Is there a dissociative subtype of exposure to PMIEs among army veterans?

Previous research has demonstrated that post-traumatic stress disorder (PTSD) symptoms and exposure to potentially morally injurious events (PMIEs) frequently co-occur in military veterans and share similar adverse mental and behavioral health outcomes. While studies have established a robust association between PTSD and dissociative symptoms in veterans, evidence supporting a direct link between exposure to PMIEs and dissociative symptoms has largely been anecdotal. In this cross-sectional study, a volunteer sample of 189 Israeli male combat veterans completed validated self-report questionnaires assessing PTSD symptoms, exposure to PMIEs, and dissociative symptoms. The results show cooccurrence of PTSD symptoms and depersonalization and/or derealization symptoms, hereby suggesting the existence of a dissociative subtype of PTSD, characterized by elevated PTSD symptoms alongside persistent or recurrent symptoms of depersonalization and/or derealization. Moreover, PTSD symptoms were found to mediate the relationship between PMIE exposure and dissociative symptoms. Notably, one of the facets of exposure to PMIEs, the commission of moral transgressions, was significantly associated with depersonalization/derealization symptoms, suggesting a dissociative subtype of PMIE exposure. These findings provide empirical support for the trauma model, which conceptualizes dissociative symptoms as resulting from severe trauma, and underscore the importance of offering specialized treatments for veterans who report having committed moral transgressions.