The DOI matches its Crossref record; 71 of the 71 references it cites were found in a registry or an index.
Moral Injury and PTSD: Often Co-Occurring Yet Mechanistically Different
Open accessOverview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“While Posttraumatic stress disorder (PTSD) and moral injury (MI) often co-occur, both are conceptually distinct: PTSD is defined by fear-based responses to life threat (e.g., hyperarousal, re-experiencing, and avoidance of trauma cues), whereas MI centers on transgressions of deeply held moral beliefs and is marked disrupted moral meaning (10, 14, 19).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [10]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Recent empirical and theoretical literature suggests that MI-related distress is sustained by maladaptive self-referential processing—recurrent rumination, rigid moral self-appraisal, and self-condemning narratives that reorganize identity around perceived transgression or betrayal (8, 10, 15–18).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [10]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Although MI often co-occurs with posttraumatic stress disorder (PTSD), it is widely understood as a distinct moral–psychological condition not fully captured by fear-based trauma models”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [10]
The cited source says what the claim attributes to it.
In the citing paper
“MI is increasingly conceptualized as a distinct psychosocial syndrome involving enduring disruptions in moral identity, meaning systems, and self-evaluative processes following exposure to potentially morally injurious events (4, 8–13).”
From The therapeutic role of self-transcendence in moral injury recovery: theory, mechanisms, and clinical implications (2026) · cites this paper as [10]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Moral injury and moral repair in war veterans: A preliminary model and intervention strategy
Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009) · Clinical Psychology Review · doi:10.1016/j.cpr.2009.07.003 · Cited by 2,738
Shay, J. (2014) · Psychoanalytic Psychology · doi:10.1037/a0036090 · Cited by 882
An exploration of the viability and usefulness of the construct of moral injury in war veterans.
Drescher, K. D., Foy, D. W., Kelly, C. M., Leshner, A., Schutz, K., & Litz, B. T. (2011) · Traumatology An International Journal · doi:10.1177/1534765610395615 · Cited by 494
Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.170021 · Cited by 407
Defining and assessing moral injury: A syndrome perspective
Jinkerson, J. D. (2016) · Traumatology · doi:10.1037/trm0000069 · Cited by 381
Akiki, T. J., Averill, C. L., & Abdallah, C. G. (2017) · Current Psychiatry Reports · doi:10.1007/s11920-017-0840-4 · Cited by 365
Initial Psychometric Evaluation of the Moral Injury Questionnaire—Military Version
Currier, J. M., Holland, J. M., Drescher, K. D., & Foy, D. W. (2013) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1866 · Cited by 288
Farnsworth, J. K., Drescher, K. D., Nieuwsma, J. A., Walser, R. D., & Currier, J. M. (2014) · Review of General Psychology · doi:10.1037/gpr0000018 · Cited by 270
Gray, M. J., Schorr, Y., Nash, W., Lebowitz, L., Amidon, A., Lansing, A., Maglione, M., Lang, A. J., & Litz, B. T. (2012) · Behavior Therapy · doi:10.1016/j.beth.2011.09.001 · Cited by 258
Moral injury, meaning making, and mental health in returning veterans
Currier, J. M., Holland, J. M., & Malott, J. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22134 · Cited by 257
A Scheme for Categorizing Traumatic Military Events
Stein, N. R., Mills, M. A., Hall, K. A. A., Mendoza, C., Borah, A. M., Resick, P. A., Litz, B. T., Belinfante, K., Borah, E. V., Cooney, J. A., et al. (2012) · Behavior Modification · doi:10.1177/0145445512446945 · Cited by 249
Loving‐Kindness Meditation for Posttraumatic Stress Disorder: A Pilot Study
Kearney, D. J., Malte, C. A., McManus, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013) · Journal of Traumatic Stress · doi:10.1002/jts.21832 · Cited by 233
Moral injury, posttraumatic stress disorder, and suicidal behavior among National Guard personnel
Bryan, C. J., Bryan, A. O., Roberge, E., Leifker, F. R., & Rozek, D. C. (2018) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000290 · Cited by 230
A functional approach to understanding and treating military-related moral injury
Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2017.07.003 · Cited by 226
Bryan, C., Bryan, A. O., Anestis, M., Anestis, J. C., Green, B. A., Etienne, N., Morrow, C. E., & Ray-Sannerud, B. (2016) · Assessment (Odessa, Fla.) · doi:10.1177/1073191115590855 · Cited by 217
Functional Neuroanatomy of Emotion and Its Regulation in PTSD
Fitzgerald, J. M., DiGangi, J. A., & Phan, K. L. (2018) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000185 · Cited by 190
Papazoglou, K., & Chopko, B. A. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01999 · Cited by 188
Feelings of shame, embarrassment and guilt and their neural correlates: A systematic review
Bastin, C., Harrison, B. J., Davey, C. G., Moll, J., & Whittle, S. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.09.019 · Cited by 177
Jordan, A., Eisen, E., Bolton, E. E., Nash, W. P., & Litz, B. T. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000249 · Cited by 171
Spiritually integrated care for PTSD: A randomized controlled trial of “Building Spiritual Strength
Harris, J. I., Usset, T., Voecks, C., Thuras, P., Currier, J., & Erbes, C. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.06.045 · Cited by 161
Carey, L. B., Hodgson, T. J., Krikheli, L., Soh, R. Y., Armour, A., Singh, T. K., & Impiombato, C. G. (2016) · Journal of Religion and Health · doi:10.1007/s10943-016-0231-x · Cited by 159
Chaplaincy, spiritual care and moral injury: Considerations regarding screening and treatment
Carey, L. B., & Hodgson, T. J. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00619 · Cited by 157
Boccia, M., D’Amico, S., Bianchini, F., Marano, A., Giannini, A. M., & Piccardi, L. (2015) · Brain Imaging and Behavior · doi:10.1007/s11682-015-9387-3 · Cited by 155
Pearce, M., Haynes, K., Rivera, N. R., & Koenig, H. G. (2018) · Global Advances in Health and Medicine · doi:10.1177/2164956118759939 · Cited by 145
Impact of killing in war: A randomized, controlled pilot trial
Maguen, S., Burkman, K., Madden, E., Dinh, J., Bosch, J., Keyser, J., Schmitz, M., & Neylan, T. C. (2017) · Journal of Clinical Psychology · doi:10.1002/jclp.22471 · Cited by 143
Monteith, L. L., Bahraini, N. H., Matarazzo, B. B., Soberay, K. A., & Smith, C. P. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22292 · Cited by 138
Moral Injury and Definitional Clarity: Betrayal, Spirituality and the Role of Chaplains
Hodgson, T. J., & Carey, L. B. (2017) · Journal of Religion and Health · doi:10.1007/s10943-017-0407-z · Cited by 134
Litz, B. T., Contractor, A. A., Rhodes, C., Dondanville, K. A., Jordan, A. H., Resick, P. A., Foa, E. B., Young‐McCaughan, S., Mintz, J., Yarvis, J. S., et al. (2018) · Journal of Traumatic Stress · doi:10.1002/jts.22276 · Cited by 128
Evans, W. R., Stanley, M. A., Fletcher, T. L., Exline, J. J., Pargäment, K. I., & Teng, E. J. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000347 · Cited by 115
Koenig, H. G., Boucher, N. A., Oliver, R. J. P., Youssef, N. A., Mooney, S., Currier, J. M., & Pearce, M. (2017) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000554 · Cited by 107
A scoping study of moral injury: Identifying directions for social work research
Haight, W., Sugrue, E. P., Calhoun, M., & Black, J. (2016) · Children and Youth Services Review · doi:10.1016/j.childyouth.2016.09.026 · Cited by 106
Learning about combat stress from Homer's Iliad
Shay, J. (1991) · Journal of Traumatic Stress · doi:10.1002/jts.2490040409 · Cited by 91
Bremner, J. D., Mishra, S., Campanella, C., Shah, M., Kasher, N., Evans, S., Fani, N., Shah, A. J., Reiff, C. M., Davis, L. L., et al. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00157 · Cited by 87
Goldsmith, R. E., Gerhart, J. I., Chesney, S. A., Burns, J. W., Kleinman, B., & Hood, M. M. (2014) · Journal of Evidence-Based Complementary & Alternative Medicine · doi:10.1177/2156587214533703 · Cited by 86
Morally injurious experiences and meaning in Salvadorian teachers exposed to violence.
Currier, J. M., Holland, J. M., Rojas-Flores, L., Herrera, S., & Foy, D. W. (2013) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0034092 · Cited by 83
Engen, H. G., Bernhardt, B. C., Skottnik, L., Ricard, M., & Singer, T. (2018) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2017.08.024 · Cited by 83
Held, P., Klassen, B. J., Brennan, M. B., & Zalta, A. K. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.09.003 · Cited by 82
Journalists covering the refugee and migration crisis are affected by moral injury not PTSD
Feinstein, A., Pavisian, B., & Storm, H. (2018) · JRSM Open · doi:10.1177/2054270418759010 · Cited by 80
Hinton, D. E., Ojserkis, R. A., Jalal, B., Peou, S., & Hofmann, S. G. (2013) · Journal of Clinical Psychology · doi:10.1002/jclp.22017 · Cited by 76
Moral injury process and its psychological consequences among Israeli combat veterans
Zerach, G., & Levi‐Belz, Y. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22598 · Cited by 75
Moral injury: A new challenge for complementary and alternative medicine
Kopacz, M. S., Connery, A. L., Bishop, T. M., Bryan, C. J., Drescher, K. D., Currier, J. M., & Pigeon, W. R. (2015) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2015.11.003 · Cited by 74
How the brain heals emotional wounds: the functional neuroanatomy of forgiveness
Ricciardi, E., Rota, G., Sani, L., Gentili, C., Gaglianese, A., Guazzelli, M., & Pietrini, P. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00839 · Cited by 73
Smith‐MacDonald, L., Morin, J.-S., & Brémault‐Phillips, S. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00592 · Cited by 70
Sources of moral injury among war veterans: A qualitative evaluation
Schorr, Y., Stein, N. R., Maguen, S., Barnes, J. B., Bosch, J. O., & Litz, B. T. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22660 · Cited by 69
Holliday, R. P., Holder, N. D., & Surís, A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.03.007 · Cited by 66
Kearney, D., McManus, C., Malte, C., Martinez, M., Felleman, B. I., & Simpson, T. L. (2014) · Medical Care · doi:10.1097/mlr.0000000000000221 · Cited by 61
Neural mapping of guilt: a quantitative meta-analysis of functional imaging studies
Gifuni, A. J., Kendal, A., & Jollant, F. (2016) · Brain Imaging and Behavior · doi:10.1007/s11682-016-9606-6 · Cited by 56
Implementing Integrated Mental Health and Chaplain Care in a National Quality Improvement Initiative
Nieuwsma, J. A., King, H. A., Jackson, G. L., Bidassie, B., Wright, L. W., Cantrell, W. C., Bates, M. J., Rhodes, J. E., White, B. S., Gatewood, S. J. L., et al. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201700397 · Cited by 54
Is and Ought: Descriptive and Prescriptive Cognitions in Military‐Related Moral Injury
Farnsworth, J. K. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22356 · Cited by 54
Held, P., Klassen, B. J., Hall, J. M., Friese, T. R., Bertsch-Gout, M. M., Zalta, A. K., & Pollack, M. H. (2019) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/tra0000364 · Cited by 52
Cunningham, K. C., Davis, J. L., Wilson, S. M., & Resick, P. A. (2017) · British Journal of Clinical Psychology · doi:10.1111/bjc.12163 · Cited by 50
Brain Activation Associated with Pride and Shame
Roth, L., Kaffenberger, T., Herwig, U., & Brühl, A. B. (2014) · Neuropsychobiology · doi:10.1159/000358090 · Cited by 47
Indirect Relations Between Transgressive Acts and General Combat Exposure and Moral Injury
Frankfurt, S. B., Frazier, P. A., & Engdahl, B. E. (2017) · Military Medicine · doi:10.7205/milmed-d-17-00062 · Cited by 46
Frankfurt, S. B., DeBeer, B. B., Morissette, S. B., Kimbrel, N. A., Bash, H. A. J. L., & Meyer, E. C. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00520 · Cited by 43
Psychometric properties of a Modified Moral Injury Questionnaire in a military population.
Braitman, A. L., Battles, A. R., Kelley, M. L., Hamrick, H. C., Cramer, R. J., Ehlke, S. J., & Bravo, A. J. (2018) · Traumatology An International Journal · doi:10.1037/trm0000158 · Cited by 41
Vermetten, E. H. G. J. M., & Jetly, R. (2018) · Military Behavioral Health · doi:10.1080/21635781.2018.1459973 · Cited by 40
Ramage, A. E., Litz, B. T., Resick, P. A., Woolsey, M. D., Dondanville, K. A., Young‐McCaughan, S., Borah, A. M., Borah, E. V., Peterson, A. L., & Fox, P. T. (2015) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsv102 · Cited by 39
The Neural Systems of Forgiveness: An Evolutionary Psychological Perspective
Billingsley, J., & Losin, E. A. R. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00737 · Cited by 35
“Opening a Door to a New Life”: The Role of Forgiveness in Healing From Moral Injury
Purcell, N., Griffin, B. J., Burkman, K. M., & Maguen, S. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00498 · Cited by 35
Moral Injury, Soul Repair, and Creating a Place for Grace
Antal, C. J., & Winings, K. (2015) · Religious Education · doi:10.1080/00344087.2015.1063962 · Cited by 33
Negative outcomes after morally injurious experiences: A replication and extension.
Lancaster, S. L. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000341 · Cited by 32
Smigelsky, M. A., Malott, J. D., Morris, K. D. V., Berlin, K. S., & Neimeyer, R. A. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22714 · Cited by 30
Spiritual Interventions in Veterans with PTSD: A Systematic Review
Smothers, Z., & Koenig, H. G. (2018) · Journal of Religion and Health · doi:10.1007/s10943-018-0680-5 · Cited by 27
Measuring Symptoms of Moral Injury in Veterans and Active Duty Military with PTSD
Koenig, H. G. (2018) · Religions · doi:10.3390/rel9030086 · Cited by 25
‘Imagined guilt’vs‘recollected guilt’: implications for fMRI
McLatchie, N. M., Giner‐Sorolla, R., & Derbyshire, S. W. G. (2016) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsw001 · Cited by 24
Moral Injury: Contextualized Care
Meador, K. G., & Nieuwsma, J. A. (2017) · Journal of Medical Humanities · doi:10.1007/s10912-017-9480-2 · Cited by 22
Litz, B. T., & Carney, J. R. (2018) · Spirituality in Clinical Practice · doi:10.1037/scp0000174 · Cited by 22
Li, H., & Lu, J. (2017) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2017.00561 · Cited by 20
The Emotional Fallout From the Culture of Blame and Shame
Ferguson, C. C. (2017) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2017.2691 · Cited by 18
Posttraumatic Stress Disorder in Emergency Medicine Residents: A Role for Moral Injury?
Murray, E., & Gidwani, S. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.03.040 · Cited by 11
Dedert, E. A., Dennis, P. A., Cunningham, K. C., Ulmer, C. S., Calhoun, P. S., Kimbrel, N. A., Hicks, T. A., Neal, J. M., & Beckham, J. C. (2018) · Behavioral Sleep Medicine · doi:10.1080/15402002.2018.1435544 · Cited by 7
Research works printed but not linked: 5
- Sun D, Depress Anxiety
- Griffin BJ, J Trauma Stress
- Maguen S, 2012, PTSD Res Quarterly, 23, 1
- Dedert EA, Behav Sleep Med
- Held P, 2018, Psychol Trauma
Cited by
Sorted by citations
Spilg, E. G., Rushton, C. H., Phillips, J. L., Kendzerska, T., Saad, M., Gifford, W., Gautam, M., Bhatla, R., Edwards, J. D., Quilty, L. C., et al. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03637-w · Cited by 202
Moral Injury: An Increasingly Recognized and Widespread Syndrome
Koenig, H. G., & Al Zaben, F. (2021) · Journal of Religion and Health · doi:10.1007/s10943-021-01328-0 · Cited by 166
Moral injury, mental health and behavioural health outcomes: A systematic review of the literature
Hall, N. A., Everson, A. T., Billingsley, M. R., & Miller, M. B. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2607 · Cited by 205
Moral Injury and Moral Resilience in Health Care Workers during COVID-19 Pandemic
Rushton, C. H., Thomas, T., Antonsdottir, I. M., Nelson, K. E., Boyce, D. M., Vioral, A. N., Swavely, D., Ley, C., & Hanson, G. C. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0076 · Cited by 178
Lentz, L. M., Smith-MacDonald, L., Malloy, D., Carleton, R. N., & Brémault-Phillips, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.639781 · Cited by 143
Metadata
- Authors
- Barnes, H. A., Hurley, R. A., & Taber, K. H.
- Affiliations
- W. G. (Bill) Hefner VA Medical Center (US)
- Venue
- The Journal of Neuropsychiatry and Clinical Neurosciences
- Published
- 2019-04
- Volume
- 31
- Issue
- 2
- Pages
- A4-103
- ISSN
- 0895-0172 (ISSN-L)
- 1545-7222
- OpenAlex
- W2942372106
- Semantic Scholar
- 8d5bbfa64f99860e143534191f3a73ab8c7a5271
- Cited by
- 172
- References
- 71
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 22 · 2023: 34 · 2022: 31 · 2021: 23 · 2020: 14 · 2019: 2
- FWCI
- 2.77
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neuropsychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- moral injury, post-traumatic stress disorder, co-occurrence, pathophysiological mechanisms
- MeSH terms
- Psychological Trauma, Combat Disorders, Humans, Morals, Psychotherapy, Self Concept, Stress Disorders, Post-Traumatic, Forgiveness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review