A Scheme for Categorizing Traumatic Military Events

1VA Boston Healthcare System, MA, USA.
Behavior modification (Impact Factor: 2.23). 06/2012; 36(6):787-807. DOI: 10.1177/0145445512446945
Source: PubMed


A common assumption among clinicians and researchers is that war trauma primarily involves fear-based reactions to life-threatening situations. However, the authors believe that there are multiple types of trauma in the military context, each with unique perievent and postevent response patterns. To test this hypothesis, they reviewed structured clinical interviews of 122 active duty service members and assigned the reported index (principal, most currently distressing) events to one or more of the following categories: Life Threat to Self, Life Threat to Others, Aftermath of Violence, Traumatic Loss, Moral Injury by Self, and Moral Injury by Others. They found high interrater reliability for the coding scheme and support for the construct validity of the categorizations. In addition, they discovered that certain categories were related to psychiatric symptoms (e.g., reexperiencing of the traumatic event, guilt, anger) and negative thoughts about the world. Their study provides tentative support for use of these event categories.

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Available from: Patricia A Resick, Oct 30, 2015
    • "Another definition conceptualizes MI as " a betrayal of what's right; by someone who holds legitimate authority (e.g., in the military—a leader); in a high stakes situation " (Shay, 2014, p. 183). Examples of morally injurious events include witnessing the consequences of violence and human carnage, having to cope with a painful loss, feeling betrayed by one's leaders, transgressing a moral code, or failing to prevent immoral acts (Currier, Holland, Drescher, & Foy, 2015; Litz et al., 2009; Nash et al., 2013; Stein et al., 2012). MI is different from PTSD in that it has been likened to a primary psychological injury with no clear diagnostic threshold (Drescher & Foy, 2008; Maguen & Litz, 2015; Shay, 2011). "
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    ABSTRACT: Moral injury is an emergent clinical concern within the literature examining mental health outcomes among current and former military personnel. Experiences of moral injury include potentially significant psychosocial consequences, highlighting the need for military social work practice to identify and treat it among clients. The objectives of this article are to: (a) describe and raise awareness of the concept of moral injury as a clinical concern for social workers in military practice; (b) advocate for the enhancement of social work competencies and practice behaviors in addressing the psychological and psychosocial needs of service members and veterans experiencing moral injury; and, (c) as research and an evidence-base for practice develops in this field, suggest ways to integrate moral injury in social work curricula based on the Advanced Social Work Practice in Military Social Work document, published by the Council for Social Work Education.
    No preview · Article · Jul 2015 · Journal of Religion & Spirituality in Social Work
    • "Moral injury is conceptualized as 'perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations' (Litz et al., 2009). In addition to life-threatening situations, military personnel may also have to deal with morally injurious events, examples of which include witnessing the aftermath of violence, coming to grips with a painful loss, and having one's moral/ethical beliefs contravened (Nash et al., 2013; Stein et al., 2012). Moral injury has been compared to a primary psychological trauma which may not necessarily be encompassed by a diagnosis of post-traumatic stress disorder (Drescher & Foy, 2008; Shay, 2011). "

    No preview · Article · Nov 2014 · International Journal of Social Psychiatry
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    • "The unique nature of these conflicts—reflective of theater-specific duties and experiences—could influence symptom presentation and treatment (Tuerk, Grubaugh, Hamner, & Foa, 2009). Besides experiencing situations which may pose a threat to the life of the service member or those close to them, the experience of active duty may also include witnessing violence, experiencing a painful loss, or having one's ethical or moral standards contravened (Nash et al., 2013; Stein et al., 2012). This has given way to the idea of spiritual or moral injury in Veteran populations, conceptually defined as " perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations " (Litz et al., 2009, p. 700). "
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    ABSTRACT: In recent years, identifying ways to mitigate the risk of suicidal behavior in Veteran populations has become a major public health challenge of special significance. This has included identifying support options that can be used by Veterans in times of distress or crisis. For example, Veterans at increased risk of suicide will sometimes voice complaints indicative of a need for spiritual and pastoral care support. At U.S. Department of Veterans Affairs Medical Centers, such support is provided to Veterans by clinical chaplains. This discussion paper aims to present the contextual framework in which chaplaincy services are provided to Veterans at increased risk of suicide, better conceptualize the spiritual and pastoral care needs of at-risk Veterans who request chaplaincy services, and offer practical suggestions for framing the provision of spiritual and pastoral care services.
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