@article{ref1,
title="Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events",
journal="Psychological trauma: theory, research, practice, and policy",
year="2017",
author="Jordan, Alexander H. and Eisen, Ethan and Bolton, Elisa and Nash, William P. and Litz, Brett T.",
volume="9",
number="6",
pages="627-634",
abstract="OBJECTIVE: We investigated whether potentially morally injurious events (PMIEs) during a combat deployment may lead to PTSD through distinct pathways from danger-based events. We also examined the prevalence of perpetration-based PMIEs, during which service members behaved in ways that violated their own moral values, and betrayal-based PMIEs, during which personal moral expectations were violated by trusted others. <br><br>METHOD: Using a sample of 867 active duty Marines from a single infantry battalion that engaged in heavy ground combat while deployed to Afghanistan, a structural equation model was built to examine the relationships between perpetration- and betrayal-based PMIEs, combat experiences, and peritraumatic dissociation reported at 1 month postdeployment, and guilt/shame, anger, and PTSD symptoms reported at 8 months postdeployment. <br><br>RESULTS: The relationship between betrayal-based PMIEs and PTSD was mediated by anger (β =.14). There was marginal evidence of mediation of the relationship between perpetration-based PMIEs and PTSD by shame and guilt (β =.09), and of the relationship between danger-based combat events and PTSD by peritraumatic dissociation (β =.08). No significant direct relationships were found between any of these 3 types of events and subsequent PTSD. Perceived perpetration and betrayal accounted for PTSD symptoms above and beyond combat exposure. Over a third of the sample reported experiencing perpetration- or betrayal-based PMIEs. <br><br>CONCLUSIONS: The associations of perpetration and betrayal with PTSD, controlling for danger-based combat events, highlight the limitations of conceptualizations and treatments of PTSD based on fear or helplessness as sole etiologic factors. (PsycINFO Database Record<br><br>(c) 2017 APA, all rights reserved).<p /> <p>Language: en</p>",
language="en",
issn="1942-9681",
doi="10.1037/tra0000249",
url="http://dx.doi.org/10.1037/tra0000249"
}