Betrayed: Why All Trauma Is Not Equal
March 18, 2013—When the topic of trauma comes up, we often wonder why some people are more resilient than others. In other words, some have a greater capacity to work through trauma effects on their own, while others fall victim to a variety of persistent psychological symptoms—and even posttraumatic stress disorder (PTSD). We know that the quality of early attachment is related to resilience, but it’s also clear that there are other factors that come into play.
Some of these relate to differences in the type and frequency of exposure. Someone who experiences a single traumatic incident would naturally be subject to different outcomes compared to someone who has experienced multiple episodes of a particular trauma—or the cumulative effect of different types of trauma over time. But even taking these factors into consideration, researchers have noticed significant differences in the severity of trauma symptoms between several specific categories of traumatic experience.
For instance, traumatic events that relate to family dysfunction (such as family violence, or child abuse) tend to cause more psychological distress than other types of events, such as grief or loss. Along these lines, research has found that survivors of child sexual abuse suffer more severe psychological effects if the abuser shared a close family tie. This is certainly understandable because in these cases, a trust-based or attachment relationship has been betrayed, leaving the survivor in conflict between the need to connect with the attachment figure and the need for self-protection. The closer the family ties in this relationship, the higher the level of betrayal that would be inherent in the experience.
Another category that offers differences to consider relates to what psychologists call “trauma appraisals.” Appraisals have to do with the way trauma survivors evaluate their experience, including how they view their own response to trauma exposure in terms of their thoughts, feelings and behaviors. If they blame themselves, or if they view their own behaviors and thoughts in a negative light, they are likely to have more severe symptoms of depression and posttraumatic stress.
A third category where researchers have observed differences in trauma effects concerns gender. There are generally higher rates of PTSD among women than among men, even though men are exposed to more traumatic events than women. Does this mean women more emotionally “fragile” than men in the face of trauma? Not necessarily. Rather, studies have found that when women experience trauma, it is usually interpersonal in nature—a betrayal trauma—which, as has already been noted, leads to more severe psychological effects than other categories of trauma.
Each of these findings amounts to one piece of the overall puzzle depicting the relationship between trauma and resilience, and while we might guess at how best to connect the pieces, we can’t know how they actually do fit together unless we test our guesses. This is essentially what researchers from three American universities did in their recent study, “The Role of Cumulative Trauma, Betrayal, and Appraisals in Understanding Trauma Symptomatology,” published in the March 2013 issue of the APA journal, Psychological Trauma.
Designed to examine how some of these factors may be linked—to test how and where to fit the puzzle pieces—the study looked specifically at cumulative trauma (the number of different types of trauma experienced) categorized by gender, level of betrayal, and the role of trauma appraisals in survivor’s symptoms.
How did the puzzle pieces fit and how did they add to the overall picture? “The level of betrayal and trauma appraisals are both important factors,” concluded the researchers. “HBTs [high-betrayal traumas] were associated with more depression, dissociation, and PTSD symptoms.” High-betrayal traumas were also linked to stronger negative appraisals, and strong negative appraisals were, in turn, linked to more severe symptoms. Interestingly, this study adds to the overall picture by finding that although women were more likely to experience high-betrayal interpersonal traumas than men, they were not more likely to experience PTSD than men who experienced high-betrayal traumas. Men and women were equally prone to making negative appraisals after high-betrayal traumas and to suffer the effects of them.
The emerging picture tells us that “not all traumas are equal,” in terms of psychological outcomes. “Survivors of HBTs may experience more trauma symptoms for several reasons,” suggest the researchers. “HBT survivors may be prone to make negative self-appraisals to maintain a relationship with an abusive attachment figure.” Children, in particular, tend to blame themselves for abuse rather than blaming a respected authority or attachment figure. “Furthermore,” say the researchers, “HBT survivors have been shown to experience more adverse events during childhood and higher revictimization rates than survivors of other trauma types. Also, the multilateral nature of HBTs, in which two developmental systems—attachment and individuation—are affected might be influential in HBT survivors experiencing more distress.”
Although it makes sense that the level of trust betrayal would have a dramatic effect on trauma symptoms, it has not always been considered by researchers, or by therapists. Of course, there is a lot of room to expand research in this area: predicting who is likely to suffer from PTSD or other persistent trauma symptoms is very complex. Still, this study contributes important detail to the emerging picture and offers important clues for potential directions in prevention, therapy, and future research.
March 18, 2013