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IN GRAPHICS PTSD vs. moral injury: a scoping review

Stéphanie A.H. Bélanger, CD, PhD Associate Scientific Director, CIMVHR; Heidi Cramm, Queen’s; Kari Fletcher, St-Thomas; Jean-Simon Demers, PhD Cand. University of Ottawa

While Post Traumatic Stress Disorder (PTSD) has garnered much research attention, the concept of moral injury has recently been increasingly raised. This scoping review was undertaken to explored how the literature conceptualizes the relation between PTSD and moral injury.

Moral injury Posttraumatic Stress Disorder “…the emotional and spiritual impact of participating “a history of exposures to a traumatic event that in, witnessing, and/or being victimized by actions and produces symptoms that can be found in the four behaviors which violate a service member’s core moral symptom clusters that include intrusion, avoidance, values and behavioral expectations of self or others. negative alterations in cognitions and mood, and Moral injury almost always pivots with the dimension alterations in arousal and ” of time: moral codes evolve alongside identities, and (American Psychological Association, 2013) transitions inform perspectives that form new conclusions about old events.” (Syracuse University, The Moral Injury Project, n.d.)

Distinctions Data Sources: 2-26 Results: What the literature shows MORAL INJURY PTSD Difficulty in Distinguishing Dimensional Taxonomy based Overlapping definitions and differences No threshold must be met Threshold must be met around whether they are separate, Not a diagnosis Diagnosis sequential, or simultaneous; mean there is 1 a lack of clarity in defining the concepts of (U.S. Department of Veterans Affairs, 2016) PTSD and moral injury.

The Research Process Protective Factors and Vulnerabilities IDENTIFIED SCREENED INCLUDED Mechanisms of acquisition, expression of the condition, neuropathological changes, and 2 the role of spirituality can create protective factors and vulnerabilities. Detection and Response 3547 61 37 Distinguishing between PTSD and moral references studies studies included

${protocol}://jmvfh.utpjournals.press/doi/pdf/10.3138/jmvfh.4.1.002 - Wednesday, July 17, 2019 8:32:14 AM Queen's University IP Address:130.15.160.43 injury remains problematic given the current identified as proceeded in full data state of the research. potential to full-text extraction and 3 sources screening analysis

Data Source: 1 Data Sources: 27-37

2 Journal of , Veteran and Family Health doi:10.3138/jmvfh.4.1.002 4 (1) 2018 REFERENCES

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4 Journal of Military, Veteran and Family Health doi:10.3138/jmvfh.4.1.002 4 (1) 2018