To Trust is to Survive: Toward a Developmental Model of Moral Injury

Research on trauma- and stressor-related disorders has recently expanded to consider moral injury, or the harmful psychological impact of profound moral transgressions, betrayals, and acts of perpetration. Largely studied among military populations, this construct has rarely been empirically extended to children and adolescents despite its relevance in the early years, as well as youths' potentially heightened susceptibility to moral injury due to ongoing moral development and limited social resources relative to adults. Application of the construct to young persons, however, requires theoretical reconceptualization from a developmental perspective. The present paper brings together theory and research on developmentally-oriented constructs involving morally injurious events, including attachment trauma, betrayal trauma, and perpetration-induced traumatic stress, and describes how they may be integrated and extended to inform a developmentally-informed model of moral injury. Features of such a model include identification of potentially morally injurious events, maladaptive developmental meaning-making processes that underlie moral injury, as well as behavioral and emotional indicators of moral injury among youth. Thus, this review summarizes the currently available developmental literatures, identifies the major implications of each to a developmentally-informed construct of moral injury, and presents a conceptual developmental model of moral injury for children and adolescents to guide future empirical research.

Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder

Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.

The Effects of Early Parental Death and Grief on Interpersonal Functioning and Alexithymia in Adults

BACKGROUND

Empirical evidence suggests that individuals who have experienced the death of a parent early in life endorse interpersonal difficulties in adulthood. However, little is known about the underlying experiences that may lead to such distress. The current study examined whether individuals who experienced early parental death would endorse greater levels of alexithymia than individuals raised in intact families, and whether early parental death and interpersonal distress were linked through alexithymia and grief.

METHODS

A total of 160 participants in a parental death group and 183 in a comparison group completed self-report measures online. Statistical analyses were conducted using ANCOVA, mediation analysis, and regression.

RESULTS

We observed that the parental death group reported greater levels of alexithymia than the comparison group. Second, alexithymia mediated the relationship between early parent death and global interpersonal distress. Third, greater levels of complicated grief were related to greater levels of alexithymic traits in the parental death group.

CONCLUSION

Results suggest that early parental death results in higher levels of alexithymic traits. Furthermore, alexithymia indirectly leads to interpersonal distress in this population. Finally, the link discovered between grief and alexithymia has important clinical implications.