Conceptualization of moral injury: A socio-cognitive perspective

LAY SUMMARY This article looks at how moral injury (MI) may develop by considering what event features may be especially salient and cause MI and what experiences an individual may have after an event that might lead to the occurrence of a MI. It proposes that the beliefs someone has about themselves, others, and the world can be shaped by experiences in childhood and early life. Once an individual has experienced a potentially morally injurious event (PMIE) - for example, witnessing something that violates deeply held moral or ethical codes but being unable to stop it, doing something that violates these ethical codes, or experiencing a significant betrayal - they may try to make sense of it by changing the way they see the world, themselves, and others. This can lead to problems in the individual's relationship with themselves and others, leading to feelings of shame and guilt and withdrawal from other people. More important, for an event to be a PMIE, it must significantly challenge strongly held moral beliefs and a sense of right and wrong. As research into moral injury (MI) develops, a clearer conceptualization is needed to support further research and development of treatments. This article draws on the existing MI literature and proposes a new model for its conceptualization. The authors propose that central to MI is deterioration in the relationship with self, others, and humanity, leading to global belief and behavioural changes. A definition of what is, and is not, a potentially morally injurious event (PMIE) is also presented, and the authors argue that events need to be high stakes and threaten previously held beliefs, regardless of the event's outcome. The model highlights key predisposing factors that may influence the later development and maintenance of MI, such as adverse childhood experiences and factors surrounding the event. By considering what distinguish PMIEs from Diagnostic and Statistical Manual of Mental Dirorderr (5th ed.) posttraumatic stress disorder criterion A events and what factors may lead to MI, a better understanding of MI development and treatment can be considered. Tandis que les recherches sur les blessures morales (BM) prennent de l'expansion, une conceptualisation plus claire s'impose pour appuyer les futures recherches et l'elaboration de traitements. Cet article, qui repose sur les publications scientifiques a l'egard des blessures morales, propose un nouveau modele pour les conceptualiser. Les auteur(e)s avancent qu'au c oe ur des BM se trouve la deterioration de la relation avec soi, autrui et l'humanite, qui entraine des changements globaux aux croyances et aux comportements. Ils et elles presentent egalement une definition de ce que sont et ne sont pas des evenements au potentiel prejudiciable sur le plan moral (ePPM) et soutiennent que ceux-ci doivent etre lies a de grands enjeux et menacer des croyances anterieures, quelle qu'en soit l'issue. Le modele fait ressortir les principaux facteurs predisposants qui peuvent influer sur la future apparition et la persistance des BM, tels que les experiences negatives de l'enfance et les facteurs entourant l'evenement. Au moment d'evaluer ce qui distingue les ePPM des evenements repondant au critere A du trouble de stress post-traumatique du Manuel diagnostique et statistique des troubles mentaux (5e edition), ainsi que les facteurs susceptibles de provoquer des BM, on peut envisager de mieux comprendre l'apparition et le traitement des BM.