BACKGROUND The construct of "moral injury" is used widely in the research literature and media to broadly describe the impact of events involving perceived violations of one's sense of right and wrong (herein referred to as "potentially morally injurious events" [PMIEs]). SUMMARY In this theoretical review, we provided a brief overview of the "moral injury" construct and its limitations including the lack of consensus-drawn boundaries and operational definitions to guide hypothesis-driven research. We discussed whether this construct can be reliably distinguished from established psychiatric diagnoses and psychological constructs and the inherent challenges in separating or classifying the impact of high-magnitude stressful life events that likely form the majority of PMIEs. Assessments that purportedly measure "moral injury" are reviewed and limitations are discussed such as shared measurement variance with established psychological instruments. KEY MESSAGES We identified conceptual strategies for investigating behavioral and neurobiological features of PMIEs that could be used to inform the field of traumatic stress. We concluded that the construct of "moral injury" may provide an interpretive framework for positing why someone may be beset by guilt, shame, and/or rage whereas existing psychiatric diagnoses such as post-traumatic stress disorder and depression provide comprehensive descriptions regarding what someone might experience following extremely stressful events. We proposed directions to better clarify the boundaries of "moral injury" versus established psychiatric categories that could be used to enhance the conceptualization and assessment of this construct.

中文翻译：

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提高关于道德伤害结构的概念清晰度。


背景 “道德伤害”的结构在研究文献和媒体中被广泛使用，以广泛描述涉及感知到违反个人是非感的事件的影响（此处称为“潜在道德伤害事件” [PMIE]）。摘要 在本理论综述中，我们简要概述了 “道德伤害 ”结构及其局限性，包括缺乏共识划定的界限和操作定义来指导假设驱动的研究。我们讨论了这种结构是否可以可靠地与已建立的精神病学诊断和心理结构区分开来，以及分离或分类可能构成大多数 PMIE 的高幅度压力生活事件的影响的固有挑战。回顾了据称测量“道德伤害”的评估，并讨论了局限性，例如与已建立的心理学工具共享测量方差。关键信息我们确定了研究 PMIEs 的行为和神经生物学特征的概念策略，这些策略可用于告知创伤应激领域。我们得出的结论是，“道德伤害”的结构可能提供了一个解释框架，用于假设为什么某人可能会受到内疚、羞耻和/或愤怒的困扰，而现有的精神病学诊断，如创伤后应激障碍和抑郁症，则提供了关于某人在极端压力事件后可能经历的事情的全面描述。我们提出了更好地阐明“道德伤害”与已建立的精神病学类别的界限的方向，这些类别可用于增强对这一结构的概念化和评估。