Moral Injury and PTSD: Toward an Integrated Model of Complex, Combat-related Trauma

Abstract

The provisional construct “moral injury” has been proposed as a means to recognize the impact of certain stressor events commonly encountered in war, yet excluded from the current definition of postraumatic stress disorder (PTSD), especially the psychological consequences of moral violations, whether experienced as perpetrator, witness, or victim. Although frequently co-morbid and exhibiting similar syndromes of symptoms, there is at the present time no clear means by which to conceptualize the relationship between moral injury and PTSD. Drawing upon resources from diverse disciplines, including contemporary neuroscience, dynamical systems theory, cognitive psychology, and psychoanalysis, this dissertation addresses this conceptual gap by first proposing a theoretical model of psychological health as the integration of information processing in the mind and in the brain—alternatively conceptualized as “the self”—as well as corresponding general, theoretical models of psychological disorder and psychological trauma as the impairment of such integration. On this basis, this dissertation then proposes an integrated theoretical model of both moral injury and PTSD, the relationships between them, and their associated syndromes. The implications of this model for clinical care and further research are also considered.