Adding insult to injury: Exploring the relation between moral injury and military sexual trauma.

Introduction: The experience of military sexual trauma (MST) is exceptional in that the environment in which harm occurs, the military, may play a role in the extent of harm incurred. MST may contribute to the onset of moral injury (MI), and its associated sequelae, through the occurrence of perpetration-based and betrayal-based acts that violate deeply held beliefs. This article aims to address a gap in the current literature and examine existing literature about the relation between MST and MI. Methods: A narrative review was conducted to identify and synthesize the literature on the relation between MST and MI. Five databases were searched - MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL - for English-language peer-reviewed articles. Results: The literature reviewed points to multiple pathways for the development of MI following MST, including through perpetuation and betrayal, while also highlighting potential consequences of MST-related MI. Moreover, MST itself may be a morally injurious event based in betrayal, which, in turn, may benefit from an MI-focused intervention approach. Discussion: This narrative review collates and provides a preliminary interpretation of findings in the literature surrounding the relation between MI and MST, thus stimulating and informing future research, as well as potentially enhancing the conceptualization of MI. Future implications may include consideration of the role of MI in trauma-informed clinical treatment options for MST, the development of health policies to support persons with lived experience of MST, and the provision of enhanced context and the foundation for a change in military culture.