Department of Medicine Publications

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Depression and Anxiety





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Background: Moral injury (MI) is consistently associated with adverse mental healthoutcomes, including the development of posttraumatic stress disorder (PTSD) andsuicidality. Methods: We investigated neural activation patterns associated with MI eventrecall using functional magnetic resonance imaging in participants with military andpublic safety‐related PTSD, relative to civilian MI‐exposed controls. Results: MI recall in the PTSD as compared to control group was associatedwith increased neural activation among salience network nodes involved inviscerosensory processing and hyperarousal (right posterior insula, dorsalanterior cingulate cortex; dACC), regions involved in defensive responding(left postcentral gyrus), and areas responsible for top‐down cognitive controlof emotions (left dorsolateral prefrontal cortex; dlPFC). Within the PTSDgroup, measures of state and trait shame correlated negatively with activityamong default mode network regions associated with self‐related processingand moral cognition (dorsomedial prefrontal cortex; dmPFC) and saliencenetwork regions associated with viscerosensory processing (left posteriorinsula), respectively. Conclusions: These findings suggest that MI event processing is altered in militaryand public safety‐related PTSD, relative to MI‐exposed controls. Here, it appearsprobable that as individuals with PTSD recall their MI event, they experience asurge of blame‐related processing of bodily sensations within salience networkregions, including the right posterior insula and the dACC, which in turn, promptregulatory strategies at the level of the left dlPFC aimed at increasing cognitivecontrol and inhibiting emotional affect. These results are consistent with previousfindings showing enhanced sensory processing and altered top‐down control inPTSD samples during autobiographical memory recall.

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