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Updated: Sep 11, 2025

Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity

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Resting-State Neural Signatures of Moral Injury: Associations With Rumination.

Travis M Fulton¹, Alfonsina Guelfo², Aziz Elbasheir²

¹Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Molecular and Systems Pharmacology Ph.D. Program, Emory University, Atlanta, Georgia.

Biological Psychiatry. Cognitive Neuroscience and Neuroimaging

|August 18, 2025

Summary

Moral injury (MI) shows distinct brain activity patterns. Betrayal-related MI is linked to increased activity in the default mode network, while other-related MI shows decreased activity in cognitive control areas, both associated with rumination.

Keywords:

ALFF Betrayal Functional MRI Moral injury Resting-state Rumination

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Published on: September 28, 2018

Area of Science:

Neuroscience
Psychiatry
Trauma Studies

Background:

Moral injury (MI) arises from violating one's moral code, causing impairment.
Rumination is a proposed mechanism for MI's functional impairment.
Neuropathophysiology of different MI facets, especially in civilians, remains under-explored.

Purpose of the Study:

To investigate the neural underpinnings of different moral injury dimensions.
To examine the relationship between moral injury facets, rumination, and brain activity (ALFF).
To explore resting-state functional connectivity in trauma-exposed civilians experiencing moral injury.

Main Methods:

Sixty trauma-exposed civilians (18-65 years) underwent resting-state fMRI.
Participants completed validated scales for moral injury (MIESS-C) and rumination (RSQ).
Voxel-wise linear regression analyzed ALFF in relation to MI dimensions and rumination.

Main Results:

Betrayal-related MI correlated with higher ALFF in the precuneus and medial prefrontal cortex (default mode network).
Other-related MI correlated with lower ALFF in the dorsolateral prefrontal cortex and insula (cognitive control/interoception).
Rumination severity positively associated with ALFF in betrayal-related MI brain regions.

Conclusions:

Distinct neural signatures differentiate MI facets.
Betrayal-related MI is associated with heightened default mode network activity, linked to rumination.
Other-related MI linked to reduced cognitive control and interoceptive network activity, possibly indicating withdrawal.
Identified neural signatures represent potential targets for neuromodulation therapies.