Frankfurt, Sheila2016-12-192016-12-192015-09https://hdl.handle.net/11299/183376University of Minnesota Ph.D. dissertation. September 2015. Major: Psychology. Advisor: Patricia Frazier. 1 computer file (PDF); vi, 84 pages.The moral injury construct was proposed to identify and describe the deleterious impact of engaging in acts that transgress accepted boundaries of behavior during combat and that challenge one’s sense of self as a good person. These acts, labeled “transgressive acts,” are proposed to lead to a guilt and shame-based syndrome of posttraumatic stress disorder (PTSD) symptoms, demoralization, self-handicapping, and self-injury. Although the moral injury construct has been gaining clinical and popular attention in recent years, little empirical research on a frequently cited model of moral injury (Litz et al., 2009) has been conducted. The current study tested key tenets of this moral injury model using structural equation modeling (SEM) in a sample of combat-exposed male veterans (N = 190). Findings supported some assertions of this moral injury model. SEM supported the direct effect of transgressive acts on guilt, and the indirect effect of transgressive acts on suicidality and demoralization through guilt. An alternative configuration of moral injury wherein demoralization was a mechanism (not outcome) of moral injury fit the data adequately; transgressive acts had an indirect effect through demoralization on suicidality and PTSD. Limitations of the study include the use of cross-sectional data and limited measures of moral injury mechanisms and outcomes. We conclude with implications for future research for veterans experiencing moral injury.encombat veteranmoral injuryPosttraumatic stress disorderPTSDtraumaThesis or Dissertation