Distinguishing War-Related PTSD Resulting From Perpetration- and Betrayal-Based Morally Injurious Events
Distinguishing War-Related PTSD Resulting From Perpetration- and Betrayal-Based Morally Injurious Events
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DOI：
10.1037/tra0000249
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发表时间：
2017-11-01
影响因子：
6.3
通讯作者：
Litz, Brett T.
中科院分区：
文献类型：
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作者：
Jordan, Alexander H.;Eisen, Ethan;Litz, Brett T.
目的：我们调查了战斗部署期间潜在的道德伤害事件(PMIE)是否可能通过不同于基于危险的事件的途径导致创伤后应激障碍。我们还考察了基于承诺的PMIE和基于背叛的PMIE的盛行情况，前者是指服役人员的行为方式违反了他们自己的道德价值观，后者是指在此期间，个人的道德期望被信任的其他人违背了。方法：以一个步兵营的867名现役海军陆战队士兵为样本，在部署到阿富汗期间进行了激烈的地面战斗，建立了一个结构方程模型，以检验部署后1个月报告的基于实施和背叛的PMIE、战斗经历和创伤后分离与部署后8个月报告的内疚/羞耻、愤怒和创伤后应激障碍症状之间的关系。结果：基于背叛的PMIE与创伤后应激障碍之间的关系受愤怒的影响(β=0.14)。有边缘证据表明，羞耻和内疚在基于实施的PMIE和创伤后应激障碍之间起中介作用(β=0.09)，基于危险的战斗事件和创伤后应激障碍之间的关系通过创伤周围分离(β=0.08)。未发现这三种事件中的任何一种与随后的创伤后应激障碍有显著的直接关系。感受到的犯罪和背叛是创伤后应激障碍症状超过战斗暴露的原因。超过三分之一的样本报告说经历过基于实施或背叛的PMIE。结论：实施和背叛与创伤后应激障碍的关联，控制了基于危险的战斗事件，突出了基于恐惧或无助作为唯一病因的创伤后应激障碍概念化和治疗的局限性。
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. 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. Results: The relationship between betrayal-based PMIEs and PTSD was mediated by anger (beta = .14). There was marginal evidence of mediation of the relationship between perpetration-based PMIEs and PTSD by shame and guilt (beta = .09), and of the relationship between danger-based combat events and PTSD by peritraumatic dissociation (beta = .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. 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.