Additional Resources

The Moral Injury Outcome Scale and Materials

In 2022, Dr. Litz and colleagues published their findings from an international study that aimed to define the syndrome of moral injury and develop and validate the Moral Injury Outcome Scale (MIOS) in three stages. The findings resulted in the development of a 14-item MIOS that was invariant and reliable across countries and has two subscales: Shame-Related (SR) and Trust-Violation-Related (TVR) Outcomes (Litz et al., 2022). You can read more about the study here.

Below you can find links to relevant MIOS materials:

MIRECC / CoE Moral Injury Webpage

If you’d like to learn more about moral injury, you can find additional background information and resources on moral injury on this VA webpage co-developed by Dr. Litz here. You can also watch a presentation given by Dr. Litz in October of 2022 as part of the “MIRECC Presents” series, titled “Moral Injury: An Overview of Conceptual, Definitional, Assessment, and Treatment Issues”, here.

Additionally, you can find PDFs of a selection of Dr. Litz’s work on moral injury below:

Select Publications on Moral Injury

Litz, B. T. (2023). The future of moral injury and its treatment. Journal of Military, Veteran and Family Health, 9(2), 1–5. View PDF

Benfer, N., Vannini, M. B. N., Grunthal, B., Darnell, B. C., Zerach, G., Levi-Belz, Y., & Litz, B. T. (2023). Moral injury symptoms and related problems among service members and Veterans: A network analysis. Journal of Military, Veteran and Family Health, 9(2), 52–71. View PDF

Litz, B. T., Plouffe, R. A., Nazarov, A., Murphy, D., Phelps, A., Coady, A., Houle, S.A., Dell, L., Frankfurt, S., Zerach, G., Levi-Belz, Y., & the Moral Injury Outcome Scale Consortium. (2022). Defining and assessing the syndrome of moral injury: Initial findings of the Moral Injury Outcome Scale Consortium. Frontiers in Psychiatry, 13, 1-13. View PDF

Yeterian, J.D., Berke, D.S, Carney, J.R., McIntyre-Smith, A., St. Cyr, C., King, L., Kline, N.K., Phelps, A., and Litz, B.T. (2019). Defining and measuring moral injury: Rationale, design, and preliminary findings from the Moral Injury Outcome Scale Consortium. Journal of Traumatic Stress, 32(3), 363-372. View PDF

Litz, B. T., & Kerig, P. K. (2019). Introduction to the special issue on moral injury: Conceptual challenges, methodological issues, and clinical applications. Journal of Traumatic Stress, 32(3), 341-349. View PDF

Schorr, Y., Stein, N. R., Maguen, S., Barnes, J. B., Bosch, J., & Litz, B. T. (2018). Sources of moral injury among war veterans: A qualitative evaluation. Journal of Clinical Psychology, 74(12), 2203-2218. View PDF

Gray, M. J., Nash, W. P., & Litz, B. T. (2017). When self-blame is rational and appropriate: The limited utility of Socratic questioning in the context of moral injury: Commentary on Wachen et al.(2016). Cognitive and Behavioral Practice, 24(4), 383-387. View PDF

Wortmann, J. H., Eisen, E., Hundert, C., Jordan, A. H., Smith, M. W., Nash, W. P., & Litz, B. T. (2017). Spiritual features of war-related moral injury: A primer for clinicians. Spirituality in Clinical Practice, 4(4), 249. View PDF

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the moral injury events scale. Military Medicine, 178(6), 646-652. View PDF

Nash, W. P., & Litz, B. T. (2013). Moral injury: A mechanism for war-related psychological trauma in military family members. Clinical Child and Family Psychology Review, 16, 365-375. View PDF

Drescher, K. D., Foy, D. W., Kelly, C., Leshner, A., Schutz, K., & Litz, B. (2011). An exploration of the viability and usefulness of the construct of moral injury in war veterans. Traumatology, 17(1), 8-13. View PDF

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695-706. View PDF