Moral injury research at a crossroads: assumptions, limitations, and the promise of relational reorientation.

Our paper makes three contributions to moral injury (MI) research. First, we observe that while researchers have repeatedly acknowledged limitations with prevailing definitions of moral injury and offered alternatives, the underlying core conceptual model-which characterizes moral injury as intrapsychic damage to belief structures-has remained largely unchanged. We argue that this is a significant impediment to research progress. Second, through conceptual analysis of the most influential etiological accounts, we identify numerous implicit and untested assumptions about morality that burden the standard model. We propose that adopting a minimalist, social-functionalist conception of morality, toward which the literature is already drifting, could reduce this conceptual burden. We further hypothesize that the literature retains these assumptions because they appear logically necessary to sustain the causal link between belief violation and MI outcomes. Third, we observe that current leading treatments already target relational repair, reconditioning, and rehabilitation, which suggests that moral injury may be better understood as a form of relational disruption rather than belief violation. We acknowledge that developing this alternative would need to be pursued by the clinical research community itself. While our findings and analysis require additional development and testing to have actionable application in clinical contexts, we believe our conceptual analysis serves as sufficient justification for reconsideration of the prevailing conceptual paradigm.