial) and within-group (ethno-cultural betrayal) trauma and mental health outcomes were examined in AAPI college students. Participants: Participants (N = 108) were AAPI college students from a predominantly white university. Data collection concluded in December 2015. Methods: Participants completed online self-report measures. Results: A multivariate analysis of variance revealed that when controlling for interracial trauma, ethno-cultural betrayal trauma significantly impacted dissociation, hallucinations, posttraumatic stress symptoms, and hypervigilance. Conclusions: The results have implications for incorporating identity, discrimination, and ethno-cultural betrayal trauma victimization into assessments and case conceptualizations in therapy.

Psychological Outcomes of Within-Group Sexual Violence: Evidence of Cultural Betrayal

Cultural betrayal trauma theory is a new framework for understanding trauma-related mental health outcomes in immigrant and minority populations. The purpose of the current study is to empirically test cultural betrayal trauma theory. We hypothesized that the association between within-group sexual violence and mental health outcomes would be stronger for minorities. Participants (N = 368) were minority and majority college students, who completed online measures of sexual violence victimization and mental health outcomes. A MANOVA revealed that the link between within-group sexual violence and total trauma symptoms, depression, sexual abuse sequelae, sleep disturbance, and sexual problems was stronger for minorities. This study provides evidence for cultural betrayal trauma theory, as the findings suggest that outcomes from the same experience—within-group sexual violence—is affected by minority status. This work has implications for how mental health is understood, investigated, and treated in immigrant and minority populations.