Childhood maltreatment and psychopathology during collective trauma: the longitudinal role of betrayal-related moral injury

Abstract

Background: Childhood maltreatment (CM) is a risk factor for posttraumatic stress disorder (PTSD), depression, and anxiety, yet the mechanisms linking early adversity to later vulnerability during traumatic events remain unclear. Betrayal-related moral injury (MI-betrayal) - the perception that trusted others or institutions have violated core moral expectations - has been proposed as one such mechanism. Since CM often involves betrayal, it may heighten sensitivity to later violations of trust, particularly during collective trauma in the context of war, when large-scale security breakdowns may be perceived as institutional failure to protect civilians. Objective: This study tested whether MI-betrayal may function as a longitudinal process linking CM with symptoms of PTSD, depression, and anxiety among civilians in the aftermath of the events of 7 October 2023. Methods: A total of 1052 individuals (aged 18-40) participated in the study. CM was measured with the Childhood Trauma Questionnaire; MI-betrayal with the Moral Injury Events Scale; and psychopathology with the PC-PTSD-5, PHQ-9, and GAD-7. Cross-lagged panel models were used to examine bidirectional longitudinal associations between betrayal-related appraisals and psychological symptoms, controlling for their stability over time. Results: CM was associated with higher MI-betrayal, PTSD, depressive, and anxiety symptoms at baseline. Both MI-betrayal and symptoms showed strong stability over time. Psychological symptoms more consistently predicted subsequent betrayal than the reverse. Conclusions: CM may confer heightened vulnerability to moral-injury appraisals during collective trauma. Distress more consistently predicted later betrayal-related appraisals, suggesting a dynamic, bidirectional pattern rather than a single unidirectional pathway. Future research should refine developmental models of MI.