Recently, post-secondary institutions have been under increased public and academic scrutiny regarding their ability to prevent and respond to instances of campus sexual violence. Emerging research has explored institutional betrayal (IB), which is a theoretical framework that states that actions and inactions on the part of the institution can cause further harm to survivors of violence. The goals of this review were, using an ecological systems lens, to identify what specific behaviors, policies, responses, and other factors constitute IB or institutional support (IS) as defined by the existing literature. A search of 16 databases across 8 disciplines led to the identification of 100 articles that mentioned either IB or IS verbatim. Factors that can be categorized as IB and IS were identified across nine levels: (1) the individual level, (2) the interpersonal level, (3) within institutional spaces, (4) within institutional procedures, (5) within institutional policies, (6) at the institutional structural level, (7) at the institutional culture level, (8) at a government and public policy level, and (9) within greater societal cultural values and established social norms. IB itself manifests across all levels of the institution and is, in fact, quite insidious—it is largely invisible and deeply rooted in systemic oppression, woven into the structure of institutions of higher education. IB remains a looming, almost inevitable outcome of the structural violence that occurs in post-secondary settings. Yet, IS and the related concept of institutional courage are emerging fields of study that pose important implications for institutional change.