Moral injury appraisals and dissociation: Associations in a sample of trauma-exposed community members

ABSTRACT

Appraisal of trauma is a critical factor in the development of impairing post-traumatic stress symptoms, such as dissociation. Individuals may appraise trauma as morally injurious (i.e., moral injury exposure [MIE]) and experience subsequent moral distress related to this exposure (i.e., moral injury distress [MID]). To date, however, investigation into the relations between moral injury appraisals and dissociation has been limited, particularly within community populations. This study investigated MIE and MID in relation to six facets of dissociation (disengagement, depersonalization, derealization, memory disturbances, emotional constriction, identity dissociation) in a sample of trauma-exposed community members (n = 177, 58.2% Black, 89.3% female) recruited from a public hospital and/or community advertisements. Participants completed measures assessing trauma exposure, MIE, MID, dissociation, and posttraumatic stress disorder (PTSD) symptoms. Partial correlation analyses revealed that after controlling for PTSD symptoms, MIE was correlated with disengagement, r = .23, p ≤ .025, and depersonalization, r = .25, p ≤ .001, and MID was correlated with depersonalization, r = .19, p ≤ .025. Sex moderated each association, with stronger associations observed for female participants. Findings suggest that moral injury appraisals are linked to more severe dissociative symptoms among female civilians, and as such, may need to be specifically targeted in empirically supported treatments.

KEYWORDS:

• Moral injury
• dissociation
• sex
• PTSD
• civilians

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data and materials that support the results or analyses presented in this study will be made available via e-mail to the corresponding author, EL ([email protected]), upon reasonable request.

Additional information

Funding

This work was primarily supported by the National Institutes of Mental Health (MH101380 to NF) and the National Center for Complementary and Integrative Health (AT011267 to NF). Support was also received from the Emory Medical Care Foundation and American Psychological Association, Society for Clinical Neuropsychology.