Journal of Trauma & Dissociation, 15:271–284, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1529-9732 print/1529-9740 online DOI: 10.1080/15299732.2013.837135

Betrayal Trauma and Dimensions of Borderline Personality Organization MATTHEW M. YALCH, MA and ALYTIA A. LEVENDOSKY, PhD Department of Psychology, Michigan State University, East Lansing, Michigan, USA

Borderline personality pathology can be conceptualized as one of many conditions within a broader spectrum of borderline personality organization (BPO). This spectrum is composed of several specific dimensions of psychological functioning (primitive psychological defenses, identity diffusion, and reality testing). Although several theories associate trauma with borderline pathology, betrayal trauma theory specifies that trauma with a high degree of betrayal has an especially pernicious influence on borderline pathology. In addition, betrayal trauma theorists propose that constructs related to each BPO dimension are influenced by traumatic betrayal, but this has not yet been tested within the context of borderline pathology specifically. In this article, we examine the relation between trauma with varying levels of betrayal and the specific dimensions of BPO using a Bayesian approach to multiple regression. Results indicated that trauma with a high degree of betrayal was associated with each dimension of BPO, that medium betrayal trauma was associated with problems in reality testing, and that low betrayal trauma was associated with primitive psychological defenses. These effects differed by gender. Limitations of the study and directions for future research are also discussed. KEYWORDS betrayal trauma, borderline personality, Bayesian

Received 18 April 2013; accepted 15 August 2013. Address correspondence to Matthew M. Yalch, MA, Department of Psychology, Michigan State University, 316 Physics Road, Room 262, East Lansing, MI 48824-1116. E-mail: [email protected] 271

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Borderline personality pathology is characterized by an unstable sense of self, affective lability, and impulsive behavior (American Psychiatric Association, 2000). Borderline pathology is currently diagnosed as a discrete category of personality disorder (i.e., borderline personality disorder; American Psychiatric Association, 2000). However, contemporary psychopathology researchers are increasingly viewing borderline pathology as a condition on a spectrum of psychological functioning (Widiger & Simonsen, 2005). Kernberg and colleagues define this spectrum as borderline personality organization (BPO; Clarkin, Yeomans, & Kernberg, 2006; Kernberg, 1984; Kernberg & Caligor, 2005). Kernberg’s (1975) theory is one of many theories (e.g., Benjamin, 1996; Herman & van der Kolk, 1987; Zanarini, Dubo, Lewis, & Williams, 1997) proposing that borderline pathology is often influenced by traumatic experiences early in life. This etiological view is also shared by betrayal trauma theory (e.g., Freyd, 1996). However, betrayal trauma theorists further propose that the psychological sequelae of trauma (e.g., borderline pathology) vary according to the degree to which the traumatic experience includes the willful violation of a person’s physical or psychological boundaries within a caregiving relationship (i.e., betrayal; Freyd, 1996). Although there is some evidence to suggest that trauma with a high degree of betrayal is associated with borderline pathology generally, there is little research on the association between trauma and specific dimensions of BPO. In this article, we examine the relation between trauma with varying levels of betrayal and the specific dimensions of BPO.

BPO Kernberg and Caligor (2005) proposed that three dimensions of psychological functioning describe pathological personality organization: primitive psychological defenses, identity diffusion, and reality testing. Primitive psychological defenses refers to a reliance on the use of immature and maladaptive strategies to cope with anxiety (e.g., denial, projection, projective identification). Prominent among these primitive defenses is splitting, when a person holds extremely dissonant views of himself or herself and/or other people (e.g., thinking that another person is alternatively all good and all bad). Identity diffusion can be defined as a person’s lack of an integrated sense of self (i.e., the degree to which a person experiences his or her own identity as stable). Reality testing refers to the capacity to distinguish oneself from and have empathy for other people. Though each of these dimensions relates to psychological functioning, each influences a person’s psychological experience of himself or herself and other people in a different way. Although each dimension has a unique function, each is hypothesized to be directly or indirectly related to traumatic life experience.

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In Kernberg’s (1975) view, trauma perpetrated by another person early in one’s psychological development is a key factor in the etiology of BPO. He proposed that a developmentally immature person may cope with the threat of the trauma via primitive defenses, specifically by splitting. Splitting allows the traumatized person to make sense of the trauma, simultaneously perceiving the abuser as both benevolent in the caregiving role and abusive in his or her role as perpetrator. However, the pervasive reliance on splitting may pave the way for further reliance on other primitive forms of defense (e.g., denial of reality, projection of one’s emotions onto others). Kernberg (1975, 1984) further proposed that interaction with the world while relying predominantly on these primitive defense strategies is ultimately maladaptive. The use of splitting to deal with subsequent trauma may contribute to an unstable and diffuse sense of self. This instability of self is less able to cope effectively with traumatic experience and may in turn lead to a blurring between oneself and other people. In this way, a traumatic experience may exhibit both direct and indirect effects on a person’s psychological experience. Kernberg’s (1975, 1984; Kernberg & Caligor, 2005) theory provides an elegant explanation for the etiology of borderline pathology. Nevertheless, although this theory is specific in its description of the psychological processes involved in the formation of borderline pathology, it is less specific in its description of the trauma that may contribute to its formation. Betrayal trauma theory (Freyd, 1996) provides a useful elaboration of etiological factors important in Kernberg’s theory of BPO.

BORDERLINE PERSONALITY PATHOLOGY AND BETRAYAL TRAUMA THEORY Research has indicated an association between borderline pathology and early life abuse and trauma (Battle et al., 2004; Belford, Kaehler, & Birrell, 2012; Bradley, Jenei, & Westen, 2005; Herman & van der Kolk, 1987; Zanarini et al., 1997). However, one shortcoming of much of the existing research literature is that researchers have measured trauma either as a unidimensional quantitative factor (e.g., number of traumatic events experienced) or as a categorical type of traumatic perpetration (e.g., physical, sexual, or psychological abuse). It is unclear from this research what the essential aspect of trauma is that influences borderline pathology. This shortcoming is addressed by betrayal trauma theory, which proposes that trauma willfully perpetrated within the context of an intimate caregiving relationship produces a sense of betrayal. Freyd (1996) proposed that traumatic experiences high in betrayal are associated with more severe posttraumatic symptoms than traumas low in betrayal, regardless of type.

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Freyd (1996) explained that receiving care from the same person who perpetrates trauma creates cognitive dissonance in the mind of the victim. This dissonance may lead to psychological fracturing, which betrayal trauma theorists believe is the core of borderline pathology. Research indicates that traumas including a high degree of betrayal influence borderline pathology above and beyond the effects of other forms of trauma (Kaehler & Freyd, 2009, 2012). Freyd (1996) further noted that trauma with a high degree of betrayal may exert a pernicious influence on other conditions that could be considered analogous to Kernberg and Caligor’s (2005) dimensions of BPO—dissociation (i.e., primitive psychological defenses), multiple personality pathology (i.e., identity diffusion), and disrupted attachment (i.e., problems in reality testing). However, researchers have not yet evaluated the link between betrayal trauma and BPO dimensions empirically. DePrince and Freyd (2002) noted that trauma with a high degree of betrayal does not occur equally across both genders. Indeed, research suggests both that women experience more traumas that are high in betrayal than do men (Goldberg & Freyd, 2006; Martin, Cromer, DePrince, & Freyd, 2011) and that women exhibit more psychological symptoms in response to these traumas than do men (Tang & Freyd, 2012). Research further indicates that the differential effect of trauma on men and women applies to the case of borderline pathology. Specifically, Kaehler and Freyd (2012) found that for females, traumas with both high and moderate levels of betrayal predicted borderline pathology, whereas for males, traumas of all types (i.e., traumas with high, medium, and low levels of betrayal) predicted borderline pathology. Kaehler and Freyd (2012) attributed this differential response to traumas with a low component of betrayal to an implicit expectation among men of a privileged social position in a patriarchal system. They argued that men do not expect potentially traumatic events like earthquakes and car accidents to happen to them, whereas women, who hold a lower status within the social patriarchy, do not hold this illusion: Whereas traumas with medium or high components of betrayal were equally dissonant with the expectations of women and men, because of expectations of male privilege, non-interpersonal traumas were as dissonant as other forms of trauma for men. However, research on gender differences in posttraumatic response has not yet been extended to the dimensions of psychological functioning within BPO. Identifying links between trauma and these specific dimensions could clarify pathways for the etiology of the borderline pathology.

THE CURRENT STUDY In the current study, we investigated the effects of traumatic experience with high, medium, and low components of betrayal on the primitive psychological defenses, identity diffusion, and reality testing dimensions of BPO.

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We hypothesized that traumas high in betrayal would exert a main effect on each dimension of BPO, incrementing the effects of traumas with medium and low components of betrayal. We further predicted that traumas with both high and medium components of betrayal would be associated with each dimension of BPO for women, whereas traumas across the spectrum of betrayal would predict the dimensions of BPO for men.

METHOD Participants Participants in this study were 544 students at a large midwestern public university. Of those who initially enrolled in the study, 37 participants were removed from the analysis for failing to respond to more than 10% of the survey items. Of the remaining participants, 16 more were omitted from the study because of overendorsement (i.e., t scores >75 in a community normative sample) of items from the Infrequency scale of the Personality Assessment Inventory (Morey, 2007), which has been validated for detecting random responding (Clark, Gironda, & Young, 2003). This left a final sample of 491 participants, the majority of whom were female (72%), with a mean age of 20 years (SD = 3 years). The demographics of the participants in the study were consistent with those of the university (82% Euro-American, 7% Asian/Pacific Islander, 4% African American, and 7% multiracial or other). Across the sample, each survey item had less than 2% of its data missing. To account for these missing data, we calculated each scale using a weighted average of all items endorsed within that scale.

Measures Betrayal trauma. The Brief Betrayal Trauma Survey (BBTS; Goldberg & Freyd, 2006) is a 24-item questionnaire assessing the presence and frequency of traumatic experiences. Respondents rated their traumatic experiences on a 3-point Likert-type scale from “never” to “1 or 2 times” to “more than that.” Items from the BBTS were grouped into one of three independent continuous subscales of traumatic experience on a spectrum of low to high betrayal: trauma with a low or null component of betrayal (low betrayal trauma; e.g., “Been in a major earthquake, fire, flood, hurricane, or tornado”), trauma with a medium component of betrayal (medium betrayal trauma; “You were made to have sexual contact by someone with whom you were not close”), and trauma with a high component of betrayal (high betrayal trauma; e.g., “You were deliberately attacked severely by someone with whom you were very close”). Borderline personality pathology. The Inventory of Personality Organization (Lenzenweger, Clarkin, Kernberg, & Foelsch, 2001) is a

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57-item questionnaire composed of statements related to BPO (e.g., “Even people who know me well cannot guess how I’m going to behave”). Participants rated each statement in terms of how applicable it was to them on a 4-point Likert-type scale ranging from rarely true to always true. The Inventory of Personality Organization yields three continuous subscales of borderline pathology: primitive psychological defenses, identity diffusion, and reality testing.

Procedures Students participated in the study in exchange for course credit. Questionnaires were administered online after the completion of a consent form. All procedures of the study were approved by the local institutional review board. Items measuring personality organization were administered first and questions about traumatic experience and demographics were measured last so as not to bias participants’ responses to questions about personality organization.

Data Analysis Bayesian estimation. This study’s hypotheses were tested using a Bayesian approach to multiple linear regression. The goal of the Bayesian approach is to determine the most credible estimates of a parameter (e.g., a regression coefficient) given the data. To this end, Bayesian analysis identifies a range of possible effect sizes that are credible (i.e., different from zero). This is in contrast to conventional null hypothesis significance testing (NHST), which seeks to determine the likelihood that the null hypothesis (i.e., the assumption that a given variable has no effect) can be rejected. As Kruschke (2012) noted, this focus on effect size provides a richer and more accurate estimation of parameter values relative to NHST methods. In addition to its focus on effect size, Bayesian estimation is also more robust to non-normality within the data because Bayesian estimation derives parameter values based on t-distributions of the data. The t-distribution accommodates otherwise outlying observations within the data by adjusting its shape to include these observations (e.g., by lengthening the distribution’s tails). The Bayesian use of the t-distribution contrasts with most NHST methods, which assume a normal distribution of data. As Micceri (1989) noted, the assumption of normality is rarely met when one uses data drawn from human participants. This is especially the case for data concerning either trauma or personality pathology, both of which are non-normally distributed in the population. As this was a study on the relation between trauma and personality pathology, Bayesian methods of estimation were particularly well suited.

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Model implementation. In this study, we implemented multiple regression models using Gibbs sampling, a variant of Markov chain Monte Carlo (Gamerman & Lopes, 2006), an algorithm for generating random numbers. In Gibbs sampling, possible values for each parameter are generated at random. These possible parameter values are preferentially sampled for inclusion in the distribution of possible parameter values by virtue of their relative likelihood given the shape of the hypothesized parameter distribution (typically normal) and likelihood of the sample taken before it (for a review, see Albert, 2009). We implemented Gibbs sampling using JAGS (Plummer, 2003) following the procedures outlined by Kruschke (2011). In each model, the BPO dimension of interest was regressed on the three levels of traumatic experience (high, medium, and low betrayal trauma) in a single block, allowing us to test the effect of trauma of one level of betrayal (e.g., high) while controlling for the effects of traumas of other levels of betrayal (e.g., medium and low). For each model, the sampling process consisted of 100,000 steps. To maximize the accuracy of the estimation, we discarded the first 1,000 steps of the sampling sequence from the final parameter distribution; this burn-in period safeguarded against the inclusion of unlikely parameter values generated during initial sampling. The estimate of a regression coefficient was deemed credible if zero did not fall within the densest 95% of the distribution. This area of high density is referred to as the high-density interval (HDI). Because we focused on estimating effect size rather than accepting or rejecting null hypotheses, however, distributions containing parameter values of zero inside the 95% HDI are still interpretable in terms of relative credibility.

RESULTS Means, standard deviations, normality statistics, internal consistency, and correlations between the variables are listed in Table 1. There was a high prevalence of traumatic experience in this sample, with 43% of participants reporting having experienced at least one trauma with a high degree of betrayal, 57% trauma with medium betrayal, and 61% trauma with low betrayal. The experience of trauma (high, medium, and low betrayal) was distributed non-normally (positively skewed and hyperkurtotic). As indicated by a preliminary analysis of variance, there were no statistically significant sex differences in the amount or type of traumas experienced, although men endorsed more symptoms of BPO of all types than women. Bivariate effects among the variables ranged from small to large (see Table 1). Correlations were generally high between dimensions within the same measure (e.g., BPO dimensions correlated highly with each other) and ranged from small to medium across measures (i.e., between type of trauma and BPO dimension). The combined effects of trauma on the dimensions

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TABLE 1 Means, Standard Deviations, Normality Statistics, Internal Consistency, and Correlations Between the Variables Variable 1. Low betrayal trauma 2. Medium betrayal trauma 3. High betrayal trauma 4. Primitive psychological defense 5. Identity diffusion 6. Reality testing M SD Skewness Kurtosis

1

2

3

4

5

6

(.70) .55 .40 .22 .12 .23 0.28 0.32 1.25 1.18

(.82) .63 .25 .19 .32 0.20 0.27 2.00 4.72

(.80) .24 .20 .28 0.25 0.39 1.84 3.27

(.87) .79 .63 2.43 0.58 0.29 0.27

(.91) .67 2.41 0.63 0.34 0.08

(.94) 1.80 0.64 1.02 0.29

Notes: Cronbach’s alpha are reported on the diagonal. All correlations are significant at p < .05.

TABLE 2 Effects of Traumatic Experiences on Dimensions of Borderline Personality Organization (N = 491) Primitive defense Variable Gender High BT Med BT Low BT

β

95% HDI

Identity diffusion R2

.088∗ .001, .173 .090∗ .143∗ .034, .254 .090 −.031, .211 .113∗ .008, .214

β

95% HDI

Reality testing R2

.091∗ .005, .179 .055∗ .137∗ .024, .248 .091 −.032, .217 .014 −.090, .120

β

95% HDI

.192∗ .109, .132∗ .026, .183∗ .067, .082 −.018,

R2

.275 .154∗ .238 .301 .180

Notes: HDI = high-density interval; BT = betrayal trauma. ∗ 95% HDI does not include zero as a credible value.

of BPO are listed in Table 2. Consistent with our hypotheses, traumas high in betrayal were positively associated with all three dimensions of BPO, although the size of these effects was modest. In addition, traumas with a low component of betrayal were positively associated with primitive psychological defenses, and traumas with a medium component of betrayal were positively associated with problems in reality testing. In each regression model, gender also exhibited a modest but credible effect on each BPO dimension. We further tested gender differences in the effects of trauma by rerunning the regression models for each sex independently. The effects of trauma on dimensions of BPO for men are listed in Table 3. Contrary to hypotheses, traumas high in betrayal were only positively associated with problems in reality testing for men. The effects of trauma on BPO dimensions differed for women (see Table 4). Also contrary to hypotheses, traumas with a high component of betrayal were only positively associated with primitive psychological defenses and identity diffusion. Zero is a credible value within the 95% HDI of the effect distribution of trauma with a high component of betrayal and identity diffusion for women; however, zero is at the tail end of the HDI. This indicates that the effect is

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TABLE 3 Effects of Traumatic Experiences on Dimensions of Borderline Personality Organization for Men (n = 139) Primitive defense Variable

β

95% HDI

Identity diffusion R

2

β

95% HDI

Reality testing R

2

β

95% HDI

R2

High BT .108 −.123, .331 .049∗ .149 −.081, .376 .029∗ .237∗ .015, .457 .106∗ Med BT .063 −.200, .330 .050 −.219, .313 .061 −.196, .316 Low BT .088 −.127, .312 .038 −.263, .181 .072 −.138, .290 Notes: HDI = high-density interval; BT = betrayal trauma. ∗ 95% HDI does not include zero as a credible value.

TABLE 4 Effects of Traumatic Experiences on Dimensions of Borderline Personality Organization for Women (n = 352) Primitive defense Variable High BT Med BT Low BT

β

95% HDI

Identity diffusion R2

β

95% HDI

Reality testing R2

β

95% HDI

R2

.145∗ .017, .273 .101∗ .125 −.004, .257 .058∗ .091 −.032, .218 .133∗ .118 −.021, .253 .120 −.024, .257 .243∗ .109, .377 .129∗ .013, .245 .038 −.082, .155 .094 −.020, .209

Notes: HDI = high-density interval; BT = betrayal trauma. ∗ 95% HDI does not include zero as a credible value.

small, but not necessarily incredible, so we chose to interpret it, albeit tentatively. In addition, traumas with a medium component of betrayal were only associated with problems in reality testing, and traumas low in betrayal were positively associated with primitive psychological defenses.

DISCUSSION In this study we applied betrayal trauma theory to a contemporary dimensional model of borderline personality pathology. Our results indicated an association between trauma high in betrayal and borderline pathology. Specifically, we found that high betrayal trauma was associated with all three dimensions of BPO. These effects differed depending on gender, although not in the anticipated ways. These findings offered partial support for our hypotheses, as well as a number of suggestions for future research. When we controlled for sex, traumas high in betrayal exerted a modest but credible main effect on all three dimensions of BPO. This suggests that across people, traumas high in betrayal influence borderline personality pathology in multiple ways. Specifically, traumas high in betrayal may influence how people cope with anxiety (e.g., via primitive defenses mechanisms like splitting) as well as how they relate to themselves and other people. These findings build upon a robust theoretical and empirical literature suggesting a link between trauma occurring within intimate relationships and borderline personality pathology.

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There were differential effects of trauma high betrayal on borderline pathology across gender. For instance, for men, only traumas high in betrayal exhibited a credible effect on BPO, specifically on the reality testing dimension. This finding differs from the results of a previous study (Kaehler & Freyd, 2012) suggesting that men were more vulnerable to a variety of traumas. One possible explanation for this may lie in our sample. For example, in contrast to previous studies (e.g., Goldberg & Freyd, 2006; Martin et al., 2011), the experience of trauma among men in this sample was as high as that among females. Also in contrast to previous research (e.g., Kaehler & Freyd, 2009), men’s self-ratings of borderline pathology were higher than women’s, although this was likely a function of our measuring borderline personality organization rather than borderline personality disorder. In any case, it may be that the different characteristics of our sample influenced the inconsistencies between our findings and those of previous research. Alternatively, it is also possible that men may exhibit a different response to traumas high in betrayal compared with those low or moderate in betrayal. Specifically, these findings may suggest that trauma high in betrayal influences borderline pathology among men primarily by disrupting their ability to distinguish self from other. Kernberg (1984) noted that problems of this kind are more characteristic of psychotic rather than borderline pathology; accordingly, in contrast to previous research (Kaehler & Freyd, 2012), these results suggest that men may have a more pathological response than women to trauma high in betrayal but not to trauma more generally. In contrast, for women, traumas high in betrayal exerted effects on primitive psychological defenses and, to a lesser extent, identity diffusion. One interpretation of this is that trauma high in betrayal affects women’s presentation of borderline pathology primarily by influencing the means by which they defend against anxiety (e.g., splitting). Female victims of betrayal trauma may then rely on splitting to understand themselves as well as others. For example, women who have experienced trauma with a high component of betrayal may hold split views of themselves, vacillating drastically between completely good and completely bad self-images. In keeping with Kernberg’s (1975) theory, this vacillation may lead to an unstable and diffuse sense of traumatized women’s own identities. From a betrayal trauma theory perspective, these split views and the unstable sense of identity associated with them may be maintained via dissociative processes that at times deny betrayed women access to information related to the trauma they experienced and to themselves in relation to it. These findings may thus provide a possible explanation for the association between betrayal trauma and general borderline pathology demonstrated in previous studies (Kaehler & Freyd, 2009, 2012). In addition to the effects observed for traumas high in betrayal, the results of this study suggest that other forms of trauma may also influence symptoms of borderline pathology for women. Specifically, our findings

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suggest that even when the influence of trauma with a high component of betrayal is controlled, trauma with a medium component of betrayal (e.g., interpersonal violence perpetrated by a stranger) may impair women’s ability to distinguish self from other. Although not hypothesized, this result is consistent with Kaehler and Freyd’s (2012) finding that trauma with a medium component of betrayal is associated with general borderline pathology. Indeed, that trauma with a medium component of betrayal influences this specific domain of borderline functioning may help to explain the association between this type of trauma and general borderline pathology in previous studies. For example, the violation of one’s physical, psychological, or sexual boundaries by a stranger blurs a trauma survivor’s implicit understanding of the distinction between intimate and nonintimate other. This specific blurring may in turn contribute to a blurring of the boundaries between self and other more generally. There was also an association between traumas low in betrayal and primitive psychological defenses in women. Although the association between trauma that was low in betrayal and borderline pathology is inconsistent both with our hypotheses and with previous research (e.g., Kaehler & Freyd, 2009, 2012), this finding may have less to do with personality pathology than with responses to non-interpersonal traumas more generally. Specifically, this finding suggests that when traumas occur that are not caused by an identifiable agent (e.g., non-interpersonal traumas like natural disasters), women may be likely to respond by engaging in specific types of psychological coping. For example, this finding may suggest that women may prefer to deny that an agent-less trauma may have occurred or was as serious as it was than engage in the more involved process of constructing new meaning of themselves and the world following trauma (e.g., coping with the idea that the world is not fair and that distressing things happen to people who may not deserve it). However, such an interpretation is speculative: More research is necessary in order to investigate the association between betrayal trauma and types of psychological defenses more thoroughly. In this study, we built upon previous research on the relation between trauma high in betrayal and borderline pathology (e.g., Kaehler & Freyd, 2009, 2012) by examining the differential effects of traumas with varying degrees of betrayal on different dimensions of borderline pathology. Our findings indicate a more nuanced association between betrayal trauma and borderline pathology than in previous studies. Specifically, the finding that trauma high in betrayal is associated with different dimensions of borderline pathology between women and men may add clarity to previous research by examining the differential effects of trauma on dimensions of pathological functioning rather than simply focusing on number of symptoms. However, the differential effects of traumas high betrayal (as well as traumas with lesser components of betrayal) raise questions about different ways in which trauma may influence psychological functioning. For example, for women,

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traumas with both high and low components of betrayal are associated with the use of primitive psychological defenses, but the nature of these defenses is unspecified; investigating the specific types of defenses associated with different levels of betrayal trauma would be one useful way to extend the findings of this study. An additional strength of this study is that by focusing on effect size within a Bayesian framework, rather than a binary acceptance or rejection of a null hypothesis, we were able to demonstrate these effects in a more nuanced way. By adopting a Bayesian approach, we showed how much effect different types of trauma exerted on different dimensions of borderline pathology rather than whether or not types of traumas exhibited these effects. Our use of a Bayesian approach to data analysis was particularly useful given the data in our sample, which included non-normally distributed (i.e., skewed and/or kurtotic) predictor variables. These strengths underscore the strength of Bayesian methodology, particularly for research on trauma. The limitations of this study also highlight useful directions for future research. One limitation of this study is its cross-sectional design. To address this, future research should replicate the findings of this and other studies regarding the relation between trauma and borderline pathology using a longitudinal design. Replications of the findings of this study could also include a greater variety of assessment instruments (e.g., structured interview, performance-based test) rather than relying exclusively on self-report measures, as we did in this study. These measures could include a measure of subjective betrayal experienced. In this study, we used a measure of traumatic experience (the BBTS) that categorized traumatic events based on the amount of betrayal implied by the event itself (e.g., sexual abuse by someone with whom victim was close was classified as a trauma high in betrayal). However, the degree of betrayal subjectively experienced was assumed and not tested; this could be corrected in future studies. An additional limitation of this study is the sample. Although personality pathology may reach its peak in young adulthood generally (Johnson, Cohen, Kasen, Skodol, & Oldham, 2008), and trauma exposure was prevalent in this sample specifically, college students may not be representative of the general population. Accordingly, another useful direction for future research would be to replicate this study in a community or clinical sample. The results of this study further add to the literature suggesting the relevance of betrayal trauma theory to the study of borderline personality pathology. More uniquely, this study also demonstrates the utility of integrating betrayal trauma theory with contemporary dimensional models of personality functioning. This continued line of research may lend insight into the etiology of borderline pathology and ultimately provide implications for treatment.

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Betrayal trauma and dimensions of borderline personality organization.

Borderline personality pathology can be conceptualized as one of many conditions within a broader spectrum of borderline personality organization (BPO...
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