Moral injury
It’s been awhile since I posted about moral injury. From the What Is Moral Injury website: “Moral injury is the damage done to one’s conscience or moral compass when that person perpetrates, witnesses, or fails to prevent acts that transgress one’s own moral beliefs, values, or ethical codes of conduct.“
Here, we look at two articles related to posttraumatic stress. First, Mojallal, Simons, Simons & Swaminath (2024) published “Betrayal Trauma, Mindfulness, and Emotional Dysregulation: Associations with moral injury and posttraumatic stress disorder” in Traumatology. Here’s the edited abstract:
This study tested a structural equation model of associations between betrayal and nonbetrayal trauma, mindfulness, emotional dysregulation, shame, moral injury, and posttraumatic stress disorder symptoms (PTSS) in a sample of college students (N = 680). We hypothesized significant associations between betrayal trauma and PTSS and moral injury, mediated by facets of emotional dysregulation and shame and moderated by mindfulness. Betrayal trauma was associated with PTSS directly and indirectly, via the following facets of emotional dysregulation: lack of emotional clarity, limited access to strategies, and difficulty in impulse control. Betrayal trauma was also associated with moral injury directly, and indirectly via limited access to strategies. Mindfulness was associated with PTSS directly, and indirectly via four facets of emotional dysregulation and moral injury. Mindfulness was also indirectly associated with PTSS via shame and moral injury, and limited access to strategies and moral injury. Mindfulness was also associated with moral injury directly and indirectly via shame and limited access to strategies. Mindfulness did not moderate the associations between betrayal trauma and facets of emotional dysregulation. The indirect effect of betrayal trauma on moral injury via shame was not significant over and above other variables. The findings extend the existing literature and support the hypotheses on the indirect effects of betrayal trauma and mindfulness on moral injury and PTSD via facets of emotional dysregulation and shame. However, it did not support the moderating effect of mindfulness on the associations between betrayal trauma and emotional dysregulation.
This is a fairly large sample and I like the relationship between betrayal trauma and posttraumatic stress via emotional dysregulation facets of lack of emotional clarity, limited access to strategies, and difficulty in impulse control. It makes sense to me that limited access to strategies and shame are associated with mindfulness and moral injury, but mindfulness didn’t moderate associations between betrayal trauma and emotional dysregulation. This suggests to me that shame and mindfulness have complicated relationships to both moral injury and posttraumatic stress. The next study looks at moral injury and posttraumatic stress in veterans. Aronson, Morgan, Doucette, McCarthy, Davenport & Perkins (2024) published “Associations Among Combat Exposure, Adverse Childhood Experiences, Moral Injury, and Posttraumatic Growth in a Large Cohort of Post-9/11 Veterans” in Psychological Trauma: Theory, Research, Practice, and Policy. Here are the edited abstract and impact statement:
Post-9/11 veterans experienced more deployments, combat exposure, and disability than earlier military cohorts. Those in the military are also more likely to have experienced adverse childhood experiences. Despite these traumatic exposures, a substantial number of veterans report experiencing personal growth, development, and maturity from their military service. This longitudinal survey study (n = 5,245) examined the degree to which posttraumatic growth (PTG) was present among post-9/11 veterans. Several components of PTG were examined, including relating to others, seeing new possibilities, personal strength, spiritual growth, and appreciation for life. Respondents rated their degree of personal growth and new appreciation of life most highly, while spiritual growth and appreciation of others were the least highly rated. Female veterans reported greater PTG. Veterans who experienced traumatic events (i.e., combat exposure, adverse childhood experiences), screened positive for posttraumatic stress disorder, and moral injury reported greater PTG than those who had not experienced those events or screened positive for posttraumatic stress disorder. Veterans reporting higher levels of social support and personal resilience were less likely to experience PTG. Veterans with other protective factors were more likely to experience PTG. Post-9/11 veterans report PTG in the face of various traumatic exposures.
This study provides information about the trauma experiences of post-9/11 veterans, as well as their ability to experience PTG. The findings suggest that PTG contributes to the successful transition of numerous post-9/11 veterans to civilian life.