Duke-UNC Brain Imaging and Analysis Center, Duke University, Durham, North Carolina.
VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, North Carolina.
Depress Anxiety. 2019 May;36(5):442-452. doi: 10.1002/da.22883. Epub 2019 Jan 28.
Moral injury is closely associated with posttraumatic stress disorder (PTSD) and characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 U.S. military veterans (two females: 28-55 years old) were investigated to determine how subjective appraisals of morally injurious events measured by Moral Injury Event Scale (MIES) and PTSD symptoms are differentially related to spontaneous fluctuations indexed by amplitude of low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging scanning. ALFF in the left inferior parietal lobule (L-IPL) was positively associated with MIES subscores of transgressions, negatively associated with subscores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L-IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with MIES total scores. Our results provide the first evidence that morally injurious events and PTSD symptoms have dissociable neural underpinnings, and behaviorally distinct subcomponents of morally injurious events are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted by moral injury.
道德伤害与创伤后应激障碍（PTSD）密切相关，其特征是社会和道德认知障碍。关于道德伤害的神经基础知之甚少，并且道德伤害和 PTSD 之间的神经相关性是否不同。本研究调查了 26 名美国退伍军人（两名女性：28-55 岁），以确定主观评估道德伤害事件的量表（MIES）和 PTSD 症状如何与自发波动（低频振幅）和静息态功能磁共振成像扫描时的功能连接的指标（ALFF）差异相关。左侧顶下小叶（L-IPL）的 ALFF 与侵犯行为的 MIES 子评分呈正相关，与背叛行为的子评分呈负相关，与 PTSD 症状无关。此外，L-IPL 与双侧楔前叶之间的功能连接与 PTSD 症状呈正相关，与 MIES 总分呈负相关。我们的研究结果首次提供了证据，表明道德伤害事件和 PTSD 症状具有可分离的神经基础，并且道德伤害的行为上不同的子成分在神经反应中是不同的。这些发现增加了我们对道德伤害和 PTSD 之间神经区别的认识，并可能有助于为遭受道德伤害的退伍军人制定分类学和干预措施。
