A qualitative exploratory study of pathways to moral repair and moral injury in U.S. veterans

Potentially morally injurious events (PMIEs) are situations in which individuals perpetrate, fail to prevent, witness, or are directly impacted by actions that violate deeply held moral beliefs. Approximately half of U.S. veterans endorse PMIE exposure, and about 13% of those exposed meet criteria for probable moral injury, a syndrome of functionally impairing moral emotions, beliefs, and social behavior indexed to one's worst and most distressing PMIE. Little is known about why some individuals recover following PMIE exposure whereas others experience enduring impairment.

This qualitative study examined psychological, social, and institutional processes that differentiate veterans with probable moral injury from PMIE-exposed noncases. In-depth interviews were conducted with 39 veterans (20 cases, 19 noncases) sampled from a nationally representative study. Applied thematic analysis was used to identify cross-cutting themes and compare trajectories across groups.

Cases and noncases described similar acute moral distress, but their reported experiences diverged over time. Six overarching themes emerged the following: (a) a widening experiential gap characterized by identity disruption, moral emotions, and functional impairment among cases; (b) early emotional and behavioral responses that shaped trajectories; (c) the central role of social ecology in maintaining or eroding belonging; (d) divergent moral emotion trajectories (i.e., shame, guilt, anger) among cases; (e) meaning-making and repair processes facilitated recovery; and (f) the influence of leadership and institutional betrayal in exacerbating impairment.

These findings offer empirical support for key components of the social-functional model of moral injury, while generating hypotheses that highlight potential targets for prevention, mitigation, and treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).