Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events.

Alexander Jordan · Ethan Eisen · Elisa E. Bolton · William P. Nash · Brett T. Litz

168 citations0/0 files storedPsychological Trauma Theory Research Practice and Policy

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Posttraumatic Stress Disorder Research Psychoanalysis and Psychopathology Research Migration, Health and Trauma

Abstract

OBJECTIVE: We investigated whether potentially morally injurious events (PMIEs) during a combat deployment may lead to PTSD through distinct pathways from danger-based events. We also examined the prevalence of perpetration-based PMIEs, during which service members behaved in ways that violated their own moral values, and betrayal-based PMIEs, during which personal moral expectations were violated by trusted others. METHOD: Using a sample of 867 active duty Marines from a single infantry battalion that engaged in heavy ground combat while deployed to Afghanistan, a structural equation model was built to examine the relationships between perpetration- and betrayal-based PMIEs, combat experiences, and peritraumatic dissociation reported at 1 month postdeployment, and guilt/shame, anger, and PTSD symptoms reported at 8 months postdeployment. RESULTS: The relationship between betrayal-based PMIEs and PTSD was mediated by anger (β = .14). There was marginal evidence of mediation of the relationship between perpetration-based PMIEs and PTSD by shame and guilt (β = .09), and of the relationship between danger-based combat events and PTSD by peritraumatic dissociation (β = .08). No significant direct relationships were found between any of these 3 types of events and subsequent PTSD. Perceived perpetration and betrayal accounted for PTSD symptoms above and beyond combat exposure. Over a third of the sample reported experiencing perpetration- or betrayal-based PMIEs. CONCLUSIONS: The associations of perpetration and betrayal with PTSD, controlling for danger-based combat events, highlight the limitations of conceptualizations and treatments of PTSD based on fear or helplessness as sole etiologic factors. (PsycINFO Database Record

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References

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2017Development and evaluation of the E xpressions of M oral I njury S cale— M ilitary V ersion 2021Moral injury, mental health and behavioural health outcomes: A systematic review of the literature 2021Compromised Conscience: A Scoping Review of Moral Injury Among Firefighters, Paramedics, and Police Officers 2019Assessment of Moral Injury in Veterans and Active Duty Military Personnel With PTSD: A Review

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