Moral injury front and center: The relationship between event centrality and moral injury

Moral injury is a potentially deleterious mental health outcome arising from unresolved distress associated with exposure to events that transgress an individual's moral code. Primarily characterized by guilt and shame, moral injury also shares some features with posttraumatic stress disorder (PTSD). However, treatments that are effective for PTSD may be limited in their effectiveness for moral injury, indicating the importance of understanding factors that distinguish the two. Research indicates that the extent to which a potentially traumatic event comes to dominate an individual's self-identity (event centrality) is associated with PTSD severity. We sought to identify whether, and to what extent, a similar association exists between event centrality and moral injury.

In this cross-sectional study, we examined the extent to which event centrality was associated with outcomes following exposure to potentially morally injurious events. Adults (N = 232) exposed to a potentially morally injurious event completed validated measures of event centrality and event-related distress, traumatic stress, depression, anxiety, guilt, and shame.

Greater event centrality was associated with more severe event-related distress and traumatic stress, though the association was significantly larger for traumatic stress. Further, the relationship between event centrality and event-related distress was fully mediated by guilt and shame, whereas the relationship with traumatic stress was only partially mediated by guilt and shame.

These findings indicate that the extent to which a potentially morally injurious event dominates an individual's self-identity is important to moral injury outcomes, and shed light on features that distinguish moral injury from PTSD. (PsycInfo Database Record (c) 2025 APA, all rights reserved).