Moral Injury and ICD-11 Complex PTSD (CPTSD) Symptoms among Treatment-Seeking Veterans in the United Kingdom

Abstract

Military veterans often encounter events with chronic or repeated traumas of an interpersonal nature that might lead to emotional, relational, and spiritual suffering. Research is needed to assess whether and/or how emerging conceptions of moral injury (MI) align with existing trauma-related conditions. Focusing on 173 veterans from the United Kingdom who had recently pursued mental health treatment, we examined associations between self- and other-directed outcomes related to MI and World Health Organization International Classifcation System for Diseases, 11th version (ICD-11) criteria for posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) in two ways. First, drawing on psychometrically validated tools for assessing MI (Currier et al., 2017) and PTSD/CPTSD (Cloitre et al., 2018), ANOVAs revealed the 57.2% of veterans in the sample who possibly met criteria for CPTSD reported greater MI related to both perpetration- and betrayal-based events compared to those with and without possible PTSD. Second, latent profile analysis revealed two distinct classes based on the symptom severity of MI and CPTSD. Specifically, when examining the six symptom clusters for CPTSD dimensionally, four in five of the veterans endorsed high levels of distress related to all indicators of MI and CPTSD symptoms compared to a group with consistently lower scores. Overall, the two sets of findings suggest the special relevance of MI among veterans who are struggling with CPTSD.