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Resting-State Brain Fluctuation and Functional Connectivity Dissociate Moral Injury from Posttraumatic Stress Disorder

Moral injury is closely associated with posttraumatic stress disorder (PTSD) and is characterized by disturbances in social and moral cognition. Little is known about the neural underpinnings of moral injury, and whether the neural correlates are different between moral injury and PTSD. A sample of 26 US military veterans (2 females; 28~55 years old) were investigated to determine how moral injury experiences and PTSD symptoms are differentially related to spontaneous fluctuations indexed by low frequency fluctuation (ALFF) as well as functional connectivity during resting-state functional magnetic resonance imaging (fMRI) scanning. ALFF in the left inferior parietal lobule (L IPL) was positively associated with moral injury sub-scores of transgressions, negatively associated with sub-scores of betrayals, and not related with PTSD symptoms. Moreover, functional connectivity between the L IPL and bilateral precuneus was positively related with PTSD symptoms and negatively related with moral injury total scores. Our results provide the first evidence that moral injury and PTSD have dissociable neural underpinnings, and behaviorally distinct sub-components of moral injury are different in neural responses. The findings increase our knowledge of the neural distinctions between moral injury and PTSD and may contribute to developing nosology and interventions for military veterans afflicted with moral injury.