Health Effects by Closeness of Sexual Abuse Perpetrator: A Test of Betrayal Trauma Theory

Betrayal trauma theory (Freyd, 1999) postulates that abuse perpetrated by a caregiver or someone close to you results in worse outcomes than abuse perpetrated by someone less central to your well-being. We used data from the Adverse Childhood Experiences (ACE) Study to examine this hypothesis in relation to a variety of adult health outcomes. We tested whether adults whose abuser was a family member or non-relative living in the home would report substantially poorer health than those whose abuser was a family friend, relative living outside the home, or a stranger. Participants were HMO members undergoing a complete physical examination. 3,100 (17.4%) reported some form of childhood sexual abuse (fondling, attempted intercourse, or intercourse) and also identified their abuser. Thirty-two percent of sexual abuse survivors had high betrayal, defined as an abuser who was a family or non-family member living in the home. Over 75% of those reporting a high betrayal abuser were women. High betrayal abuse was related to depression, anxiety, suicidality, panic, and anger. High betrayal subjects had poorer health functioning on the SF-36 role-physical, role-emotional, and social functioning scales than low betrayal victims