Examining the Overlap between Moral Injury and PTSD in US Veterans and Active Duty Military

Harold G. Koenig, Nagy A. Youssef, Donna Ames, Ellen J. Teng, Terrence D. Hill

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Moral injury (MI) is a syndrome thought to be separate from posttraumatic stress disorder (PTSD), yet having some overlap. To determine the overlap, we examined the relationship between MI and the four DSM-5 PTSD symptom clusters (B, C, D, E) in US veterans and active duty military (ADM). The 45-item Moral Injury Symptom Scale (MISS-M) was administered to 591 veterans and ADM who had served in a combat theater and had PTSD symptoms. PTSD symptoms were measured with the PTSD Symptom Checklist-5, which assesses the four PTSD symptom clusters. Total MISS-M scores were more strongly associated with PTSD symptom cluster D (negative cognitions and emotions) in both bivariate and multivariate analyses. Findings for a 10-item version of the MISS-M (MISS-M-SF) closely followed those of the MISS-M. Although the overlap between MI and PTSD occurs to some extent across all PTSD symptoms clusters, the largest overlap tends to be with the negative cognitions and emotions cluster.

Original languageEnglish (US)
Pages (from-to)7-12
Number of pages6
JournalJournal of Nervous and Mental Disease
Issue number1
StatePublished - Jan 1 2020
Externally publishedYes


  • Moral injury
  • active duty military
  • overlap
  • posttraumatic stress disorder
  • symptom clusters
  • veterans

ASJC Scopus subject areas

  • Psychiatry and Mental health


Dive into the research topics of 'Examining the Overlap between Moral Injury and PTSD in US Veterans and Active Duty Military'. Together they form a unique fingerprint.

Cite this