Litz Brett T, Walker Hannah E
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts, USA.
Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA; email:
Annu Rev Clin Psychol. 2025 May;21(1):251-277. doi: 10.1146/annurev-clinpsy-081423-022604. Epub 2025 Jan 29.
Moral injury (MI) is a potential clinical problem characterized by functionally impairing moral emotions, beliefs, and behaviors as well as adverse beliefs about personal or collective humanity and life's meaning and purpose. MI can arise from personal transgressive acts or from being a victim of or bearing witness to others' inhumanity. Despite widespread interest in MI, until recently, there was no reliable measure of MI as an outcome, and prior research has revealed little about its causes, consequences, and intervention approaches. This review provides background information on the history of MI, defines key terms, and critically reviews assessment tools. Additionally, we describe a social-functional theory of the etiology of MI and a social-functional rehabilitation approach to treatment. This treatment approach, which can be used by any clinician regardless of clinical context, employs cross-cutting change agents to promote lasting corrective and humanizing prosocial experiences, enhancing belonging through valued actions and relationships.
道德伤害（MI）是一个潜在的临床问题，其特征是功能性地损害道德情感、信念和行为，以及对个人或集体人性以及生命意义和目的的负面信念。道德伤害可能源于个人的违规行为，也可能源于成为他人不人道行为的受害者或目击者。尽管人们对道德伤害广泛关注，但直到最近，还没有可靠的方法来衡量道德伤害这一结果，而且先前的研究对其原因、后果和干预方法揭示甚少。本综述提供了关于道德伤害历史的背景信息，定义了关键术语，并对评估工具进行了批判性综述。此外，我们描述了道德伤害病因的社会功能理论以及一种社会功能康复治疗方法。这种治疗方法可被任何临床医生使用，无论临床背景如何，它采用贯穿各领域的变革因素来促进持久的纠正性和人性化亲社会体验，通过有价值的行动和关系增强归属感。
