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

Objective: 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. Method: 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 the World Health Organization's International Classification System for Diseases, 11th version (ICD-11), criteria for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in two ways. Results: First, drawing on validated tools for assessing MI and PTSD/CPTSD, analyses of variance revealed 57.2% of veterans in the sample who possibly met criteria for CPTSD reported greater MI related to perpetration- and betrayal-based events compared to those with and without possible PTSD. Second, latent profile analysis revealed two distinct classes based on symptom severity of MI and CPTSD. Specifically, when we examined the six symptom clusters for CPTSD dimensionally, four in five veterans endorsed high levels of distress related to all indicators of MI and CPTSD symptoms compared to a group with lower scores. Conclusions: Overall, the two sets of findings suggest the special relevance of MI among veterans who are struggling with CPTSD.