Moral Injury and Shame Mediate the Relationship Between Childhood Trauma and Borderline Personality Disorder, PTSD, and Complex PTSD Symptoms in Psychiatric Inpatients

Abstract

Moral injury (MI) has received increased research attention in the past decades. However, despite its detrimental mental health consequences, MI has not been studied in psychiatric patients. We aimed to establish the relationship between childhood trauma, MI, and borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and disturbances in self-organization symptoms (DSO), a core diagnostic criterion of complex PTSD besides PTSD symptoms, and shame as a moral emotion in an inpatient psychiatric sample (N = 240). We found that the impact of childhood trauma on present BPD, PTSD, and DSO symptoms was mediated by MI and shame; the models accounted for up to 31% of variance in symptomatology. To our knowledge, this study is the first to investigate MI in a psychiatric sample, and our results highlight the importance of considering MI as a critical factor of patient experiences in relation to childhood trauma that potentially contributes to the development of psychiatric symptoms.

Historical intergenerational trauma transmission model: A comprehensive framework of family and offspring processes of transgenerational trauma.

“…Thus, HMI undermines basic humanistic beliefs about the meaning of life and the general good of all people. Moral injury has been shown to be related to distress, as well as feelings of shame and guilt (Békés et al, 2023; Litz et al, 2009). Studies have highlighted feelings of injustice and moral outrage, loss of trust, and sense of betrayal in HT survivor families.…”