When the Protector Is the Perpetrator: Institutional Betrayal as a Distinct Form of Moral Injury in Civilian Survivors of War
DOI:
https://doi.org/10.67336/5sd8t953Keywords:
forced displacement, impunity, refugees, shame, social contract, trust in authorityAbstract
Objective: Moral injury theory was built on what soldiers did, failed to prevent, or witnessed. Civilian survivors of war often describe a different wound: harm or abandonment by the institutions that owed them protection, followed by years in which nobody is held to account. This paper sets out a theoretical model of that form of moral injury, called here protector betrayal.
Methods: The paper integrates four bodies of work: moral injury theory and its betrayal dimension, institutional betrayal theory, social contract theory, and research on impunity, justice and mental health after mass violence. Published findings from refugees and from civilians living through war were used to check each step of the argument.
Results: The model specifies three conditions (a recognised protective duty, a breach by harm or abandonment, and dependence without agency), one maintaining condition (impunity and non-acknowledgement), and a three-part signature (shame without agency, collapse of the social contract, and mistrust specific to authority). Five testable propositions follow. They concern factorial separability, emotional profile, authority-specific mistrust and avoidance of formal help, persistence under impunity, and separation from fear-based posttraumatic stress in symptom networks. Each is paired with a result that would count against it.
Conclusions: Protector betrayal identifies a transgressor and a time course that current measures of moral injury do not capture together. The model gives researchers a construct that can be measured and tested in war-affected populations. It also implies that repair depends partly on acknowledgement and accountability, which lie outside the consulting room.
References
American Psychiatric Association. (2025). DSM-5-TR update: Supplement to Diagnostic and statistical manual of mental disorders, fifth edition, text revision. https://psychiatry.org/psychiatrists/practice/dsm/updates-to-dsm/updates-to-dsm-5-tr-criteria-text
Amsalem, D., Haim-Nachum, S., Fisch, C. T., Lazarov, A., Levi-Belz, Y., Markowitz, J. C., Nacasch, N., Wainberg, M. L., Lurie, I., Mendlovic, S., & Neria, Y. (2025). Betrayal experiences among individuals living in war zones: A longitudinal study. Journal of Psychiatric Research, 187, 95–100. https://doi.org/10.1016/j.jpsychires.2025.05.023
Amsalem, D., Markowitz, J. C., Fisch, C. T., Lazarov, A., Levi-Belz, Y., Lurie, I., Wainberg, M. L., Mendlovic, S., Neria, Y., & Haim-Nachum, S. (2026). One-year longitudinal effects of war on mental health and sense of betrayal: Roles of age, gender, and ethnicity. Psychiatric Services, 77(6), 524–532. https://doi.org/10.1176/appi.ps.20250340
Başoğlu, M., Livanou, M., Crnobarić, C., Frančišković, T., Suljić, E., Đurić, D., & Vranešić, M. (2005). Psychiatric and cognitive effects of war in former Yugoslavia: Association of lack of redress for trauma and posttraumatic stress reactions. JAMA, 294(5), 580–590. https://doi.org/10.1001/jama.294.5.580
Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91–121. https://doi.org/10.1146/annurev-clinpsy-050212-185608
Bryan, C. J., Bryan, A. O., Anestis, M. D., Anestis, J. C., Green, B. A., Etienne, N., Morrow, C. E., & Ray-Sannerud, B. (2016). Measuring moral injury: Psychometric properties of the Moral Injury Events Scale in two military samples. Assessment, 23(5), 557–570. https://doi.org/10.1177/1073191115590855
Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New WHO prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), 240–248. https://doi.org/10.1016/S0140-6736(19)30934-1
Christl, M.-E., Pham, K.-C. T., Rosenthal, A., & DePrince, A. P. (2024). When institutions harm those who depend on them: A scoping review of institutional betrayal. Trauma, Violence, & Abuse, 25(4), 2797–2813. https://doi.org/10.1177/15248380241226627
Cloitre, M., Garvert, D. W., Brewin, C. R., Bryant, R. A., & Maercker, A. (2013). Evidence for proposed ICD-11 PTSD and complex PTSD: A latent profile analysis. European Journal of Psychotraumatology, 4(1), Article 20706. https://doi.org/10.3402/ejpt.v4i0.20706
Elisha, E., Peled-Laskov, R., & Or, O. (2026). Institutional betrayal and posttraumatic adaptation among Nova festival survivors following the 7 October 2023 attack. European Journal of Psychotraumatology, 17(1), Article 2737601. https://doi.org/10.1080/20008066.2026.2737601
Epskamp, S., Borsboom, D., & Fried, E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195–212. https://doi.org/10.3758/s13428-017-0862-1
Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Harvard University Press.
Friedler, Y., Cohen, R., Zabag, R., Bergman, M., & Haim-Nachum, S. (2026). Childhood maltreatment and psychopathology during collective trauma: The longitudinal role of betrayal-related moral injury. European Journal of Psychotraumatology, 17(1), Article 2665508. https://doi.org/10.1080/20008066.2026.2665508
Griffin, B. J., Purcell, N., Burkman, K., Litz, B. T., Bryan, C. J., Schmitz, M., Villierme, C., Walsh, J., & Maguen, S. (2019). Moral injury: An integrative review. Journal of Traumatic Stress, 32(3), 350–362. https://doi.org/10.1002/jts.22362
Haim-Nachum, S., Lazarov, A., Markowitz, J. C., Levi-Belz, Y., Lurie, I., Wainberg, M. L., Mendlovic, S., Neria, Y., & Amsalem, D. (2025). War-related stressors and mental health: The longitudinal mediating role of betrayal-related moral injury among civilians. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0002072
Herman, J. L. (1992). Trauma and recovery. Basic Books.
Hobbes, T. (1996). Leviathan (R. Tuck, Ed.; Rev. student ed.). Cambridge University Press. (Original work published 1651)
Hoffman, J., Liddell, B., Bryant, R. A., & Nickerson, A. (2018). The relationship between moral injury appraisals, trauma exposure, and mental health in refugees. Depression and Anxiety, 35(11), 1030–1039. https://doi.org/10.1002/da.22787
Hoffman, J., Liddell, B., Bryant, R. A., & Nickerson, A. (2019). A latent profile analysis of moral injury appraisals in refugees. European Journal of Psychotraumatology, 10(1), Article 1686805. https://doi.org/10.1080/20008198.2019.1686805
Houle, S. A., Birch, M., Murphy, D., Greenberg, N., Nazarov, A., & Richardson, J. D. (2026). An expert-driven consensus framework for the study of potentially morally injurious events and their impacts: Findings from an e-Delphi study. European Journal of Psychotraumatology, 17(1), Article 2602301. https://doi.org/10.1080/20008066.2025.2602301
Hyatt, C. S., Fulton, T. M., Guelfo, A., Lathan, E. C., Turner, J. A., Turner, M. D., Currier, J. M., Mekawi, Y., Merrill, N., Powers, A., & Fani, N. (2026). Structure and correlates of the Moral Injury Exposure and Symptom Scale for Civilians (MIESS-C) in a community sample with high trauma exposure. European Journal of Psychotraumatology, 17(1), Article 2617839. https://doi.org/10.1080/20008066.2026.2617839
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. Free Press.
Jones, P. J., Ma, R., & McNally, R. J. (2021). Bridge centrality: A network approach to understanding comorbidity. Multivariate Behavioral Research, 56(2), 353–367. https://doi.org/10.1080/00273171.2019.1614898
Jordan, A. H., Eisen, E., Bolton, E., Nash, W. P., & Litz, B. T. (2017). Distinguishing war-related PTSD resulting from perpetration- and betrayal-based morally injurious events. Psychological Trauma: Theory, Research, Practice, and Policy, 9(6), 627–634. https://doi.org/10.1037/tra0000249
Kakouris, A. F., Murphy, D., Greenberg, N., & McClintock, R. (2026). Evaluating the association between potentially morally injurious events (PMIEs) and types of psychological distress. A systematic review. European Journal of Psychotraumatology, 17(1), Article 2705628. https://doi.org/10.1080/20008066.2026.2705628
Kaminer, D., Stein, D. J., Mbanga, I., & Zungu-Dirwayi, N. (2001). The Truth and Reconciliation Commission in South Africa: Relation to psychiatric status and forgiveness among survivors of human rights abuses. The British Journal of Psychiatry, 178(4), 373–377. https://doi.org/10.1192/bjp.178.4.373
Kapel Lev-Ari, R., Haim-Nachum, S., Markowitz, J. C., Fisch, C. T., Lazarov, A., Levi-Belz, Y., Lurie, I., Wainberg, M. L., Mendlovic, S., Neria, Y., & Amsalem, D. (2026). Betrayal as consequence and catalyst: Longitudinal and reciprocal relations with PTSD and depression during ongoing conflict. Journal of Affective Disorders, 406, Article 121700. https://doi.org/10.1016/j.jad.2026.121700
Linden, M. (2003). Posttraumatic embitterment disorder. Psychotherapy and Psychosomatics, 72(4), 195–202. https://doi.org/10.1159/000070783
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, Article 923928. https://doi.org/10.3389/fpsyt.2022.923928
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. https://doi.org/10.1016/j.cpr.2009.07.003
Mezhenska, M., Contractor, A. A., & Nazarenko, T. (2026). Moral injury and PTSD among Ukrainians exposed to full-scale war. European Journal of Psychotraumatology, 17(1), Article 2685934. https://doi.org/10.1080/20008066.2026.2685934
Miller, K. E., & Rasmussen, A. (2010). War exposure, daily stressors, and mental health in conflict and post-conflict settings: Bridging the divide between trauma-focused and psychosocial frameworks. Social Science & Medicine, 70(1), 7–16. https://doi.org/10.1016/j.socscimed.2009.09.029
Molendijk, T. (2018). Moral injury in relation to public debates: The role of societal misrecognition in moral conflict-colored trauma among soldiers. Social Science & Medicine, 211, 314–320. https://doi.org/10.1016/j.socscimed.2018.06.042
Monteith, L. L., Bahraini, N. H., Matarazzo, B. B., Soberay, K. A., & Smith, C. P. (2016). Perceptions of institutional betrayal predict suicidal self-directed violence among veterans exposed to military sexual trauma. Journal of Clinical Psychology, 72(7), 743–755. https://doi.org/10.1002/jclp.22292
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. https://doi.org/10.7205/MILMED-D-13-00017
Nickerson, A., Byrow, Y., Hoffman, J., O’Donnell, M., Bryant, R. A., Mastrogiovanni, N., McMahon, T., Benson, G., Mau, V., & Liddell, B. J. (2022). The longitudinal association between moral injury appraisals and psychological outcomes in refugees. Psychological Medicine, 52(12), 2352–2364. https://doi.org/10.1017/S0033291720004262
Nickerson, A., Schnyder, U., Bryant, R. A., Schick, M., Mueller, J., & Morina, N. (2015). Moral injury in traumatized refugees. Psychotherapy and Psychosomatics, 84(2), 122–123. https://doi.org/10.1159/000369353
Norman, S. B., Griffin, B. J., Pietrzak, R. H., McLean, C., Hamblen, J. L., & Maguen, S. (2024). The Moral Injury and Distress Scale: Psychometric evaluation and initial validation in three high-risk populations. Psychological Trauma: Theory, Research, Practice, and Policy, 16(2), 280–291. https://doi.org/10.1037/tra0001533
Oriya, S. (2026). Psychological responses to armed conflict among university students: The Kabul University attack. European Journal of Psychotraumatology, 17(1), Article 2737595. https://doi.org/10.1080/20008066.2026.2737595
Passardi, S., Hocking, D. C., Morina, N., Sundram, S., & Alisic, E. (2022). Moral injury related to immigration detention on Nauru: A qualitative study. European Journal of Psychotraumatology, 13(1), Article 2029042. https://doi.org/10.1080/20008198.2022.2029042
Pham, P. N., Weinstein, H. M., & Longman, T. (2004). Trauma and PTSD symptoms in Rwanda: Implications for attitudes toward justice and reconciliation. JAMA, 292(5), 602–612. https://doi.org/10.1001/jama.292.5.602
Pitcho, S., Cohen, L., Nissim, S., Adler, M., Abu Rashed, N., Dahan, I., Oren Tourgeman, D., Shalom Telem, L., & Pergal, R. (2026). Governmental betrayal trauma: When failures of state protection undermine public trust and mental health. American Journal of Orthopsychiatry. Advance online publication. https://doi.org/10.1037/ort0000945
Rees, S., Silove, D., Verdial, T., Tam, N., Savio, E., Fonseca, Z., Thorpe, R., Liddell, B., Zwi, A., Tay, K., Brooks, R., & Steel, Z. (2013). Intermittent explosive disorder amongst women in conflict affected Timor-Leste: Associations with human rights trauma, ongoing violence, poverty, and injustice. PLOS ONE, 8(8), Article e69207. https://doi.org/10.1371/journal.pone.0069207
Shay, J. (1994). Achilles in Vietnam: Combat trauma and the undoing of character. Atheneum.
Shay, J. (2014). Moral injury. Psychoanalytic Psychology, 31(2), 182–191. https://doi.org/10.1037/a0036090
Silove, D. (1999). The psychosocial effects of torture, mass human rights violations, and refugee trauma: Toward an integrated conceptual framework. The Journal of Nervous and Mental Disease, 187(4), 200–207. https://doi.org/10.1097/00005053-199904000-00002
Silove, D., Brooks, R., Bateman Steel, C. R., Steel, Z., Hewage, K., Rodger, J., & Soosay, I. (2009). Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Social Science & Medicine, 69(5), 670–677. https://doi.org/10.1016/j.socscimed.2009.06.030
Singh, N. (2026). Moral Trauma and Identity Disruption Scale (MTIDS): Instrument, supplementary modules, scoring, and administration manual (Version 1.0, pre-validation research edition) [Unpublished manuscript].
Smith, C. P. (2017). First, do no harm: Institutional betrayal and trust in health care organizations. Journal of Multidisciplinary Healthcare, 10, 133–144. https://doi.org/10.2147/JMDH.S125885
Smith, C. P., & Freyd, J. J. (2013). Dangerous safe havens: Institutional betrayal exacerbates sexual trauma. Journal of Traumatic Stress, 26(1), 119–124. https://doi.org/10.1002/jts.21778
Smith, C. P., & Freyd, J. J. (2014). Institutional betrayal. American Psychologist, 69(6), 575–587. https://doi.org/10.1037/a0037564
Sonis, J., Gibson, J. L., de Jong, J. T. V. M., Field, N. P., Hean, S., & Komproe, I. (2009). Probable posttraumatic stress disorder and disability in Cambodia: Associations with perceived justice, desire for revenge, and attitudes toward the Khmer Rouge trials. JAMA, 302(5), 527–536. https://doi.org/10.1001/jama.2009.1085
Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. JAMA, 302(5), 537–549. https://doi.org/10.1001/jama.2009.1132
Talmon, A., Hasson, R., Hollander, Y., & Tsur, N. (2026). Fractured trust amidst war: The role of institutional betrayal and childhood maltreatment in shattered world assumptions and multilevel distress. Psychiatry Research, 358, Article 116959. https://doi.org/10.1016/j.psychres.2026.116959
Tangney, J. P., Stuewig, J., & Mashek, D. J. (2007). Moral emotions and moral behavior. Annual Review of Psychology, 58, 345–372. https://doi.org/10.1146/annurev.psych.56.091103.070145
Tay, A. K., Rees, S., Steel, Z., Liddell, B., Nickerson, A., Tam, N., & Silove, D. (2017). The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste. Epidemiology and Psychiatric Sciences, 26(4), 403–413. https://doi.org/10.1017/S2045796016000317
Ter Heide, F. J. J., & Olff, M. (2023). Widening the scope: Defining and treating moral injury in diverse populations. European Journal of Psychotraumatology, 14(2), Article 2196899. https://doi.org/10.1080/20008066.2023.2196899
Tyler, T. R. (2006). Why people obey the law. Princeton University Press.
United Nations. (1999). Report of the Secretary-General pursuant to General Assembly resolution 53/35: The fall of Srebrenica (A/54/549). https://digitallibrary.un.org/record/372298
United Nations Commission on Human Rights. (2005). Updated set of principles for the protection and promotion of human rights through action to combat impunity (E/CN.4/2005/102/Add.1). United Nations. https://digitallibrary.un.org/record/541829
United Nations General Assembly. (2005). 2005 World Summit Outcome (A/RES/60/1). United Nations. https://digitallibrary.un.org/record/556636
United Nations High Commissioner for Refugees. (2026). Global trends: Forced displacement in 2025. https://www.unhcr.org/sites/default/files/2026-06/global-trends-report-2025.pdf
Downloads
Published
Issue
Section
License
Copyright (c) 2026 The Journal of Mind & Psychological Science
This work is licensed under a Creative Commons Attribution 4.0 International License.
Google Scholar
