Betrayal Trauma Can Have Lasting Mental Health Effects

If someone you've depended on has violated your trust or well-being, either during a one-time incident or over time, you may have experienced betrayal trauma. Jennifer Joy Freyd, PhD, author and professor of psychology at the University of Oregon, was one of the first to introduce the concept.

"In the early 1990s, I was trying to make sense of why people often seemed to remain unaware of or forget certain types of trauma," said Dr. Freyd. "I realized that the need to stay attached to a caregiver could override the need to detect betrayal even when the betrayal was traumatic, like sexual abuse. Betrayal captures the dilemma people face."

That betrayal usually causes a person to feel shame and fear, and it can have lasting mental health repercussions. Here's what to know about this specific form of trauma.

What Is Betrayal Trauma?

In short, betrayal trauma stems from mistreatment by a caregiver or a trusted person, like an intimate partner. It can include physical violence, emotional abuse, or sexual abuse, according to the Macmillan Encyclopedia of Intimate and Family Relationships.

Not everyone who experiences it reacts the same way. 

"How people respond [to betrayal trauma] depends on the person and details of the experience," explained Dr. Freyd. "But we do see common reactions, including anxiety, depression, and dissociation."

The Difference Between Betrayal Trauma and PTSD

Clinical psychologist Melissa Platt, PhD, who works with trauma survivors, recalled becoming interested in understanding betrayal trauma while working with war veterans returning from Iraq and Afghanistan in the mid-2000s.

The veterans Dr. Platt interviewed as a part of a post-traumatic stress disorder (PTSD) study often answered "no" to many PTSD assessment questions, yet they seemed deeply pained. PTSD is a psychiatric disorder that occurs in people who have experienced trauma. 

According to the American Psychiatric Association, examples of traumatic events can include:

• Natural disaster
• Rape or sexual violence
• Serious injury
• War or combat
• Serious accident
• Terrorist attack

"It seemed like the PTSD interview was not always asking the right questions in situations in which the trauma was perpetrated by a commander, fellow unit members, or anyone else the veteran trusted or depended on for survival," said Dr. Platt. "Since then, my career has focused on understanding and treating betrayal trauma."

Traditionally, psychologists and other mental health professionals have focused on PTSD as trauma's typical negative health impact. 

"Although PTSD does impact a lot of survivors, its diagnosis and treatment do not take into account the particular ways that being abused by someone trusted or depended upon impacts a survivor," said Dr. Platt.

Ttraditional PTSD results in fear and problems caused by trying to avoid fear. Betrayal trauma, on the other hand, often results in shame and dissociation, as well as problems caused by trying to avoid shame and dissociation, according to the Macmillan Encyclopedia of Intimate and Family Relationships. 

"These different trauma consequences necessitate quite different treatment approaches," noted Dr. Platt.

Familial Betrayal

Betrayal that occurs within a family can include childhood physical, emotional, or sexual abuse perpetrated by a caregiver. But it's not restricted to childhood. 

Infidelity and intimate partner violence are other events that can cause betrayal trauma because they all involve a breach of trust between people in an intimate relationship. This type of betrayal has been associated with symptoms of dissociation and PTSD, per the Macmillan Encyclopedia of Intimate and Family Relationships.

Institutional Betrayal

Betrayal trauma can also happen when an institution harms the individuals it claims to serve. That can include hospitals, mental health facilities, the government, or police departments, according to the Macmillan Encyclopedia of Intimate and Family Relationships. 

Those institutions are expected to provide safety for the people they serve. For instance, if a therapist blames their client for the abuse they experienced, they are betraying their client's trust and worsening the effects of that abuse.

Cultural Betrayal

Betrayal can also happen within cultural groups—specifically minority groups. In a minority group, there is a high level of trust associated with the members of the group. 

Being a part of a group provides some protection, or a sense of safety, against social inequality, according to the Macmillan Encyclopedia of Intimate and Family Relationships. Cultural betrayal trauma has been associated with dissociation, hallucinations, and internalized prejudice.

"Anyone can experience betrayal trauma, but our research suggests that women experience more betrayal traumas than men, while men experience more non-betrayal traumas than women," revealed Dr. Freyd.

Betrayal Trauma Recovery

Betrayal trauma is not a diagnosis. Rather, it's a way to understand the type of harm inflicted on a person. 

With that in mind, there's no single treatment approach. But Dr. Platt said the following elements are necessary for deep healing to be possible.

Psychoeducation

Betrayal trauma survivors can believe that there's something wrong with them. 

"They often believe they are 'bad' because they feel bad and because shame is a normal survival response to experiencing betrayal trauma, but they are not usually aware that is the case," said Dr. Platt.

Dissociation and shame are survival mechanisms that keep a person from making waves while they are in the relationship with the perpetrator, which might make things worse, according to the Macmillan Encyclopedia of Intimate and Family Relationships. 

"Survivors need to understand that these symptoms are signs that their mind was trying to help them to survive, rather than signs that there is anything wrong with them," said Dr. Platt.

Interoception

Betrayal trauma survivors are often disconnected from their bodies, but developing the skill of interoception can help them heal. 

"Interoception is the ability to recognize and understand the body's internal sensations," Dr. Platt explained. "Without adequate interoceptive skills, psychoeducation will not effectively change the survivor's negative beliefs about themselves because the negative beliefs will still feel true."

While it can be scary at first for survivors to tune in and listen to their bodies, they often learn that their body's messages are more trustworthy than they ever imagined. 

"Many somatic approaches, such as somatic experiencing and sensorimotor psychotherapy, help survivors develop interoceptive skills," said Dr. Platt.

Self-Compassion

Survivors must embody compassion. 

"Survivors also need to learn to treat themselves with kindness and compassion in order to be able to stay the course and heal," said Dr. Platt. "Approaches such as compassion-focused therapy and mindful self-compassion offer wonderful tools for building compassion and self-compassion."

A Quick Review

Betrayal trauma typically involves abuse over months, years, or even decades. And therapy for betrayal trauma can also take time. As Dr. Platt explained, it's about healing rather than fixing or getting rid of symptoms.

Since Dr. Freyd's first betrayal trauma paper was published in 1994, research on betrayal trauma has increased. Hundreds of articles and chapters on betrayal trauma are now published each year. 

"This gives me hope that survivors will have access to more and more betrayal-trauma-informed providers in the coming years," said Dr. Platt.