Fulton Travis M, Guelfo Alfonsina, Elbasheir Aziz, McDermott Timothy J, Lee Jiwon, Ahluwalia Vishwadeep, Ely Timothy D, Lathan-Powell Emma, Fani Negar
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences; Molecular and Systems Pharmacology PhD Program, Emory University.
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2025 Aug 16. doi: 10.1016/j.bpsc.2025.08.001.
Moral injury (MI) is a condition that may emerge following a violation of an individual's moral code. MI leads to significant functional impairment in many trauma-exposed civilians with rumination proposed as a mechanism of action. Little is known about the neuropathophysiology of different MI dimensions, including MI related to transgressions caused by the self or others. We examined links between facets of MI, resting-state amplitude of low frequency fluctuations (ALFF) and rumination in trauma-exposed civilians.
Sixty adults (18-65 years, 51 female) completed measures of moral injury (Moral Injury Exposure and Symptom Scale for Civilians, MIESS-C), rumination (Response Styles Questionnaire, RSQ), and resting-state fMRI. Voxel-wise linear regression on ALFF was performed with rumination and MIESS-C-derived self, other, and betrayal-related MI as regressors.
Betrayal-related MI associated with higher ALFF in the bilateral precuneus and left medial prefrontal cortex. Other-related MI associated with lower ALFF in the left dorsolateral prefrontal cortex and insula (voxel-wise p<.001, cluster false discovery rate-corrected p<.05). Rumination severity was positively associated with betrayal-related ALFF clusters in the bilateral precuneus r =0.32, p =0.012, and left medial prefrontal cortex, r =0.31, p =0.017.
Results reveal distinct neural signatures of MI, with betrayal-related MI associated with greater ALFF in default mode network regions, and this activation related to rumination severity. Other-related MI linked with diminished activation in cognitive control and interoceptive network regions, which may reflect physiological withdrawal. These signatures are attractive candidate neuromodulatory targets.
道德伤害（MI）是一种可能在个人道德准则被违反后出现的状况。道德伤害会导致许多经历创伤的平民出现严重的功能障碍，沉思被认为是其作用机制。对于不同道德伤害维度的神经病理生理学，包括与自我或他人造成的违规行为相关的道德伤害，我们知之甚少。我们研究了道德伤害各方面、低频波动静息态振幅（ALFF）与经历创伤的平民的沉思之间的联系。
60名成年人（18 - 65岁，51名女性）完成了道德伤害测量（平民道德伤害暴露与症状量表，MIESS - C）、沉思测量（反应方式问卷，RSQ）以及静息态功能磁共振成像。以沉思以及MIESS - C得出的自我、他人和背叛相关的道德伤害为预测变量，对ALFF进行体素级线性回归。
与背叛相关的道德伤害与双侧楔前叶和左侧内侧前额叶皮质较高的ALFF相关。与他人相关的道德伤害与左侧背外侧前额叶皮质和岛叶较低的ALFF相关（体素级p <.001，聚类错误发现率校正p <.05）。沉思严重程度与双侧楔前叶（r = 0.32，p = 0.012）和左侧内侧前额叶皮质（r = 0.31，p = 0.017）中与背叛相关的ALFF聚类呈正相关。
结果揭示了道德伤害独特的神经特征，与背叛相关的道德伤害在默认模式网络区域与更大的ALFF相关，且这种激活与沉思严重程度有关。与他人相关的道德伤害与认知控制和内感受网络区域的激活减少有关，这可能反映了生理上的退缩。这些特征是有吸引力的神经调节候选靶点。
