Does Gender Matter? An Exploratory Study of Cultural Betrayal Trauma and Hallucinations in Latino Undergraduates at a Predominantly White University

Abstract

Violence victimization, such as physical, sexual, and emotional abuse, has been linked with hallucinations. How abuse-related distress manifests is dependent on a host of factors, including gender, ethnicity, and societal inequality. Cultural betrayal trauma theory may provide insight into hallucinatory experiences for Latinos in the United States, as it is a contextualized framework that identifies societal trauma (e.g., discrimination) as a contributor to the harm of within-group interpersonal violence victimization in minority populations. Though men may experience higher rates of hallucinations, there is little work on gender differences in the predictive power of violence victimization on hallucinations, particularly in Latino populations. Therefore, with cultural betrayal trauma theory as a guide, the purpose of the current exploratory study is to examine gender differences in the association of ethno-cultural betrayal trauma (within-group violence victimization) on tactile, visual, and auditory hallucinations in a sample of Latino undergraduate students at a predominantly White university in the United States. Participants (N = 80) completed online self-report measures on ethno-cultural betrayal trauma and hallucinatory experiences. Sizable proportions of the sample reported experiencing ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations. Controlling for between-group trauma, the link between ethno-cultural betrayal trauma and tactile, visual, and auditory hallucinations was moderated by male gender. With cultural betrayal trauma theory as its framework, these preliminary results suggest that gender differences in hallucinatory experiences may be affected by the way trauma-related distress is expressed in Latino undergraduate students in the United States.

Keywords

mental health and violence CBTT abuse minorities Hispanic

Interpersonal violence victimization, such as physical, sexual, and emotional abuse, has been linked with hallucinations (Read & Bentall, 2012). How trauma-related distress manifests is dependent on a host of factors, including gender, ethnicity, and societal inequality (e.g., Brown, 2008; Bryant-Davis, 2005). Discrimination at college harms Latino undergraduates (Hwang & Goto, 2008; Lopez, 2005), creating an unsafe context that may impact mental health related to violence victimization. Cultural betrayal trauma theory (CBTT; Gómez, 2012, 2015a, 2015b, 2016a, 2017a, 2017c) may provide insight into mental health for Latinos, as it is a contextualized framework that identifies societal inequality as a contributor to the harm of within-group violence victimization in minority populations.

CBTT and Hallucinations

As a theory from a minority perspective, CBTT (e.g., Gómez, 2012) incorporates societal inequality into the framework for understanding outcomes of within-group violence victimization in minority populations, while being sensitive to within- and between-group differences and other considerations (Table 1). According to CBTT, some minorities develop (intra)cultural trust, similar to racial loyalty (e.g., Lopez, 2005), as a protective mechanism against societal trauma, such as racism. Thus, violence perpetrated by persons of the same minority group (e.g., the same ethnicity) is indicative of a cultural betrayal, as it is a violation of this (intra)cultural trust (Figure 1). In CBTT (Gómez, 2017a), outcomes of within-group violence victimization, termed cultural betrayal trauma, are predicted to be diverse and include hallucinations (Figure 2).

Table 1.

CBTT: Frequently Asked Questions.

Question	Answer
Does CBTT treat all minorities as if they are the same?	No. With CBTT, both within-group differences and between-group differences can be systematically examined.
Does CBTT propose that there is more violence within minority groups?	No. CBTT says nothing about prevalence of trauma, as within-group violence occurs across majority and minority groups.
Does CBTT assume that between-group violence—particularly with majority perpetrators and minority victims—is not harmful?	No. CBTT focuses on one facet of trauma (within-group) and does not speak to other forms of trauma (between-group) that themselves may be uniquely harmful in their own way.
Does CBTT ignore all the other harmful aspects of trauma (e.g., severity, high betrayal)?	No. CBTT highlights cultural betrayal as a specific contributing factor of trauma sequelae but also includes characteristics of trauma, interpersonal betrayal (Freyd, 1996), institutional betrayal (Smith & Freyd, 2014), judicial betrayal (Smith, Gómez, & Freyd, 2014), and other factors.
Does CBTT presume that perpetrators of cultural betrayal trauma are actively trying to betray?	No. Similar to BTT (Freyd, 1996), the intent of perpetrators is distinct from the betrayal implicit in within-group violence in minority populations.
Does CBTT ignore the complexity of identity?	No. CBTT is informed by intersectionality (e.g., Crenshaw, 1991) and multiplicity (Hames-García, 2011). There are multiple types of cultural betrayal that a single individual could experience (e.g., ethno-cultural betrayal; gender- cultural betrayal).
Do victims of trauma need to explicitly feel cultural betrayal for it to count as such?	No. However, future research should explore if outcomes vary based on individuals’ perceptions of cultural betrayal in the trauma.
Isn’t CBTT a cultural betrayal in and of itself, as it highlights trauma, violence, and abuse that occur within minority groups?	No. The ultimate determinant of cultural betrayal is societal trauma, which promotes silence to protect the in-group. The next responsible party are perpetrators for violating (intra)cultural trust. Disclosing and/or discussing cultural betrayal trauma is not a cultural betrayal.

Source. Adapted from ©Jennifer M. Gómez, 2016a, reprinted with permission.

Note. BTT = betrayal trauma theory, CBTT = cultural betrayal trauma theory.

Figure 1.

Interpersonal, societal, and cultural betrayal trauma.

Figure 2.

Cultural betrayal trauma theory flowchart.

Several studies (Gómez, 2017a, 2017b, 2017c; Gómez & Freyd, 2017b) provide empirical evidence in diverse minority populations for the harmful role of cultural betrayal in trauma. Specifically, Gómez and Freyd (2017b) compared the impact of within-group sexual violence on outcomes between diverse minorities and majority members. They found that there was a moderation of minority status, with the link between within-group violence and outcomes (e.g., depression, sleep disturbances) being stronger for minorities. These findings suggest that within-group violence may be disproportionately harmful for minorities, potentially due to cultural betrayal in trauma. In another study with Asian/Asian American/Pacific Islander college students, within-group trauma was linked with hallucinations and other outcomes while controlling for between-group trauma (Gómez, 2017a). These findings further provide evidence for CBTT by suggesting that, unlike between-group trauma, within-group trauma may have an implicit cultural betrayal that contributes to outcomes. The salience of anti-Latino sentiment currently in the United States (e.g., via proposed legislation; see Shear & Davis, 2017) may make ethno-cultural betrayal trauma particularly toxic to Latinos’ mental health.

Hallucinations are extrasensory perceptions that are tactile (e.g., feeling things on or in the body that are not there), visual (e.g., seeing things that are not there), and auditory (e.g., hearing things that are not there) (Ohayon, 2000). Though typically conceptualized as indicative of severe psychopathology (for a discussion, see Johns, Nazroo, Bebbington, & Kuipers, 2002), hallucinatory experiences are present in nonclinical populations (e.g., Beavan, Read, & Cartwright, 2011; Ohayon, 2000) and have been linked with violence victimization in nonclinical populations (e.g., Daalman et al., 2012; Gómez & Freyd, 2017a; Gómez, Kaehler, & Freyd, 2014; Morrison & Petersen, 2003). Thus, while hallucinations are relatively common and not necessarily indicative of psychosis, hallucinations may still be a form of trauma-related psychological distress. Moreover, hallucinatory experiences may have different meanings across ethnic groups (e.g., Johns et al., 2002) based on discrimination, environmental adversity, and culture (DeVylder et al., 2013). Some culturally determined meanings of hallucinatory experiences are derived from supernatural, spiritual, and/or religious beliefs (Earl et al., 2015). Therefore, explicitly focusing on hallucinations as an important outcome of cultural betrayal trauma can add to the literature on trauma-related hallucinations in nonclinical samples (Daalman et al., 2012) through utilizing a contextualized framework to incorporate underrepresented Latinos into this literature.

Latinos, Mental Health, and Intersectionality Theory

Some research suggests that as many as 30% of college students suffer from mental health problems (e.g., Hunt & Eisenberg, 2010). Moreover, the majority of these difficulties arise in adolescence and early adulthood (Hunt & Eisenberg, 2010; Kessler et al., 2005). Latinos’ mental health in predominantly White universities further may be impacted by discrimination (Hwang & Goto, 2008; Lopez, 2005). Intersectional approaches (Crenshaw, 1989, 1991) that examine mental health across multiple identities (e.g., ethnicity and gender) likely better benefit individuals across various communities (Bauer, 2014) while reducing the oppressive nature of one-dimensionalizing complex individuals (see Anzaldúa & Keating, 2013, for a discussion).

With Latinos underrepresented in the literature, research suggests that whereas women are more vulnerable to some forms of violence victimization (Goldberg & Freyd, 2006; Gómez, Becker-Blease, & Freyd, 2015; Gómez, Rosenthal, Smith, & Freyd, 2015; Gracie et al., 2007; Tang & Freyd, 2012), men have higher rates of hallucinations (Johns, Nazroo, Bebbington, & Kuipers, 1998; Tien, 1991). The reasons for this gender difference are unclear. Thus, examining how the associations between violence victimization and hallucinations may vary by gender can help elucidate the differential experiences of trauma and mental health among Latinos. Doing so within a college population capitalizes on the critical time of emerging mental health problems in late adolescence/early adulthood (Hunt & Eisenberg, 2010; Kessler et al., 2005).

Purpose of the Study

CBTT (e.g., Gómez, 2017a) is a theoretical framework that incorporates aspects of the sociocultural context into the examination of within-group violence victimization in minority populations. Violence victimization (Porter & McQuiller Williams, 2011) and mental health problems (Hunt & Eisenberg, 2010; Kessler et al., 2005) are relatively prevalent among late adolescents and emerging adults, with Latino college students facing additional stressors of discrimination on college campuses (e.g., Lopez, 2005), perhaps particularly at predominantly White universities. Though the research on the link between violence victimization and hallucinations is growing (e.g., Gómez & Freyd, 2017a; Read, Van Os, Morrison, & Ross, 2005), Latinos are underrepresented in this literature. Examining the role of gender in the association between violence victimization and hallucinations among Latinos can further specify findings (see Bauer, 2014, for a discussion on intersectionality and population health research). Therefore, with CBTT (e.g., Gómez, 2017a) as a guide, the purpose of the current exploratory study is to examine gender differences in the association of ethno-cultural betrayal trauma (within-minority ethnic group interpersonal violence victimization) on tactile, visual, and auditory hallucinations in a sample of Latino undergraduate students at a predominantly White university.

Method

These data are part of a larger data collection on CBTT in ethnic minority populations (N = 296; Gómez, 2016b); the current study includes only participants who identified as Latino to examine CBTT in this population specifically.

Participants and Procedure

Participants (N = 80) were Latino undergraduate students attending a predominantly White university in the United States (76.25% reported the United States as nation of origin). The university Institutional Review Board (IRB) approved the current study. Participants were prescreened for ethnic minority status, with eligible potential participants choosing the current study based on study characteristics (e.g., duration of the study) without information on study content. Therefore, participants did not self-select into the current study based on interest or experience with violence victimization or hallucinations. Following informed consent, participants completed the 60-min online study at a location of their own choosing. Participants received course credit for their participation and, without penalty, could decline to answer any question or withdraw from the study. Only participants who identified their race and/or ethnicity as Hispanic/Latino American were included in the current study. The sample was 63% women (n = 50) and 37% men (n = 30). Women (M = 19.33 years, SD = 1.71) were significantly younger—t(38.43) = 2.12, p = .04—than men (M = 20.77 years, SD = 3.45). Finally, the majority of the total sample identified with Catholicism (46%) or another Christian denomination (16%), with 35% of participants identifying as agnostic, atheist, or not religious and 3% declining to answer.

Measures

Ethno-cultural betrayal trauma: Brief Betrayal Trauma Survey (BBTS)

For the current study, 12 items were used from the BBTS (Goldberg & Freyd, 2006) that were modified to assess for lifetime experience of physical, sexual, or emotional abuse that is perpetrated by someone of the same ethnicity (ethno-cultural betrayal trauma) or a different ethnicity (between-group trauma). A sample item is “You were deliberately attacked so severely as to result in marks, bruises, blood, broken bones, or broken teeth by someone of your same ethnicity with whom you were very close.” Responses were on a Likert-type scale, from 1 = never to 6 = more than 100 times. Because the BBTS assesses for experiencing separate events, as opposed to an underlying construct, a measure of internal consistency would not be appropriate. The BBTS is considered a reliable measure of victimization (Goldberg & Freyd, 2006). For descriptive analyses, I created mean variables of between-group trauma and ethno-cultural betrayal trauma. For descriptive and inferential analyses, I created a dichotomous variable, with 1 = any abuse reported and 0 = no abuse reported.

Hallucinations: Composite International Diagnostic Interview (CIDI) and Ohayon

Tactile, visual, and auditory hallucinations were assessed using six items total, with three items from the CIDI, “Beliefs and Experiences Module” (World Health Organization, 1990) and three items from Ohayon (2000). Two items assessed each type of hallucination (tactile, visual, and auditory). A sample item is “Have you ever had the experience of hearing things other people could not hear, such as noises or a voice?” Responses were on a Likert-type scale from 1 = never to 5 = almost always. For descriptive analyses, I created four dichotomous variables (hallucinations [total], tactile hallucinations, visual hallucinations, and auditory hallucinations), with 1 = any hallucinations and 0 = no hallucinations. For descriptive and inferential analyses, I created four mean variables for analyses—hallucinations [total] (α = .85), tactile hallucinations (α = .72), visual hallucinations (α = .73), and auditory hallucinations (α = .62). Because test reliability is a function of unidimensionality of items and test length (Tavakol & Dennick, 2011), all subscales were used in analyses.

Results

In this small sample of Latino undergraduate students, a sizable minority of women and men reported experiencing any between-group trauma (M = 1.13, SD = .31), ethno-cultural betrayal trauma (M = 1.10, SD = .29), and hallucinations (total: M = 1.26, SD = .43; tactile: M = 1.38, SD = .63; visual: M = 1.20, SD = .44; and auditory: M = 1.25, SD = .52) (Table 2). I ran analyses of covariance (ANCOVAs) on the total sample to examine how ethno-cultural betrayal trauma, gender, and the interaction between ethno-cultural betrayal trauma and gender would be associated with hallucinations [total], tactile hallucinations, visual hallucinations, and auditory hallucinations (Table 3). As expected, controlling for between-group trauma, ethno-cultural betrayal trauma was significantly related to all measured hallucinatory experiences. Furthermore, there was a main effect of (male) gender on hallucinations [total], visual hallucinations, and auditory hallucinations. Finally, controlling for between-group trauma, the interaction between ethno-cultural betrayal trauma and gender was associated with hallucinations [total], tactile hallucinations, visual hallucinations, and auditory hallucinations. Specifically, ANCOVAs for men and women separately revealed that the links between ethno-cultural betrayal trauma and hallucinations [total], tactile hallucinations, visual hallucinations, and auditory hallucinations were present for men but not women (Table 4). The findings from these preliminary analyses on Latino undergraduate students suggest that controlling for between-group trauma, the relationships between ethno-cultural betrayal trauma and different types of hallucinations vary as a function of gender.

Table 2.

Percentages Reporting Between-Group Trauma, Ethno-cultural Betrayal Trauma, and Hallucinations.

	Womenn (%)	Menn (%)	χ² (1)
Between-group trauma	25 (50)	9 (30)	3.07
Ethno-cultural betrayal trauma	20 (40)	8 (27)	1.47
Hallucinations [total]	23 (46)	9 (30)	1.71
Tactile	20 (40)	9 (30)	0.64
Visual	10 (20)	7 (23)	0.19
Auditory	13 (26)	6 (20)	0.28

Table 3.

Ethno-cultural Betrayal Trauma: Controlling For Between-Group Trauma, Analyses of Covariance (ANCOVAs) Assessing the Association of Ethno-cultural Betrayal Trauma, Gender, and the Interaction of Ethno-cultural Betrayal Trauma and Gender on Hallucinations.

	Between-Group TraumaF (1, 74)	Ethno-cultural Betrayal TraumaF (1, 74)	GenderF (1, 74)	InteractionTermF (1, 74)
Hallucinations [total] R² = .327	2.745	21.585***	4.082*	9.498**
Tactile R² = .190	.017	13.354***	2.156	6.836*
Visual R² = .251	.034	18.337***	4.641*	10.271**
Auditory R² = .314	3.938	17.744***	5.248*	9.010**

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

Table 4.

Ethno-cultural Betrayal Trauma: Controlling for Between-Group Trauma, Analysis of Co-Variance (ANCOVA) Assessing Main Effects Separately for Women and Men.

	Women		Men
	Between-Group TraumaF (1, 47)	Ethno-cultural Betrayal TraumaF (1, 47)	Between-Group TraumaF (1, 26)	Ethno-cultural Betrayal TraumaF (1, 26)
Hallucinations [total]	0.459	3.070	4.597*	15.662**
Tactile	0.264	1.771	0.882	7.652*
Visual	0.520	1.793	3.450	16.480***
Auditory	1.018	2.129	4.641*	12.242**

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

Discussion

The current exploratory study was guided by CBTT (e.g., Gómez, 2017a), which incorporates societal inequality into how within-group violence victimization outcomes are understood. The purpose of the current study was to examine gender differences in the link between ethno-cultural betrayal trauma (also known as within-group violence victimization) and hallucinations in a sample of Latino college students attending a predominantly White university in the United States. The prevalence of hallucinations in this sample (40%) is similar to the rates found in a sample of Asian/Asian American/Pacific Islanders (42%; Gómez, 2017a), as well as general population estimates in various European countries (38.7%; Ohayon, 2000). Data from nine countries suggest that some hallucinations (e.g., auditory hallucinations) are normative in general populations, with prevalence rates as high as 84% (Beavan et al., 2011).

As expected, when controlling for between-group trauma, ethno-cultural betrayal trauma was significantly related to hallucinations [total] and tactile, visual, and auditory hallucinations separately. In addition to contributing to the literature linking violence victimization and hallucinations (e.g., Gómez & Freyd, 2017a; Gómez, Kaehler, & Freyd, 2014; Gracie et al., 2007; Read et al., 2005), these findings provide evidence for CBTT (e.g., Gómez, 2017a), as they suggest that the identity of the perpetrator(s) as an in-group minority member(s) adds a dimension of harm that cannot fully be explained by the trauma itself. Furthermore, when controlling for between-group trauma, these associations were moderated by gender, with ethno-cultural betrayal trauma being linked with all measured hallucinatory experiences: hallucinations [total], and tactile, visual, and auditory hallucinations for men, but not women. Examinations of gender differences in the link between violence victimization and hallucinations has been sparse, particularly in Latino college student populations, who are subject to additional stressors, such as discrimination (Hwang & Goto, 2008; Lopez, 2005). Thus, these preliminary results add to the literature by suggesting that higher rates of hallucinatory experiences among men (e.g., Johns et al., 1998; Tien, 1991) may be affected by the way abuse-related psychological distress is expressed.

Understanding predictors of hallucinations in nonclinical populations has implications for persons who struggle with more extreme forms of psychological distress (e.g., Johns et al., 2002). Furthermore, examining hallucinatory experiences in college may be particularly beneficial as mental health problems tend to arise in early adulthood (Hunt & Eisenberg, 2010; Kessler et al., 2005). Though the findings cannot be generalized to all Latinos or all ethnic minority groups, the current study has preliminary implications for Latino undergraduate students as a community of interest.

By conceptualizing the impact of ethno-cultural betrayal trauma as being affected by societal inequality, the current study contextualizes how violence victimization, psychological distress, and posttraumatic growth can be understood in minority populations specifically. For instance, in using a CBTT lens, abuse-related hallucinations are not understood as occurring in isolation but are contextualized within experiences related to minority status (e.g., discrimination) and cultural values (e.g., DeVylder et al., 2013). Thus, future studies that build on this exploratory work can have implications for clinical interventions; individuals who have experienced ethno-cultural betrayal trauma may benefit from therapy that privileges cultural competency related to gender norms and ethnicity, as issues related to oppression and societal expectations are important in healing from violence victimization (Brown, 2008; Bryant-Davis, 2005; Gómez, Lewis, Noll, Smidt, & Birrell, 2016). Furthermore, hallucinatory experiences for Latinos specifically should be further examined as such experiences may indicate psychological distress (e.g., negative command hallucinations), protective factors (e.g., comfort), or both, as the meaning of posttraumatic outcomes varies as a function of culture, minority status, ethnicity, and processing of abuse (e.g., Brown, 2008; Bryant-Davis, 2005; DeVylder et al., 2013; Johns et al., 2002).

Limitations and Future Directions

There is much room for future research to build upon the current study. First, this study was exploratory with the potential for inflated Type I error due to multiple comparisons; thus, future researchers should attempt to replicate the findings using corrections to alpha levels as warranted. Next, though this study utilized CBTT (e.g., Gómez, 2012) as a guiding framework for examining violence victimization, gender, and hallucinations among Latino college students, understanding the impact of ethnicity, culture, and minority status on mental health requires directly assessing systemic discrimination, perception of discrimination, socioeconomic status (SES), cultural values, levels of (intra)cultural trust, and other factors. In addition, investigating other aspects of the context surrounding violence, such as relationship with the perpetrator (e.g., betrayal trauma theory; Freyd, 1997) and harmful institutional actions and inactions (e.g., institutional betrayal; Smith & Freyd, 2014), could further elucidate the complexity of the aftermath of violence victimization. Specifically, close relationship with the perpetrator could be confounded with within-group ethnicity; therefore, future studies should attempt to disentangle the differential impact of each.

Furthermore, given that (a) religion plays a role in how individuals conceptualize experiences of hallucinations (Earl et al., 2015) and violence (Brown, 2008; Bryant-Davis, 2005) and (b) the majority of the sample reported faith in Christianity, future qualitative and quantitative studies could examine the role that religion and spirituality have in the experience and meaning-making of trauma-related hallucinatory experiences. Finally, though there is theoretical and empirical evidence to suggest that violence victimization predicts hallucinations (Evans, Reid, Preston, Palmier-Claus, & Sellwood, 2015; Gómez, 2017a; Gómez & Freyd, 2017a; Gómez, Kaehler, & Freyd, 2014; Read & Bentall, 2012; Read et al., 2005), temporal precedence could not be established with the cross-sectional design. Therefore, future studies should assess the effect of the link between ethno-cultural betrayal trauma and hallucinations longitudinally.

Concluding Thoughts

Though it is limited in scope and depth, the current preliminary study nevertheless provides insight into the role of minority status, gender, and violence victimization on mental health; specifically, the findings provide a foundation for future work on CBTT, hallucinations, and mental health in Latinos in the United States to build upon. Thus, in demonstrating that the link between ethno-cultural betrayal trauma and hallucinatory experiences is dependent on gender in a sample of Latino undergraduates, lines of empirical inquiry and clinical intervention can incorporate these and other aspects of diversity and the societal context into conceptualizations of trauma healing and mental health across diverse populations.

Footnotes

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by The National Academies of Sciences, Engineering, and Medicine through the Ford Foundation Dissertation Fellowship.

Author Biography

Jennifer M. Gómez, PhD, is a Ford Fellow (2015), coeditor of the special issue of Journal of Trauma & Dissociation—Self Injury & Suicidality: The Impact of Trauma and Dissociation (2015), and current postdoctoral fellow in the Wayne State University Postdoctoral to Faculty Transition Fellowship (PFT) Program studying trauma in minority adolescents and emerging adults at Merrill Palmer Skillman Institute. She developed cultural betrayal trauma theory to examine how violence victimization in conjunction with discrimination affects mental health in minority populations ().

References

Anzaldúa

Keating

(Eds.). (2013). This bridge we call home: Radical visions for transformation. New York, NY: Routledge.

Bauer

G. R.

(2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science & Medicine, 110, 10-17.

Beavan

Read

Cartwright

(2011). The prevalence of voice-hearers in the general population: A literature review. Journal of Mental Health, 20, 281-292.

Brown

L. S.

(2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.

Bryant-Davis

(2005). Thriving in the wake of trauma: A multicultural guide (No. 49). Westport, CT: Greenwood.

Crenshaw

(1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. The University of Chicago Legal Forum, 140, 139-167.

Crenshaw

(1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241-1299.

Daalman

Diederen

K. M. J.

Derks

E. M.

Van Lutterveld

Kahn

R. S.

Sommer

I. E.

(2012). Childhood trauma and auditory verbal hallucinations. Psychological Medicine, 42, 2475-2484.

DeVylder

J. E.

H. Y.

Yang

L. H.

Cabassa

L. J.

Chen

F. P.

Lukens

E. P.

(2013). Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States. Schizophrenia Research, 150, 223-228.

10.

Earl

T. R.

Fortuna

L. R.

Gao

Williams

D. R.

Neighbors

Takeuchi

Alegría

(2015). An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life. Ethnicity & Health, 20, 273-292.

11.

Evans

G. J.

Reid

Preston

Palmier-Claus

Sellwood

(2015). Trauma and psychosis: The mediating role of self-concept clarity and dissociation. Psychiatry Research, 228, 626-632.

12.

Freyd

J. J.

(1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.

13.

Freyd

J. J.

(1997). Violations of power, adaptive blindness and betrayal trauma theory. Feminism & Psychology, 7, 22-32.

14.

Goldberg

L. R.

Freyd

J. J.

(2006). Self-reports of potentially traumatic experiences in an adult community sample: Gender differences and test-retest stabilities of the items in a brief betrayal-trauma survey. Journal of Trauma & Dissociation, 7, 39-63.

15.

Gómez

J. M.

(2012). Cultural betrayal trauma theory: The impact of culture on the effects of trauma. In Blind to betrayal. Retrieved from https://sites.google.com/site/betrayalbook/betrayal-research-news/cultural-betrayal

16.

Gómez

J. M.

(2015a). Conceptualizing trauma: In pursuit of culturally relevant research. Trauma Psychology Newsletter (American Psychological Association Division 56), 10, 40-44.

17.

Gómez

J. M.

(2015b). Rape, Black men, and the degraded Black woman: Feminist psychologists’ role in addressing within-group sexual violence. The Feminist Psychologist: Newsletter for the Society of the Psychology of Women (American Psychological Association Division 35), 42(2), 12-13.

18.

Gómez

J. M.

(2016a, June 23). Black, raped, shamed, and supported: Our responses to rape can build or destroy our community. The Black Commentator, (659). Retrieved from http://www.blackcommentator.com/659/659_campus_rape_gomez_guest.html

19.

Gómez

J. M.

(2016b, May 11). Cultural betrayal trauma theory (Dissertation). Retrieved from http://dynamic.uoregon.edu/jjf/theses/gomez16.pdf

20.

Gómez

J. M.

(2017a). Does ethno-cultural betrayal in trauma affect Asian American/Pacific Islander college students’ mental health outcomes? An exploratory study. Journal of American College Health, 65(6), 432-436.

21.

Gómez

J. M.

(2017b, September). Introducing cultural betrayal as a new dimension of harm: Intra-racial vs. interracial trauma. Paper presented at Michigan Regional Postdoctoral Symposium, Detroit, MI.

22.

Gómez

J. M.

(2017c, September). Testing cultural betrayal trauma theory: Within-group violence victimization among Black college students. Poster presented at the 22nd International Summit on Violence, Abuse & Trauma: Building Peace by Linking Research, Practice, Advocacy & Policy to End Violence & Abuse, San Diego, CA.

23.

Gómez

J. M.

Becker-Blease

Freyd

J. J.

(2015). A brief report on predicting self- harm: Is it gender or abuse that matters? Journal of Aggression, Maltreatment, & Trauma, 24, 203-214. doi:10.1080/10926771.2015.1002651

24.

Gómez

J. M.

Freyd

J. J.

(2017a). High betrayal child sexual abuse and hallucinations: A test of an indirect effect of dissociation. Journal of Child Sexual Abuse, 26. 507-518. doi:10.1080/10538712.2017.1310776

25.

Gómez

J. M.

Freyd

J. J.

(2017b, September). Psychological outcomes of within-group sexual violence: Evidence of cultural betrayal. Poster presented at the 22nd International Summit on Violence, Abuse & Trauma: Building Peace by Linking Research, Practice, Advocacy & Policy to End Violence & Abuse, San Diego, CA.

26.

Gómez

J. M.

Kaehler

L. A.

Freyd

J. J.

(2014). Are hallucinations related to betrayal trauma exposure? A three-study exploration. Psychological Trauma: Theory, Research, Practice, and Policy, 6, 675-682.

27.

Gómez

J. M.

Lewis

J. K.

Noll

L. K.

Smidt

A. M.

Birrell

P. J.

(2016). Shifting the focus: Nonpathologizing approaches to healing from betrayal trauma through an emphasis on relational care. Journal of Trauma & Dissociation, 17, 165-185. doi:10.1080/15299732.2016.1103104

28.

Gómez

J. M.

Rosenthal

M. N.

Smith

C. S.

Freyd

J. J.

(2015). Participant reactions to questions about gender-based sexual violence: Implications for campus climate surveys. eJournal of Public Affairs: Special Issue on Higher Education’s Role on Preventing and Responding to Gender-based Violence, 4, 39-71.

29.

Gómez

J. M.

Smith

C. P.

Freyd

J. J.

(2014). Zwischenmenschlicher und institutioneller verrat [Interpersonal and institutional betrayal]. In Vogt

(Ed.), Verleumdung und Verrat: Dissoziative Störungen bei schwer traumatisierten Menschen als Folge von Vertrauensbrüchen (pp. 82-90). Roland, Germany: Asanger Verlag.

30.

Gracie

Freeman

Green

Garety

P. A.

Kuipers

Hardy

. . . Fowler

(2007). The association between traumatic experience, paranoia and hallucinations: A test of the predictions of psychological models. Acta Psychiatrica Scandinavica, 116, 280-289.

31.

Hames-García

(2011). Identity complex: Making the case for multiplicity. Minneapolis, Minnesota: University of Minnesota Press.

32.

Hunt

Eisenberg

(2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46, 3-10.

33.

Hwang

W. C.

Goto

(2008). The impact of perceived racial discrimination on the mental health of Asian American and Latino college students. Cultural Diversity & Ethnic Minority Psychology, 14, 326-335.

34.

Johns

L. C.

Nazroo

J. Y.

Bebbington

Kuipers

(1998). Occurrence of hallucinations in a community sample. Schizophrenia Research, 29, 23-23.

35.

Johns

L. C.

Nazroo

J. Y.

Bebbington

Kuipers

(2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. The British Journal of Psychiatry, 180, 174-178.

36.

Kessler

R. C.

Berglund

Demler

Jin

Merikangas

K. R.

Walters

E. E.

(2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

37.

Lopez

J. D.

(2005). Race-related stress and sociocultural orientation among Latino students during their transition into a predominately White, highly selective institution. Journal of Hispanic Higher Education, 4, 354-365.

38.

Morrison

A. P.

Petersen

(2003). Trauma, metacognition and predisposition to hallucinations in non-patients. Behavioural and Cognitive Psychotherapy, 31, 235-246.

39.

Ohayon

M. M.

(2000). Prevalence of hallucinations and their pathological associations in the general population. Psychiatry Research, 97, 153-164.

40.

Porter

McQuiller Williams

(2011). Intimate violence among underrepresented groups on a college campus. Journal of Interpersonal Violence, 26, 3210-3224.

41.

Read

Bentall

R. P.

(2012). Negative childhood experiences and mental health: Theoretical, clinical and primary prevention implications. The British Journal of Psychiatry, 200, 89-91. doi:10.1192/bjp.bp.111.096727

42.

Read

Van Os

Morrison

A. P.

Ross

C. A.

(2005). Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica, 112, 330-350. doi:10.1111/acp.2005.112.issue-5

43.

Shear

M. D.

Davis

J. H.

(2017, September 5). Trump moves to end DACA and calls on Congress to act. The New York Times. Retrieved from https://www.nytimes.com/2017/09/05/us/politics/trump-daca-dreamers-immigration.html

44.

Smith

C. P.

Freyd

J. J.

(2014). Institutional betrayal. American Psychologist, 69, 575-587.

45.

Smith

C. P

Gómez

J. M.

Freyd

J. J.

(2014). The psychology of judicial betrayal. Roger Williams University Law Review, 19, 451-475. Retrieved from http://docs.rwu.edu/cgi/viewcontent.cgi?article=1539&context=rwu_LR

46.

Tang

S. S.

Freyd

J. J.

(2012). Betrayal trauma and gender differences in posttraumatic stress. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 469-478.

47.

Tavakol

Dennick

(2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53-55.

48.

Tien

A. Y.

(1991). Distribution of hallucinations in the population. Social Psychiatry & Psychiatric Epidemiology, 26, 287-292.

49.

World Health Organization. (1990). Composite International Diagnostic Interview (CIDI. Version 1) “Beliefs and Experiences Module.” Geneva, Switzerland: Author.