836783

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JIVXXX10.1177/0886260519836783Journal of Interpersonal ViolenceLee et al.

Original Research
Journal of Interpersonal Violence
1­–18
Intimate Partner © The Author(s) 2019
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DOI: 10.1177/0886260519836783
https://doi.org/10.1177/0886260519836783
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Maladjustment:
Examining the Role of
Institutional Betrayal
Among Survivors

Jenny Y. Lee, BS,1  Rachel L. Micol, PhD,1

and Joanne L. Davis, PhD1

Abstract
Research has found that a majority of individuals, irrespective of gender,
experienced their first intimate partner violence (IPV) victimization between
the ages of 18 and 24 years. Indeed, researchers have found that college
students’ experiences of IPV are comparable if not higher than that of the
general population. IPV victimization also places individuals at a higher risk
for developing psychological conditions. In addition, when IPV experiences
occur on college campuses, there are a variety of institutional factors that may
impact the outcome of the traumatic event for the survivor. The present study
seeks to examine whether institutional betrayal moderates the relationship
between IPV and different psychological outcomes (i.e., depression,
posttraumatic stress, anxiety). The study analyzed survey responses from a
sample of 316 undergraduate students attending a Midwestern University.
Three separate hierarchical regression analyses were conducted for each of
the maladaptive psychological outcomes. Results showed that institutional

1The University of Tulsa, OK, USA

Corresponding Author:
Jenny Y. Lee, The University of Tulsa, 800 S. Tucker Dr., Lorton Hall Room 101A, Tulsa, OK
74104, USA.
Email: Jyl266@utulsa.edu
2 Journal of Interpersonal Violence 00(0)

betrayal was positively correlated with depressive symptoms, posttraumatic

stress symptoms, and anxiety symptoms. Interestingly, institutional betrayal
was a significant predictor of depressive symptoms, posttraumatic stress
symptoms, and anxiety symptoms when controlling for the effects of physical
violence, sexual violence, and psychological aggression. The present study
highlights the significance of the impact of institutional betrayal, independent
of interpersonal betrayal, on mental health.

Keywords
sexual assault, PTSD, dating violence, domestic violence

According to the World Health Organization (WHO), intimate partner vio-

lence (IPV) is a behavior that causes physical, sexual, or psychological harm
to those involved in an intimate relationship (WHO Media Centre, 2016).
Results from the National Intimate Partner and Sexual Violence Survey
(NISVS) indicated that a majority of individuals, irrespective of gender,
experienced IPV for the first time between the ages of 18 and 24 years
(Breiding et al., 2014). Consistent with these findings, research demonstrates
college students are particularly at risk to experience IPV and report rates
comparable to, if not higher than, the general population (Nabors, Dietz, &
Jasinski, 2006; Tjaden & Thoennes, 2000). Indeed, researchers have found
that between 20% and 50% of college students experience violence in their
dating relationships (Bryant & Spencer, 2003; Shook, Gerrity, Jurich, &
Segrist, 2000; Straus, 2004).
Research supports that individuals who experience IPV are at increased risk
for developing psychological disorders (e.g., depression, posttraumatic stress
disorder [PTSD], anxiety; Calvete, Corral, & Estévez, 2008; Carlson, McNutt,
Choi, & Rose, 2002; Helfrich, Fujiura, & Rutkowski-Kmitta, 2008; Marais, de
Villiers, Moller, & Stein, 1999; Roberts, Lawrence, Williams, & Raphael,
1998; Woods, 2005). In addition, research studies found specific forms of IPV
may be more likely to lead to certain psychopathologies (e.g., Stuart, Moore,
Gordon, Ramsey, & Kahler, 2006). For example, Pico-Alfonso et al. (2006)
found that among female IPV survivors, psychological violence was a more
robust predictor of depressive and anxiety symptoms than physical violence.
Moreover, the experience of sexual violence, in addition to physical and psy-
chological violence, was linked to greater depressive symptoms than the expe-
rience of physical violence or physical and psychological violence alone.
Another study found sexual coercion was associated with a greater risk of
developing PTSD, whereas psychological aggression was associated with a
greater risk of developing generalized anxiety disorder (Stuart et al., 2006).
Lee et al. 3

Research suggests traumas that involve interpersonal violence can be

more psychologically harmful to an individual than other types of traumas
(e.g., motor vehicle accident, natural disaster; Briere & Spinazzola, 2005;
Cloitre et al., 2009). One reason for this may be related to the role of betrayal
within intimate partner relationships. Betrayal is understood as violations of
trust and power within relationships that can exacerbate the negative psycho-
logical outcomes individuals experience. Given its potentially significant
role in interpersonal forms of trauma, researchers have noted betrayal is a
distinct psychological construct that merits empirical attention (Brewin,
2003; Freyd, 1996, 1999; Kelley, Weathers, Mason, & Pruneau, 2012).
Indeed, research has found traumas that involve a perpetrator are associated
with higher levels of betrayal compared with traumas without a perpetrator
(Kelley et al., 2012). Betrayal trauma theory was developed by Freyd (1996)
to conceptualize interpersonal traumas in which there is an imbalance of
power between individuals who are closely involved (i.e., caregiver and
child, intimate partners). The imbalance of power suggests that one individ-
ual depends on the other for survival and safety, and betrayal traumas occur
when the depended-upon individual harms and violates the trust of the other
(Freyd, Klest, & Allard, 2005). Although betrayal trauma may not involve
threatened death or injury, it can be detrimental to the relationship, as well as
to the individual’s mental health (Freyd et al., 2005).
In accordance with betrayal trauma theory, Smith and Freyd (2013) exam-
ined the consequences of traumatic interpersonal events as they occur within
institutional contexts. The theory has expanded to posit that betrayal can
occur not only within interpersonal relationships but also in a relationship an
individual has with an institution, otherwise known as institutional betrayal
(Smith & Freyd, 2013). The reasons an individual develops an attachment
toward an institution can be understood as the same reasons an individual
forges close interpersonal relationships—trust and dependency (e.g., Somers,
2010). When trust is violated by an institution, the psychological damage can
appear similar to that of interpersonal betrayal (Smith & Freyd, 2013). Smith
and Freyd (2017) conducted a study examining the unique effect of institu-
tional betrayal on physical and mental well-being. The researchers surveyed
a sample of undergraduate students and asked respondents to specify a trau-
matic event involving interpersonal betrayal and whether an institution (e.g.,
university, military, church) was involved in this traumatic experience.
Findings from the study indicated institutional betrayal is linked to health
problems and dissociative symptoms independent of interpersonal betrayal
(Smith & Freyd, 2017). The study suggests it is important to examine institu-
tional betrayal as a distinct risk factor among survivors of trauma. Institutional
betrayal may be particularly salient for individuals who are repeatedly
4 Journal of Interpersonal Violence 00(0)

exposed to the environment in which the trauma occurred, such as a college

student who was sexually assaulted on his or her campus (Smith & Freyd,
2017). The studies noted above examined institutional betrayal and sexual
violence in interpersonal contexts that are not specific to intimate partners
(Smith & Freyd, 2013, 2017). To the best of the authors’ knowledge, no study
to date has explored the effect of institutional betrayal in the context of IPV.
The present study seeks to examine whether institutional betrayal may
interact with physical violence, sexual violence, and psychological aggres-
sion and thus moderate the relationship between the three types of IPV and
maladaptive psychological outcomes (i.e., depression, posttraumatic stress,
anxiety) among college students. Given the research suggesting that IPV is
associated with increased risk for psychopathology, and institutional betrayal
may have a unique effect on mental well-being, this study offered three
hypotheses. First, we expected a positive association between each type of
IPV (physical [Hypothesis 1a], sexual [Hypothesis 1b], psychological
[Hypothesis 1c]) and psychological outcomes (depression, posttraumatic
stress, and anxiety). Second, we hypothesized a positive association between
institutional betrayal and psychological outcomes. Finally, we hypothesized
institutional betrayal will moderate the relationship of the three types of IPV
with maladaptive psychological outcomes, such that these relationships are
stronger under experiences of institutional betrayal as compared with no
experiences of institutional betrayal.

Method
Participants
The present study examines a sample of undergraduate students attending a
private Midwestern University. Participants were eligible to participate if
they were at least 18 years of age and enrolled in a psychology course at the
university. These were the only specified inclusion criteria. There were no
exclusion criteria. A total of 330 undergraduate students met these initial eli-
gibility criteria. Due to missing data from incomplete survey measures, the
final sample size consisted of 316 participants. The age of participants ranged
from 18 to 43 years (M = 20.32, SD = 2.47). Participants consisted of 75.3%
women, 23.4% men, and 0.6% “other.” Ethnically, 79.7% of participants
identified as Caucasian or White, 8.5% as American Indian or Alaska Native,
8.5% as Asian or Pacific Islander, 5.4% as African American or Black, 5.4%
as Hispanic or Latino, 2.2% as Asian Indian, and 2.8% as “other race.” In the
current sample, 16.5% reported being freshmen, 33.2% sophomores, 26.9%
juniors, and 23.1% seniors.
Lee et al. 5

Procedure
Approval for the study was obtained from the institutional review board prior
to data collection. All participants for the study were recruited via Sona
Systems®, an online recruitment system accessible to undergraduate students
enrolled in a psychology course. The study, along with a brief description of
the content, was posted to Sona Systems®. All participants who signed up for
the study via the Sona system were presented with a link to a survey on
Qualtrics® (Qualtrics, 2014). The survey software, Qualtrics, provided par-
ticipants with a randomly generated ID number that removed any information
associated with the participants’ e-mail address from the data collection pro-
cess. Once directed to the survey, participants read a full description of the
study and the informed consent form. To consent to the study, participants had
to continue past the informed consent on the computer screen and complete
the survey, although participation was completely voluntary. To protect the
anonymity of the participants, no personally identifiable data were collected in
the survey. All participants received information about campus counseling and
community violence services in the informed consent and again at the end of
the survey. Participants received research credit, the only form of compensa-
tion, for their time regardless of the status of completion of the survey.

Measures
Demographics.  Participants were asked to indicate their age, gender, ethnic-
ity, grade level, relationship status, and organization affiliation in college
(e.g., Greek, student government, service/volunteer, etc.) using text entry and
multiple choice options.

Revised Conflict Tactics Scale (CTS2).  The CTS2 (Straus, Hamby, Boney-McCoy,
& Sugarman, 1996) is used to measure physical and sexual violence between
intimate partners in the past year. The CTS2 includes five subscales: injury,
negotiation, psychological aggression, physical aggression, and sexual coer-
cion. The CTS2 contains items that examine both the respondents’ and their
partners’ physically and sexually violent behaviors. For the purposes of the
present study, only information regarding respondents’ experience of violence
was included. Respondents indicated the frequency to which they experienced
violence (e.g., my partner pushed or shoved me) on an 8-point Likert-type
scale from 0 (this has never happened) to 7 (not in the past year, but it has
happened before). The physical violence scale was derived from 12 items. The
total score for physical violence was calculated by summing the 12 items and
the score ranged from 0 to 84. The sexual violence scale was derived from
6 Journal of Interpersonal Violence 00(0)

seven items. The total score for sexual violence was calculated by summing
the seven items and the score ranged from 0 to 49. The total scores for physical
violence and sexual violence were used in the present study to examine physi-
cal and sexual IPV. This scale has demonstrated good reliability in a previous
study, with internal consistencies ranging from .79 to .95 (Straus et al., 1996).
For the current study, α = .90 for the sexual violence subscale and α = .92 for
the physical violence subscale.

Modified-Multidimensional Measure of Emotional Abuse (MMEA).  The MMEA

(Murphy, Hoover, & Taft, 1999) is a measure of psychological abuse between
intimate partners. In the present study, items from only three of the four sub-
scales were included (i.e., restrictive engulfment, denigration, and domi-
nance/intimidation). The fourth subscale, hostile withdrawal, was not used
due to low internal consistency estimates in the present study (α = .73). The
measure specifies psychologically abusive behaviors that respondents and
their current or ex-partners may have experienced in the past 6 months, or at
any time point prior if not in the past 6 months. For the purposes of the study,
only information regarding respondents’ experience of psychological abuse
was included, which consisted of 20-items. Respondents indicate how often
they experienced a specific psychologically abusive behavior from their cur-
rent or ex-partner (e.g., asked me where I had been or who I was with in a
suspicious manner) on an 8-point Likert-type scale from 0 (this has never
happened) to 7 (not in the past 6 months, but it has happened before). A total
score is calculated by summing all of the item scores and ranges from 0 to
140. This total score was used in the present study to examine psychological
IPV. The internal reliability estimate for the current study was α = .95 for the
three subscales combined. Research also finds evidence of convergent and
discriminate validity (Murphy & Hoover, 1999; Murphy et al., 1999).

Overall Anxiety Severity and Impairment Scale (OASIS).  The OASIS (Norman,
Cissell, Means-Christensen, & Stein, 2006) is a measure of experiences of
anxiety in the past week. The OASIS is a five-item measure that assesses the
frequency and severity of anxiety symptoms, as well as the amount of impair-
ment associated with anxiety on a 5-point Likert-type scale from 0 (no anxi-
ety in the past week) to 4 (constant anxiety; felt anxious all the time and never
really relaxed). A total score is calculated by summing the frequency, sever-
ity, and amount of impairment for all of the items, and scores range from 0 to
20. The total score was used in the present study to examine symptoms of
anxiety. The scale has been demonstrated to have excellent 1-month test–
retest reliability and convergent and divergent validity (Norman et al., 2006).
The internal reliability estimate for the current study was α = .91.
Lee et al. 7

Center for Epidemiologic Studies Depression Scale (CES-D).  The CES-D (Radl-
off, 1977) is a measure of depressive symptoms in the past week. The CES-D
is a 20-item measure that was developed to assess for behaviors and feelings
the respondent may have had (e.g., I was bothered by things that usually don’t
bother me). Respondents are asked to indicate how often they felt this way
using a 4-point Likert-type scale, ranging from 0 (rarely or none of the time)
to 3 (most or all of the time). Evidence for the construct validity of the CES-D
has been reported by Zung (1965). A total CES-D score is obtained by sum-
ming all of the item scores and ranges from 0 to 60. The total score was used
in the present study to examine depressive symptoms. In general, higher
scores on the CES-D indicate a greater level of depressive symptoms. The
internal reliability estimate for the current study was α = .79.

PTSD Checklist (PCL-5).  The PCL-5 (Weathers et al., 2013) is a 20-item mea-
sure of posttraumatic stress symptoms (PTSS) in accordance with the Diag-
nostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American
Psychiatric Association, 2013). The PCL-5 is used as a screening tool for
PTSD and can also be used to provide a provisional diagnosis of PTSD. The
measure in the present study assesses symptom severity in the past month.
The items are scored on 5-point Likert-type scale from 0 (not at all) to 4
(extremely). Examples of items include “In the past month, how much were
you bothered by repeated, disturbing, and unwanted memories of the stress-
ful experience?” and “In the past month, how much were you bothered by
feeling distant or cut off from other people?” A total symptom severity score
was obtained by summing the score of each item in the measure. Total scores
can range from 0 to 80, with higher scores indicating greater PTSS. The total
score was used in the present study to examine PTSS. The internal reliability
estimate for the current study was α = .96.

Institutional Betrayal Questionnaire (IBQ).  The IBQ (Smith & Freyd, 2013) is a
measure that assesses institutional betrayal and involvement. The measure
consists of a seven-item checklist that pertains to the different forms of insti-
tutional betrayal the respondents may have experienced. All items on the
checklist are scored as either 0 (no) or 1 (yes). The measure explains institu-
tions as “large systems such as a university, the military, Greek system, or
organized religion” as well as “parts of systems such as a campus dormitory,
a military unit, a specific sorority or fraternity, or particular church.” Exam-
ples of items in the checklist include “Did an institution play a role by not
taking proactive steps to prevent this type of experience?” In addition, the
measure consists of three items that ask respondents how strongly they iden-
tified with the institution prior to the betrayal on a scale from 0 (not at all) to
8 Journal of Interpersonal Violence 00(0)

Table 1.  Description of Sample Characteristics.

Characteristic n %
Sex
 Male 74 23.4
 Female 238 75.3
 Other 2 0.6
Race/ethnicity
 Caucasian/White 252 79.7
  American Indian/Alaska Native 27 8.5
  Asian/Pacific Islander 27 8.5
  African American/Black 17 5.4
 Latino/Spanish 17 5.4
  Asian Indian 7 2.2
 Other 9 2.8
Disability
 Physical 9 2.8
 Mental 38 12.0

Note. n ≠ 316 due to missing data on sex or participants selecting multiple categories for race/
ethnicity.

4 (very much), if they remained a part of the institution (0 = no, 1 = yes), and
to describe the institution. In the present study, institutional betrayal is exam-
ined as a dichotomous variable that is based on the seven-item checklist, so
that respondents who checked yes in response to any of the items were con-
sidered to have experienced institutional betrayal.

Data Analysis
The sample demographics were obtained using frequencies to examine sam-
ple size and percentages (Table 1). Pearson’s correlations and point-biserial
correlations were conducted to examine relationships between the predictors
(i.e., institutional betrayal, physical violence, sexual violence, psychological
aggression) and the outcome variables (i.e., depression, PTSS, anxiety).
Three separate hierarchical regression analyses were conducted for each of
the maladaptive psychological outcomes (i.e., depression, PTSS, anxiety).
For the regression models, physical violence, sexual violence, and psycho-
logical aggression were entered in Step 1, followed by institutional betrayal
entered in Step 2. Next, the interaction terms between these variables were
included in Step 3. This was done to examine the extent to which the effect of
the three types of IPV on the maladaptive psychological outcomes depended
Lee et al. 9

Table 2.  Correlations for Study Measures (n = 316).

Variable 1 2 3 4 5 6 7
1. Institutional —  
betrayal
2.  Physical violence .17** —  
3.  Sexual violence .23*** .62*** —  
4. Psychological .22*** .27*** .31*** —  
aggression
5. Depressive .25*** .01 .12* .26*** —  
symptoms
6. PTSS .37*** .11 .28*** .38*** .58*** —  
7.  Anxiety symptoms .32*** .07 .11 .31*** .70*** .61*** —
M — 2.84 2.79 15.18 18.54 16.73 5.19
SD — 9.88 7.65 26.20 7.89 17.12 4.08

Note. PTSS = posttraumatic stress symptoms.

*p < .05. **p < .01. ***p < .001.

upon institutional betrayal. Prior to creating the interaction terms, the physi-
cal violence, sexual violence, and psychological aggression variables were
centered. To examine the main effect (i.e., the individual effects of the three
types of IPV and institutional betrayal on each of the maladaptive psycho-
logical outcomes), results from the correlational analyses are presented
alongside with the results from Step 1 and Step 2 of the regression analyses.
Based on the Bonferroni correction, the level of significance was set at p <
.0167 to account for Type 1 errors that occur given the three separate regres-
sion analyses (Fisher, Kerr, & Cunningham, 2019).

Results
Hypothesis 1 Results: Main Effect of IPV Types
Hypothesis 1a suggested physical violence would have a positive association
with maladaptive psychological outcomes (i.e., depressive symptoms, PTSS,
and anxiety symptoms). This hypothesis was not supported as shown by the
zero-order correlations (Table 2). Hypothesis 1b suggested sexual violence
would have a positive association with maladaptive psychological outcomes.
This hypothesis was partially supported (Table 2). Sexual violence was posi-
tively and significantly correlated with depressive symptoms and PTSS, but
not with anxiety symptoms. Hypothesis 1c suggested psychological aggres-
sion would have a positive association with maladaptive psychological
10 Journal of Interpersonal Violence 00(0)

Table 3.  Hierarchical Regression Predicting Depressive Symptoms (n = 316).

Step 1 Step 2 Step 3

Variable β t β t β t
Physical violence −.12 −1.65 −.13 −1.85 −.24 −1.60
Sexual violence .11 1.50 .09 1.16 .23 1.37
Psychological aggression .25 4.06* .21 3.40* .27 2.34
Institutional betrayal .23 3.81* .22 3.69*
Physical × Institutional Betrayal .14 0.88
Sexual × Institutional Betrayal −.18 −1.04
Psychological × Institutional −.08 −0.74
Betrayal
R2 .07 .12 .13  
F 7.23* 9.32* 5.66*  
ΔR2 — .05 .01  
ΔF — 14.54* .80  

*p < .05.

outcomes. This hypothesis was fully supported (Table 2). In addition, Step 1
of the regression predicting depressive symptoms shows psychological
aggression was a significant predictor (β = .25, p < .0167), whereas physical
and sexual violence were not (Table 3). Step 1 of the regression predicting
PTSS shows sexual violence (β = .26, p < .0167) and psychological aggres-
sion (β = .34, p < .0167) were significant predictors, whereas physical vio-
lence was not (Table 3). Step 1 of the regression predicting anxiety symptoms
shows psychological aggression was a significant predictor (β = .31, p <
.0167), whereas physical and sexual violence were not (Table 3).

Hypothesis 2 Results: Main Effect of Institutional Betrayal

Hypothesis 2 suggested institutional betrayal would show a positive associa-
tion with maladaptive psychological outcomes and was supported. Step 2 of the
regression predicting depressive symptoms showed institutional betrayal (β =
.23, p < .0167) remained a significant predictor when controlling for the effects
of physical and sexual violence and psychological aggression (Table 3). For
PTSS, Step 2 of the regression showed institutional betrayal (β = .25, p < .0167)
remained a significant predictor when controlling for the effects of the three
types of IPV (Table 4). Finally, for anxiety symptoms, the regression showed
institutional betrayal (β = .28, p < .0167) remained a significant predictor when
controlling for the effects of three types of IPV (Table 5). Together, these results
fully support Hypothesis 2.
Lee et al. 11

Table 4.  Hierarchical Regression Predicting Posttraumatic Stress Symptoms

(n = 316).

Step 1 Step 2 Step 3

Variable β t β t β t
Physical violence −.13 −1.94 −.15 −2.18 −.21 −1.49
Sexual violence .26 3.69* .22 3.30* .42 2.67*
Psychological aggression .34 5.96* .30 5.36* .26 2.52*
Institutional betrayal .25 4.65* .25 4.44*
Physical × Institutional Betrayal .09 0.66
Sexual × Institutional Betrayal −.23 −1.43
Psychological × Institutional −.04 0.37
Betrayal
R2 .19 .25 .25  
F 21.25* 22.53* 13.14*  
ΔR2 — .06 .01  
ΔF — 21.61* .71  

*p < .05.

Hypothesis 3 Results: Interaction of IPV Types and Institutional

Betrayal
Hypothesis 3 suggested institutional betrayal would moderate the relation-
ship between the three types of IPV and the maladaptive psychological out-
comes, such that these relationships would be stronger under experiences of
institutional betrayal as compared with no experiences of institutional
betrayal. Tables 3 to 5 indicate institutional betrayal was not a significant
moderator. Taken together, Hypothesis 3 was not supported.

Discussion
The purpose of the present study was to examine the potential moderating
role of institutional betrayal in the relationship between IPV types (i.e., phys-
ical violence, sexual violence, and psychological aggression) and maladap-
tive psychological outcomes (i.e., depressive symptoms, PTSS, and anxiety
symptoms). Physical violence was not significantly correlated with depres-
sive symptoms, PTSS, or anxiety symptoms. Sexual violence was positively
correlated with depressive symptoms and PTSS. Psychological aggression
was positively correlated with depressive symptoms, PTSS, and anxiety
symptoms. The findings regarding physical violence were unexpected, given
findings of previous research examining this construct (e.g., Schumacher,
12 Journal of Interpersonal Violence 00(0)

Table 5.  Hierarchical Regression Predicting Anxiety Symptoms (n = 316).

Step 1 Step 2 Step 3

Variable β t β t β t
Physical violence −.02 −1.94 −.04 −0.55 −.13 −0.93
Sexual violence .01 3.69* −.02 −0.33 .23 1.39
Psychological aggression .31 5.96* .26 4.51* .21 1.96
Institutional betrayal .28 5.08* .27 4.83*
Physical × Institutional Betrayal .14 0.94
Sexual × Institutional Betrayal −.29 −1.77
Psychological × Institutional .04 0.43
Betrayal
R2 .10 .17 .18  
F 10.06* 14.63* 8.86*  
ΔR2 — .07 .01  
ΔF — 25.77* 1.14  

*p < .05.

Feldbau-Kohn, Slep, & Heyman, 2001). However, the nonsignificant asso-

ciations between physical violence and psychological outcomes in the pres-
ent study may be attributable to differences in the frequency of violence
experienced across IPV types, although this was not assessed in the current
study. Consistent with previous research (e.g., Lawrence, Yoon, Langer, &
Ro, 2009; Stuart et al., 2006), experiences of sexual violence and psychologi-
cal violence were associated with negative mental health outcomes. In par-
ticular, psychological aggression correlated with all three outcomes, which
contributes to a growing body of literature that suggests experiences of psy-
chological IPV may be more harmful to an individual’s mental well-being
than experiences of physical IPV (e.g., Taft et al., 2006). The results of the
current study highlight the importance of examining the different forms of
IPV as distinct predictors of psychological maladjustment, rather than exam-
ining IPV as a uniform construct.
Results showed institutional betrayal was positively correlated with
depressive symptoms, PTSS, and anxiety symptoms. This finding is similar
to findings on interpersonal betrayal in previous studies. Researchers found
in a clinical sample of adults, experiences of higher levels of betrayal in trau-
matic events was correlated with greater anxiety, depression, and dissociation
symptoms (Freyd et al., 2005). Likewise, a separate study found individuals
who experienced high-level betrayal in their trauma exhibited more symp-
toms of dissociation compared with those who experienced low-level betrayal
Lee et al. 13

in their trauma (Gobin & Freyd, 2009). Interestingly, institutional betrayal

was a significant predictor of depressive symptoms, PTSS, and anxiety
symptoms when controlling for the effects of physical violence, sexual vio-
lence, and psychological aggression. These findings have important implica-
tions in that they indicate while IPV exposure may be necessary, it may not
be sufficient in explaining mental health outcomes in survivors. The negative
mental health implications of institutional betrayal support previous research
suggesting individuals are likely to maintain symptoms of depression, post-
traumatic stress, and anxiety when an institution becomes a barrier to access-
ing mental health services (i.e., access to free counseling and psychological
services on a college campus where IPV occurred; Smith & Freyd, 2017).
Moreover, this finding is consistent with Smith and Freyd (2013), specifi-
cally in regards to institutional betrayal being a unique predictor of PTSS
among survivors of IPV. In a similar vein, a study on the effect of interper-
sonal betrayal on PTSD found betrayal accounted for a significant amount of
variance in the severity of PTSD symptoms beyond trauma type (Kelley
et al., 2012). The present findings on institutional betrayal lend further sup-
port to the empirical research suggesting that although institutional betrayal
and interpersonal betrayal are associated with similar mental health conse-
quences, institutional betrayal is indeed distinct from interpersonal betrayal
(Smith & Freyd, 2017).

Limitations
The present study has some limitations. The study is cross-sectional in nature
and poses the limitation of examining how the relationships between types of
IPV, institutional betrayal, and maladaptive psychological outcomes may
reveal across time. It is reasonable to assume the experience of IPV, institu-
tional betrayal, depressive symptoms, PTSS, and anxiety symptoms may vary
within a temporal context. Research has shown that over time, changes in
psychological aggression are linked to changes in mental health outcomes
associated with IPV (Lawrence et al., 2009). The sample of the study predomi-
nantly consisted of White women, which is a limitation in terms of the gener-
alizability of the findings. A study found Black Americans may be particularly
susceptible to experiencing mental health disparities and institutional betrayal
in the form of microaggressions (Gómez, 2015). It would be important to
examine for potential racial differences in frequency of experiences related to
institutional betrayal that could lead to variation in severity of psychological
outcomes. Moreover, a total of 14 participants were excluded from the study
for any missing data in the measures of interest, which is a limitation given
that these data may have provided useful insight to the relationships between
14 Journal of Interpersonal Violence 00(0)

IPV, institutional betrayal, and mental health outcomes. In addition, the mea-
sure of PTSS did not require participants to specify an index trauma, which
posed the limitation of directly linking PTSS to physical violence, sexual vio-
lence, and psychological aggression. The present study did not assess for med-
ical history of physical injuries resulting from IPV (i.e., traumatic brain injury,
disability) or medication use for depression and anxiety. This may have pro-
vided useful information about the severity of experiences related to IPV.
Differences in trauma frequency were not assessed, which is another limita-
tion to the study, given that variation in trauma frequency can account for an
effect on mental health outcomes. Finally, the study used an older seven-item
version of the IBQ (Smith & Freyd, 2013). Smith and Freyd (2017) has since
published an expanded version of the IBQ that includes five additional items
which entail other ways an institution may have played a role in exacerbating
the negative mental health consequences of a traumatic experience. Future
studies should utilize the expanded IBQ to capture a more comprehensive
form of institutional betrayal.

Conclusion
In spite of the limitations, the present study highlights the significance of the
impact of institutional betrayal, independent of interpersonal betrayal, on
mental health. The actions or inactions of institutions have the potential to
contribute to the detrimental psychological consequences for survivors of
IPV, whether it is a systemic or isolated event, and even when controlling for
physical violence, sexual violence, and psychological aggression. Given the
majority of IPV occurs during the ages that span through the college years, it
is important for researchers to work with campus administrators and organi-
zations to develop a better understanding of how to effectively reduce rates of
such crimes (Breiding et al., 2014). The purpose of conducting campus-wide
surveys is so that policy makers and university officials alike can be accu-
rately informed of the impact of physical and sexual violence and psycho-
logical aggression on the health and well-being of students. The present study
assessing IPV, institutional betrayal, and mental health is an integral piece of
the larger nation-wide initiative to help shed light on the seriousness of vio-
lent crimes that often occur in the context of intimate relationships and to
decrease the prevalence of such crimes committed on college campuses.
Moreover, the results of the study add to the expanding body of literature
on institutional betrayal as a related but distinct construct from interpersonal
betrayal. None of the interactions between institutional betrayal and IPV
types were statistically significant, indicating institutional betrayal did not
have an additive effect on the relationship between IPV types and depressive
Lee et al. 15

symptoms, PTSS, and anxiety symptoms. Future studies may want to exam-
ine these relationships using a different statistical approach (e.g., mediation).
It is possible that institutional betrayal may be better accounted for as a vari-
able that explains the relationships between IPV types and maladaptive psy-
chological outcomes, rather than one that influences the strength of the
relationships. In addition, researchers may want to examine if the findings in
the present study on the role of institutional betrayal in IPV and psychologi-
cal consequences can be replicated among non-college students. Research
has shown the implications of IPV are far-reaching and can go beyond asso-
ciations with negative psychological outcomes. A study found that survivors
of high-betrayal traumas (i.e., IPV) are significantly impacted in their inter-
personal functioning including being less trusting of others, decreased aware-
ness of intimate partner betrayal, and being more likely to remain in a
relationship after being betrayed (Gobin & Freyd, 2009). Future studies may
also seek to examine the effect of institutional betrayal on outcomes among
IPV survivors, such as attitudes toward authority figures, perception of the
severity of betrayal, and extent of engaging in avoidant behaviors.

Acknowledgments
The author would like to thank her advisor, Dr. Joanne Davis, and her coauthor, Dr.
Rachel Micol, for their support and mentorship throughout this process.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

ORCID iD
Jenny Y. Lee   https://orcid.org/0000-0003-1069-9129

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Author Biographies
Jenny Y. Lee, BS, is a clinical psychology doctoral student at The University of
Tulsa. Her research focuses on the treatment efficacy of posttrauma nightmares and
sleep problems in reducing maladaptive psychological outcomes, as well as the effects
of interpersonal trauma among survivors of sexual assault.
Rachel L. Micol, PhD, is a postdoctoral fellow at the VA Boston Healthcare System.
Her research focuses on the evaluation and dissemination of treatment for nightmares
and sleep problems in trauma-exposed individuals, as well as examination of barriers
to engagement in mental health treatment, and exploration of the impact of trauma,
particularly within sexual minority, gender minority, and female Veterans.
Joanne L. Davis, PhD, is a professor of psychology at The University of Tulsa, direc-
tor of the Trauma Research: Assessment, Prevention, and Treatment Center, and codi-
rector of The University of Tulsa Institute of Trauma, Adversity, and Injustice. Her
research focuses on the treatment of nightmares and sleep problems in trauma-exposed
individuals as well as on prevention efforts related to interpersonal trauma.