🗡️ When Pain Comes from Betrayal: The Hidden Wounds Behind Chronic Symptoms

Lingering pain may not just be about what happened to your body—but about who hurt you, and how deeply they betrayed your trust.

For years, chronic pain has been explained through structural injuries, inflammation, and nervous system sensitisation. But emerging research reveals another layer to the story—the psychological pain of betrayal may physically manifest in the body, influencing not only how we feel but how we heal.

Two major studies—across civilians and veterans—now show us that betrayal trauma is associated with chronic pain.

Let’s unpack the research—and what it means for healing.

Stabbed in the bark

😔 Study #1: When Those Closest Cause the Most Damage

The 2012 study by Goldsmith et al., examined the impact of “high betrayal trauma” (such as abuse by a caregiver or trusted loved one) versus low betrayal trauma (e.g., natural disasters or accidents).

📊 Among 185 university students:

• Over 50% had experienced at least one betrayal trauma.

• High-betrayal traumas were linked to:

  • Higher rates of depression, anxiety, and dissociation

  • More physical health complaints

  • More days sick in the past month

The results indicate that betrayal trauma is associated with young adults’ physical and mental health difficulties to a greater extent than are other forms of trauma.

🪖 Study #2: Moral Injury in Veterans – Betrayal & Pain Intensify Together

In a 2022 study of nearly 12,000 U.S. veterans, researchers explored a concept called moral injury—distress from experiences that violate one’s deeply held moral beliefs, such as:

• Witnessing or perpetrating a morally injurious event

• Being betrayed by trusted leaders, peers or those outside the military

💥 Key finding: Betrayal—not witnessing or perpetration—was significantly associated with higher pain intensity.

And this effect was strongest in female veterans, where betrayal also predicted joint pain, even after accounting for PTSD and adverse childhood experiences.

PTSD symptoms partially explained this link—but betrayal had a unique impact on pain, independent of PTSD severity.

🔪 How Does Betrayal Trauma Trigger Pain?

Think of betrayal trauma like an emotional virus: invisible, often dormant—but with profound systemic effects.

Here’s one mechanism:

1. Trust is Broken: The nervous system registers betrayal as a threat to safety and survival.

2. Emotions Are Suppressed: Especially in invalidating environments, people may disconnect from their emotions (alexithymia).

3. Body Keeps the Score: This threat and emotional shutdown increases physiological arousal, dysregulates the immune system, and promotes somatisation—where emotional pain shows up as physical symptoms.

4. Pain Becomes Persistent: These unresolved emotional loops keep the brain in a state of hypervigilance, fuelling ongoing pain even in the absence of physical injury.

🎯 Healing Betrayal Requires a Biopsychosocial Approach

A pivotal paper by Gómez et al. called out a critical issue in the medical model that seeks to find treatments based on an individual's symptoms:

“Trauma treatments grounded in this paradigm implicitly locate the pathology of trauma within the individual—often an individual who has been deeply betrayed—instead of within the person(s) or environment(s) responsible for the betrayal.”

They argue that standard, symptom-focused treatments—while sometimes helpful—often pathologize survivors, reinforcing the belief that they are broken whilst minimising the pathology of those actually responsible.

Asking about social relationships can be uncomfortable as many clinicians are more accustomed to the biomedical model; however, recognition of toxic social environments, such as at work or within a family, can be essential in empowering someone to heal. It is therefore crucial that these areas are asked about as part of a thorough history taking.

🪬Pain Isn’t Just About Damage—It’s About Protection

Pain is a message - not a malfunction.

Pain's inherent discomfort prompts action, which can be incredibly helpful if it alerts you to and gets you out of an environment where someone close to you is betraying you. It is very hard to heal whilst being stabbed in the back.

Being hurt by someone close to you is not your fault, but it is your responsibility to decide how you respond. Social dynamics can be incredibly complex to navigate and if you do have pain related to betrayal trauma, you may, on balance, decide a change of environment is not what is best for you right now, all things considered.

Regardless, giving voice to the unspoken via healthy social connection—and freeing the nervous system from the burden of holding it all in is where healing begins.

References

• Goldsmith, R. E., Freyd, J. J., & DePrince, A. P. (2012). Betrayal trauma: associations with psychological and physical symptoms in young adults. Journal of interpersonal violence, 27(3), 547–567. https://doi.org/10.1177/0886260511421672

• 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 : the official journal of the International Society for the Study of Dissociation (ISSD), 17(2), 165–185. https://doi.org/10.1080/15299732.2016.1103104

• Ranney, R. M., Maguen, S., Bernhard, P. A., Holder, N., Vogt, D., Blosnich, J. R., & Schneiderman, A. I. (2022). Moral injury and chronic pain in veterans. Journal of psychiatric research, 155, 104–111. https://doi.org/10.1016/j.jpsychires.2022.08.009