Moral Injury in Veterans with Nonepileptic Seizures
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Morally injurious experiences are divided between those involving personal responsibility and those involving others' responsibility. Oftentimes, negative internally directed emotions (e.g., guilt, shame, spiritual conflict) result from MIEs involving personal responsibility, while externally directed emotions (e.g., anger, trust issues) come from MIEs involving the responsibility of others. In comparison with other traumatic events, MIEs may not be associated with fear.
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We conducted a retrospective cross-sectional study of 82 male and female Veterans with video-electroencephalography (EEG)-confirmed PNES consecutively seen in a Veterans Administration neuropsychiatry clinic. Identification of MIEs (witnessed or experienced events that conflict with one's moral compass) was made based by an independent observer using a survey of MIEs. Comorbidities, trauma history, and symptom scales were compared among those with and without MIEs.
Of the 82 Veterans included in the analysis, MIE endorsement was present in 12 participants (14.6%). The Veterans with a MIE were an average of 9 years younger than those without MI. No significant differences were found for the other demographic variables in the study. Additionally, we found that there were no significant differences for categorical PTSD, or depression DSM-5 diagnoses, rates of substance abuse, suicidal ideation severity, or history of traumatic experiences (physical, emotional, verbal, and sexual). This may suggest that MI has its own symptomatic and historical exposure criteria.
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Likewise, feelings of guilt were significantly higher in Veterans with PNES and MIE than those with PNES and no MIE. Guilt is defined as feeling regretful about an act or behavior. The hypothesis for the study was confirmed, building on prior work, as many MIEs are described as guilt-provoking by those who witness or participate in them. Those with MIEs believe that their core values have been transgressed. Some of the Veterans who report MIEs describe a sense of spiritual death, with one Veteran who endorsed a personal faith prior to deployment recalling MIEs where child noncombatants were killed.
This is the first study that describes MIEs in Veterans with PNES. Identifying moral-spiritual conflicts, and addressing interventions such as forgiveness may be an approach to address MI. An increased understanding of this condition may aid in the development of diagnostic screenings and therapy options for those with PNES.
From: LaFrance, W. C., Jr., Vo, P., Baird, G., East, R., Stein, N. R. (2019). Moral injury in Veterans with nonepileptic seizures. Epilepsy Behav. 102, 106681. doi: 10.1016/j.yebeh.2019.106681. [Epub ahead of print].
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LaFrance, W. C., Jr. & Stein, N. (2020). Moral Injury in Veterans with Nonepileptic Seizures. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2020/01/moral-injury-in-veterans-with.html