Commentary on the Special Issue on Moral Injury: Advances, Gaps in Literature, and Future Directions

Abstract

We contextualize and provide commentary on articles in the current issue that address the nature, measurement, and consequences of exposure to potentially morally injurious events (PMIEs) and moral injury (MI). PMIEs involve acts of commission or omission of oneself and others and can include perpetration of, and failure to prevent, harm; MI includes “the lasting psychological, biological, spiritual, behavioral, and social impact of perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations” (Litz et al., 2009). New and informative research aims to characterize types of PMIEs among military service members and veterans, including in multinational samples. There are also ongoing efforts to devise outcome scales that reliably capture broad MI outcome themes. Further, several new measures of MI assess emotional, cognitive, and behavioral responses of wrong‐doing; the nature of distress following PMIEs in civilians, servicemembers, and veterans; and interpersonal consequences in youth. These are promising efforts toward ecologically valid definitions of a potential MI phenotype. Notably, PMIEs may or may not meet DSM PTSD Criterion A, yet early longitudinal data reveal predictive and reciprocal effects of MI and PTSD on one another. Further, a growing literature on MI outcomes beyond PTSD is identifying ways in which MI is linked to alcohol misuse and self‐injurious behaviors. The sum of these efforts has led experts to consider the utility and shortcomings of extant PTSD interventions for individuals with MI. We address clinical implications of this emerging research domain, gaps in the literature, and future directions for research.

The Role of Moral Injury in PTSD Among Law Enforcement Officers: A Brief Report

“…Practically, questions remain regarding best practices for treating moral injury and the extent to which current treatments for PTSD are suitable to treat moral injury (e.g. Barnes et al, 2019;Griffin et al, 2019;Neria and Pickover, 2019) or if new treatments designed specifically for moral injury would be more efficacious (e.g. Jordan et al, 2017).…”

Associations between moral injury, PTSD clusters, and depression among Israeli veterans: a network approach

“…These experiences may, in turn, trigger significant moral dissonance, which, if left unresolved, could lead to the development of posttraumatic stress disorder (PTSD) symptoms along with deep psychological, behavioural, and spiritually aversive consequences (e.g. Jordan, Eisen, Bolton, Nash, & Litz, 2017;Neria & Pickover, 2019).…”

Moving Moral Injury Into the Future With Functional Contextualism: A Response to Nash's “Unpacking Two Models for Understanding Moral Injury” (2019)

“…Several authors in the Journal of Traumatic Stress special issue on MI (Griffin et al, 2019;Litz & Kerig, 2019;Neria & Pickover, 2019) note that one of the major advances in the MI field has been its extension to civilian populations (e.g., Chaplo, Kerig, & Wainryb, 2019;Steinmetz, Gray, & Clapp, 2019). This expansion is important given that morality is a ubiquitous component of both human flourishing and suffering and thus pertains to a wide variety of life experiences, clinical issues, and research questions.…”