Betrayal trauma and somatic symptoms

Sometimes, I am simply intrigued by an article. Here’s one that immediately captured my attention. Chang, Silver & Holman (2024) published “Betrayal Trauma and Somatic Symptoms among Patients in a Medically Underserved Primary Care Clinic” in Psychological Trauma: Theory, Research, Practice, and Policy.  Here are the edited abstract and impact statements:

Betrayal Trauma Theory posits that victims of trauma are more prone to developing psychological and physical problems if the traumatic event includes the element of betrayal. We sought to evaluate the impact of betrayal trauma versus nonbetrayal trauma and no trauma exposure on the risk of patients’ reporting somatic symptoms in six domains (gastrointestinal, cardiopulmonary, musculoskeletal, pseudoneurological, gynecological, or any symptom). Medically underserved patients (N = 1,350) who presented to a primary care clinic in California completed a structured standardized interview that assessed trauma history (Diagnostic Interview Schedule) and somatization symptoms (Composite International Diagnostic Interview). Using Betrayal Trauma Theory as a guide, respondents were classified into “no trauma,” “nonbetrayal trauma,” and “betrayal trauma” groups. Compared to “no trauma” patients, patients who experienced nonbetrayal trauma were more likely to endorse all symptom domains (ORs = 1.30–1.50) except gastrointestinal and musculoskeletal; compared to “no trauma” patients, patients who experienced betrayal trauma were more likely to endorse all symptom domains (ORs = 1.61–3.12) except gynecological. Compared to patients who experienced nonbetrayal trauma, exposure to betrayal trauma increased the likelihood of reporting any (OR = 2.25), gastrointestinal (OR = 1.56), and pseudoneurological symptoms (OR = 1.71), as well as symptoms spanning multiple physiological systems (incidence rate ratio = 1.27). Each nonbetrayal trauma increased the likelihood of symptom reporting across all domains (ORs = 1.18–1.40); each betrayal trauma increased the likelihood across all domains (ORs = 1.41–2.31) except gynecological. Both nonbetrayal and betrayal trauma may predispose victims to somatization. Compared to nonbetrayal trauma, betrayal trauma confers a greater magnitude of risk for having a somatic symptom across each symptom domain except gynecological. 

This study documents associations between betrayal/nonbetrayal trauma and somatic symptoms in a large sample of diverse primary care patients in the United States that included non-Hispanic White Americans and Mexican and Central American immigrants. Both betrayal and nonbetrayal trauma conferred greater risk of experiencing somatic symptoms relative to no trauma exposure. Betrayal trauma conferred greater risk of experiencing somatic symptoms across multiple physiological systems than did nonbetrayal trauma. Trauma exposure is an important risk factor to screen for in primary care settings, yet it is rarely done. Primary care settings need to incorporate trauma-informed care models to best serve the needs of their patients. 

This is a large, relatively diverse sample with important findings. What I like about the study are the findings that both nonbetrayal and betrayal trauma create greater risk of somatic symptoms and that betrayal trauma is worse (except for gynecological symptoms). While the authors emphasize the importance of their work in primary care settings, other professionals may well want to be aware of these relationships.