Resting-state neural signatures of moral injury: associations with rumination
Open accessAbstract
Background 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. Methods Sixty adults (ages 18-56 years; 51 female) completed measures of MI (Moral Injury Exposure and Symptom Scale for Civilians [MIESS-C]), rumination (Response Styles Questionnaire), and resting-state functional magnetic resonance imaging. Voxelwise linear regression on ALFF was performed with rumination and MIESS-C-derived self-, other-, and betrayal-related MI as regressors. Results Betrayal-related MI associated with higher ALFF in the bilateral precuneus and left medial prefrontal cortex (mPFC). Other-related MI was associated with lower ALFF in the left dorsolateral PFC and insula (voxelwise 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 = .012) and left mPFC (r = 0.31, p = .017). Conclusions Results revealed 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 was linked to diminished activation in cognitive control and interoceptive network regions, which may reflect physiological withdrawal. These signatures are attractive candidate neuromodulatory targets.
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Emerging studies associate moral injury with altered activity in large-scale brain networks supporting self-referential thought, particularly the Default Mode Network.
“Emerging studies associate moral injury with altered activity in large-scale brain networks supporting self-referential thought, particularly the Default Mode Network (DMN) (40, 41, 51, 52).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [51]
Resting-state findings suggest heightened self-referential processing in core DMN hubs during betrayal-related moral injury, evidenced by increased amplitude of low-frequency fluctuations in medial prefrontal and precuneus regions that covary with rumination severity.
“Resting-state findings likewise suggest heightened self-referential processing in core DMN hubs during betrayal-related moral injury, as evidenced by increased amplitude of low-frequency fluctuations in medial prefrontal and precuneus regions that covary with rumination severity (51).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [51]
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The Neural Correlates of Moral Thinking: A Meta-Analysis
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Flagged first, then by citations
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Sorted by citations
Moral Injury in the DSM-5-TR: Syndrome Spectrum vs. Categorical Disorder
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Fleming, W. H. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1701564
“Emerging studies associate moral injury with altered activity in large-scale brain networks supporting self-referential thought, particularly the Default Mode Network (DMN) (40, 41, 51, 52).”
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Self-citationThompson, M. M., Granek, J. A., & Vartanian, O. A. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1813972
- Authors
- Fulton, T. M., Guelfo, A., Elbasheir, A., McDermott, T. J., Lee, J., Ahluwalia, V., Ely, T. D., Lathan, E. C., & Fani, N.
- Affiliations
- Emory University (US)
- Georgia Institute of Technology (US)
- Auburn University (US)
- Corresponding author
- Fani, Negar
- ORCID
- Venue
- Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
- Publisher
- Elsevier BV
- Published
- 2026-08
- Volume
- 11
- Issue
- 8
- Pages
- 932-940
- ISSN
- 2451-9022 (ISSN-L)
- PMC
- PMC12415846
- OpenAlex
- W4413290156
- Cited by
- 5
- References
- 98
- Citations by year
- 2026: 5
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Biological Psychiatry Cognitive Neuroscience and Neuroimaging (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Funders
- National Center for Complementary and Integrative Health
- National Center for Mental Health
- Emory Medical Care Foundation
- NIH (MH138893)
- Center for Advanced Brain Imaging
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Keywords
- moral injury, rumination, amplitude of low-frequency fluctuation, resting-state functional connectivity, default mode network, medial prefrontal cortex, precuneus, insula, dorsolateral prefrontal cortex, interoception, cognitive control, neuromodulation targets
- MeSH terms
- Psychological Trauma, Rumination, Cognitive, Insular Cortex, Adolescent, Adult, Brain Mapping, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Morals, Young Adult
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