How Do Morally Injurious Events Occur? A Qualitative Analysis of Perspectives of Veterans With PTSD

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Morally injurious events (MIEs) represent a distinct type of trauma that veterans might confront in the context of their war-zone service. However, there is little research on contextual factors that may contribute to MIEs in this population. As such, the present study examined the possible circumstances of MIEs by probing into the perspectives of 14 veterans from the Iraq/Afghanistan era who were in the final month of completing an intensive residential treatment program for PTSD. Drawing on emerging research findings and clinical knowledge on moral injury, semistructured interviews were conducted to inquire about the veterans’ explanations for why MIEs occurred during their war-zone deployments. Content analytic procedures yielded a total of 25 distinct themes that comprised 4 higher order clusters – (a) organizational circumstances, (b) environmental circumstances, (c) cultural and relational circumstances, and (d) psychological circumstances. Findings are discussed in relation to emerging conceptions of moral injury in the military trauma literature and possible applications for future research and clinical practice with morally injured veterans.

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