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. 2025 Jul 11;38(4):393–403. doi: 10.1080/08995605.2025.2525662

Service members’ exposure to potentially morally injurious events: Intimate partner knowledge and response

Emily Taverna a,b,c, Brett T Litz b,c,d, Steffany J Fredman e, Keith D Renshaw f, Elizabeth S Allen g,✉
PMCID: PMC13313232  PMID: 40644641

ABSTRACT

Moral injury entails functionally impairing moral emotions, beliefs, and behaviors resulting from enacting, experiencing, or witnessing events that transgress deeply held moral beliefs. Moral injury is associated with concerns about disclosure regarding military experiences, such as feeling judged. Yet, little research has documented the extent to which intimate partners know about service members’ exposure to potentially morally injurious experiences (PMIEs) and their reactions to this knowledge. The current study is a secondary analysis of data from a sample of 579 couples (1,158 individuals) that included male service members’ reports of experiencing specific events during deployment (i.e., PMIEs by self, PMIEs by others, loss, or life threat) and their female civilian partners’ reports of the service member telling them about such events. Results suggest that partners are significantly less likely to report being told about service members’ exposure to PMIEs compared to exposure to experiences of threat and loss. In general, service members’ reports of the seriousness of deployment experiences and their distress regarding these experiences were associated with a greater likelihood of partners’ reports of being told about such experiences. In the current sample, partners had low ratings of negative changes in opinions of the service member after learning of their exposure to PMIEs by self or by others. Although preliminary, findings may inform understanding of the conditions under which disclosure of military experiences to intimate partners is more or less likely and the type of partner reactions that might be observed among military couples in intact relationships.

KEYWORDS: Trauma, moral distress, trauma disclosure, intimate relationships, posttraumatic stress disorder

What is the public significance of this article?—This study documented that service members may be less likely to disclose potentially morally injurious events (PMIEs) to their intimate partners relative to other types of deployment exposures. Although partners experienced some degree of distress due to knowing about service members’ PMIEs, reports of negative changes in opinions about the service member were low. Our findings suggest that greater attention to how PMIEs impact intimate relationships is warranted.

During military deployments, service members are frequently exposed to a range of highly stressful events that can have significant consequences for health, well-being, and relationship functioning following return from deployment (Knobloch et al., 2023; Vogt et al., 2011; Wisco et al., 2017). Prior literature is mixed with respect to the potential benefits of disclosing about military experiences to intimate partners. Some research suggests that disclosure can have positive effects for both the individual and the couple, contingent on factors such as communication skills, privacy boundaries, and the response of the listener (see Knobloch et al., 2023 for a review). Cross-sectional research, which cannot demonstrate causality, demonstrates that disclosure of deployment experiences to a supportive intimate partner is associated with service members experiencing fewer posttraumatic stress disorder (PTSD) symptoms and that the extent of deployment-related disclosure is associated with better post-deployment family reintegration and relationship satisfaction (Balderrama-Durbin et al., 2013, 2015; Campbell & Renshaw, 2013). Qualitative research on veteran couples further supports that those who engage in higher levels of disclosure about deployment and/or trauma experiences to an intimate partner report more positive relationship experiences (e.g., support, relationship cohesion), whereas those who engage in lower levels of deployment and/or trauma disclosure report more negative relationship experiences (e.g., greater conflict and stress, poor communication; Nelson Goff et al., 2015). When levels of trauma disclosure are low, service members’ greater trauma symptoms are associated with their partners’ experience of lower perceived relationship quality, whereas trauma symptoms and partners’ relationship quality are not associated for those with high levels of disclosure (Monk & Nelson Goff, 2014).

These studies suggest that disclosure is associated with better relationship quality, which may be due to better relationship quality facilitating disclosure, disclosure having benefit to the intimate partnership, or other mechanisms. Importantly, other research suggests that there can also be potential negative consequences of disclosure. For example, research suggests that greater military disclosures by those who experience elevated psychological distress can exacerbate distress for their intimate partners (Campbell & Renshaw, 2012). In fact, some service members may engage in protective buffering during deployment, whereby they actively refrain from disclosing deployment-related events to their partners due to perceptions that they are protecting them from distressing information (Carter et al., 2020). Although greater buffering is associated with lower levels of partner distress during the deployment, it is also associated with higher levels of psychological distress among service members (Carter et al., 2020). This association could reflect that elevated personal distress is a consequence of buffering, that elevated distress related to specific events may cause more buffering, or other mechanisms. Overall, the findings on buffering in military couples (see review by Knobloch et al., 2023) align with broader research suggesting that individuals who experience stressful or traumatic events may avoid discussing their experiences to relieve distress in the short-term but that this can contribute to relationship and psychological distress (Pineles et al., 2011; Rodriguez et al., 2012).

Importantly, studies focused on disclosure within military couples typically do not evaluate these issues separately for different types of deployment exposures. Over the past 15 years, there has been increased attention to potentially morally injurious events (PMIEs), which refer to exposure to events that transgress deeply held moral beliefs because of one’s own or another person’s actions or inactions (Litz et al., 2009). Exposure to PMIEs is separate from moral injury as an outcome of these events, similar to the distinction between exposure to potentially traumatizing events and development of PTSD (Litz & Walker, 2025). Stein et al. (2012) delineated categories of potentially traumatic events during military service. These include exposure to threat to the life of oneself or others, loss due to witnessing or learning about the death of a family member, friend, or unit member, moral injury by others due to witnessing or experiencing an action that is a violation of moral standards, and moral injury by self due to committing a violation of moral standards. Turning to the possible outcomes of such events, evidence suggests that these categories are associated with unique presentations of peri- and post-traumatic emotional sequelae (Litz et al., 2018; Stein et al., 2012). For example, moral injury by self may be more closely linked to self-conscious cognitive and emotional reactions (e.g., guilt, shame) than other exposure types (Litz et al., 2018; Stein et al., 2012).

Given that moral values function to foster adaptive social interactions (Farnsworth et al., 2017), transgressions of moral values by oneself or others may uniquely compromise how one experiences interpersonal interactions after the morally injurious event. Litz and Walker (2025) explain distinct domains of impact of moral injury, including social impacts, such as the degree of connectedness and sense of belonging with others. The emotions associated with moral injury and the nature of morally injurious events are posited to predict more isolation and less disclosure (La Fleur et al., 2020). Additionally, Nazarov et al. (2024) found that service members in England were less likely to disclose PMIEs to mental health professionals because of concerns about potential legal and career harm. Thus, multiple factors (e.g., shame, legal concerns, general patterns of avoidance common to post-traumatic stress) may inhibit disclosure of PMIEs.

Research suggests that reports of exposure to military-related PMIEs and related distress are associated with functional impairment in relationships and lower levels of perceived social support (Chestnut et al., 2020; Currier et al., 2017; Fernandez & Currier, 2023; Koenig et al., 2018; Maguen et al., 2022; Nash et al., 2013). In a qualitative study, first responders reported experiences of isolation and detachment from family, friends, and loved ones subsequent to exposure to PMIEs (Knobloch & Owens, 2024). With respect to intimate relationships specifically, one study of service members returning from a deployment found that killing during a deployment, which may reflect a self-transgression, is associated with intimate relationship problems above and beyond general experiences of combat exposure (Maguen et al., 2010). Findings more specific to disclosure of PMIEs to close others are limited, but La Fleur et al. (2020) found that higher levels of moral injury among veterans were associated with more concerns about disclosing military experiences to others (e.g., civilians, friends, family), such as feelings of judgment from others. Together, these findings suggest that exposure to PMIEs may be disclosed less often to intimate partners relative to other types of deployment exposures, but to our knowledge this has not been empirically evaluated.

The present study builds upon prior literature by leveraging both service member and partner reports to examine if partners are less likely to report being told by service members of exposure to PMIEs relative to other types of military exposures (i.e., loss, threat to the life of self or others). We additionally examine whether the extent of service members’ distress related to various experiences, and their reports of the seriousness of these events, is associated with partners’ reports of being told of these experiences. Finally, among partners who report being told of specific types of events, we descriptively explore partners’ appraisals and reactions to this knowledge. Drawing from prior literature on the reluctance to disclose moral injury (La Fleur et al., 2020, Nazarov et al., 2024), we hypothesized that (1) partners would be less likely to report being told by their service member spouse of PMIEs, compared to experiences of loss or threat to their or another’s life, and (2) given that emotions of shame and guilt may inhibit disclosure (La Fleur et al., 2020), higher service member ratings of guilt or shame about PMIEs by self would predict lower likelihood of partners reporting being told by their service member spouse of such events. We did not specify hypotheses regarding the additional analyses given their novelty and competing possibilities regarding patterns of results.

Method

Participants and procedure

Data for the current study were drawn from the first time point of the Relationships Among Military Personnel study, which is a longitudinal study that aimed to examine the post-deployment mental and relationship health of Army couples. Participants were recruited for the study between June 2013 and June 2014. Recruitment materials clearly indicated the topics of interest in the study (e.g., personal and relationship experiences, psychological health after deployment) and that both members of the couple would be asked to participate. Recruitment materials directed potential participants to a study website that included study information, a brief screening survey, and the informed consent document. To determine eligibility, both partners in the couple had to complete the online screening survey. Participants were eligible if they were: 1) age 18 or older, English proficient, and passed informed consent comprehension questions, and 2) were part of a couple that consisted of (a) a male who returned from an Army deployment in the past 2 years, and (b) a female civilian partner, and 3) the couple had been in a serious relationship for at least 1 year and the relationship began prior to the most recent deployment. Although some male participants may have left active duty by the time of the survey, we retain the use of the term service member due to our reference to their experiences during deployment. There were 715 couples (1,430 individuals) who were eligible to participate in the study and were sent an invitation with a unique link to an online survey. Participants had 4 weeks to complete the survey, and they were compensated with a $50 gift card in exchange for participation. There were 603 service members (84.3% response rate for male participants) and 645 partners (90.2% response rate for female participants) who participated in the initial survey. Among these participants, there were 579 matched couples, for a couple-level response rate of 80.9%. Given that the aims of the current study required examination of data for both partners, we limited the sample to the 579 couples in which both members of the couple participated (N = 1,158). All study procedures had approval from a university institutional review board and from the Army Human Research Protections Office.

Service members were 31.15 years old (SD = 5.84) and partners were 30.20 years old (SD = 5.80), on average. Service members identified as White (85.1%), Black or African American (7.8%), American Indian or Alaska Native (2.2%), Asian (1.2%), Native Hawaiian or Pacific Islander (<1%), or identified their race as “other” (6.2%). Partners identified as White (85.3%), Black or African American (7.1%), Asian (2.6%), American Indian or Alaska Native (1.7%), Native Hawaiian or Pacific Islander (<1%), or identified their race as “other” (5.0%). There were 11.2% of servicemembers and 11.2% of partners who identified as Hispanic or Latino. Racial and ethnic identities are not mutually exclusive. Most service members completed some college or trade or technical school (52.5%), 22.1% reported a high school diploma or equivalent, 15.5% reported completing a bachelor’s degree, 9.7% reported post-bachelor’s education, and a small portion (<1%) did not graduate from high school. Most partners completed some college or trade or technical school (52.5%), 10.4% reported a high school diploma or equivalent, 21.9% reported completing a bachelor’s degree, 14.5% reported post-bachelor’s education, and a small portion (<1%) did not graduate from high school. There were 58.5% of service members and 87.3% of partners who reported personal income of less than $50,000. Most service members had an OEF/OIF deployment (95.0%) and were currently active duty (91.4%).

Measures

Service members’ exposure to deployment experiences

We assessed exposure to four types of potentially traumatic deployment events to align with categories proposed by Stein et al. (2012). Exposure to potentially morally injurious events by self (“PMIE-self”) was indicated by the item Did anything happen during a deployment that you may regret or feel guilt or shame about (this may be something you did, failed to do, or thoughts and feelings you had or did not have)? Exposure to potentially morally injurious events by others (“PMIE-other”) was indicated by the item Did anything happen during a deployment when you witnessed or were victim to something that really went against what you believe is right or moral? Exposure to loss (“loss”) was indicated by the item During a deployment, did you witness or learn about the death of someone close to you? Exposure to threat (“threat”) was indicated by the item Did anything happen during a deployment where your life or when the lives of others around you were threatened? Service members rated items for PMIE-self, PMIE-other, and threat using a 5-point Likert response scale (1 = not at all; 5= frequently), which were then dichotomized for the current study such that those who endorsed “not at all” were coded as “0” to reflect no exposure and all other response options were coded as “1” to reflect exposure to that event type. Service members rated loss using a dichotomous response format (0 = no; 1 = yes). These items are conceptualized as “potentially” traumatic, as no study processes confirmed whether participants experienced them as traumatic. Although the PMIE-self item includes a degree of potential “impact” in terms of regret, guilt, and shame, the PMIE-self and PMIE-other items are not considered evidence of moral injury per se. Prior research in this sample indicated that these items performed as expected in demonstrating differential prediction of willingness to seek treatment and/or receipt of treatment for service members (Paige et al., 2019).

Service members’ perceived seriousness and distress regarding deployment experiences

Service members who endorsed exposures to these events were asked follow-up questions for each event type to ascertain perceived seriousness and aspects of distress. Some aspects of distress in relation to these events were worded based on Stein et al. (2012). For all four exposure types, service members rated the following items using a 5-point Likert response format: a) How serious were these experiences? (1 = Not at all serious; 5 = Extremely Serious); b) How much have these experiences haunted you (occupied your mind) in the last month? (1 = Never; 5 = Constantly). In addition, for each exposure type, different aspects of emotional distress were assessed with respect to specific emotions that are often posited to be most relevant to PMIE-self (i.e., guilt, shame), PMIE-other (i.e., anger, horror), loss (i.e., guilt, grief), and threat (i.e., anxiety): a) Indicate the intensity or severity of [emotion] that you had about these experiences at the time (0 = None; 4 = Extreme); b) Indicate the intensity or severity of [emotion] that you had about these experiences in the last month (0 = None; 4 = Extreme). Given different response anchors, there is no standard scoring for these ratings, and each item was examined individually. We rescaled items rated on a 0 to 4 scale to be on a 1 to 5 scale prior to conducting analyses to facilitate ease of comparing results across different reaction types.

Partners’ reports of service members’ disclosure

Partners were administered items that parallel those administered to service members to assess whether the service members revealed to them any degree of exposure to the various deployment event types. Specifically, for each deployment exposure type, partners were administered items asking “Has your partner told you about any experiences during deployment … ,” which was then followed by the same description of the event types as described for the service members. For example, the PMIE-self item for the partner read: “Has your partner told you about anything happening during a deployment that he may regret or feel guilt or shame about (this may have been something he did, something he failed to do, or thoughts and feelings he had or did not have).” Partners rated the respective items using a dichotomous response format (0 = No; 1 = Yes). The strict parallel wording for service members and partners supports this as a reasonable index of disclosure for this initial exploration of this research question. At this assessment, service members were not asked directly if they disclosed to partners or not.

Partners’ perceived seriousness and distress regarding service member disclosures of deployment experiences

Partners who endorsed being told of the respective event type were administered parallel items to those administered for the service members reflecting the partner’s perceived seriousness of the event and the extent to which the event has haunted the partner’s mind in the past month. These items were rated using the same Likert-type response format as previously described. In addition, for all event types, partners were also administered the following three items: 1) How upsetting was it for you to hear about these things? (1 = Not at all upsetting; 5 = Extremely Upsetting); How much did this change your opinion of your partner positively? (0 = None; 4 = Extreme); How much did this change your opinion of your partner negatively? (0 = None; 4 = Extreme). Given different response anchors, there is no standard scoring, and each item was examined individually. We rescaled items rated on a 0 to 4 scale to be on a 1 to 5 scale prior to conducting analyses to facilitate ease of comparing results across different reaction types.

Analytic approach

First, we used chi-square tests to determine concordance of service members’ reports of different types of exposures occurring and their partners’ reports of whether the service members disclosed such an event to inform our understanding of potential discrepancies before interpreting primary results. Second, to evaluate whether partners were more likely to be told of certain types of deployment exposures relative to others, we conducted six McNemar’s chi-square tests. Each test included service members who endorsed (at least) the two specific exposures under evaluation and compared partner-reported disclosure rates for the two exposures. This approach avoided inflation due to nonoccurrence of specific exposure types. Each test will have overlap in samples (e.g., service members who reported exposure to all four experiences will be included in each test). Odds ratios were examined as a measure of effect size. Next, we conducted a series of logistic regressions to examine whether the perceived seriousness of the event and the extent of distress that the service member reported in relation to the deployment exposure was associated with the likelihood of a partner reporting being told of the event. Finally, we conducted descriptive analyses among partners who reported being told of an event to assess aspects of perceived seriousness of the event, distress regarding the event, and possible changes in opinions of the service member. Averages in the lower range of potential scores (i.e., 2 or lower) will be described as low, averages in the midpoint of potential scores (i.e., around 3) will be described as moderate, and scores in the higher range of potential scores (e.g., 4 or higher) will be described as high.

Results

Descriptives

Initial chi-square tests showed significant concordance of service members’ report of specific exposure types occurring (or not) and partner reports of being told (or not) about the exposure (ps < .001). Most cases were expected combinations: partners who reported being told of exposures that the service member also reported had occurred, or partners who reported not being told of an exposure that service members said either occurred or did not occur. However, among service members who reported that an exposure type did not occur, there was a subset of partners who reported being told about that exposure by the service member (14.4% for PMIE-self; 11.3% for PMIE-other; 38.5% for threat; 19.5% for loss). Patterns of responding that may contribute to this type of discrepancy include (a) events having aspects of multiple exposure types and/or partners’ differential perceptions about how to label aspects of a disclosed event; (b) partners’ imperfect recall about what a service member did or did not share with them; or (c) poor responding (e.g., inattention to item content).

Focusing on the primary question of rates of disclosure, we first calculated simple percentages by the number of partners who reported being told of a specific event divided by the number of their service member husbands who reported such an event occurring. There were 50.5% of service members who reported exposure to PMIE-self, and of these, 39.2% of their partners reported being told by the service member of a PMIE-self. There were 29.1% of service members who reported exposure to PMIE-other, and of these, 26.8% of their partners reported being told by the service member of a PMIE-other. There were 76.1% of service members who reported exposure to threat, and of these, 77.7% of their partners reported being told by the service member of such a life-threatening event. There were 47.8% of service members reported exposure to loss, and of these, 68.4% of their partners reported being told by the service member of a loss.

Comparisons of partners knowing about various exposures

As presented in Table 1, McNemar’s chi-square tests comparing relative rates of disclosure showed significant differences in all comparisons of disclosures of two different exposure types. Consistent with the patterns observed for the basic percentages, partners were less likely to report being told of PMIE-self relative to loss and threat but were more likely to report being told of PMIE-self relative to PMIE-other. Being told of PMIE-other was less likely than being told of all other types of experiences. Being told of loss was less likely than being told of threat.

Table 1.

Comparisons of female partners’ reports of knowing about different exposure types.

      Exposure 1
 Exposure 2
    
Exposure 1 Exposure 2 N Aware of exposure
N (%)		 Not aware of exposure
N (%)		 Aware of exposure
N (%)		 Not aware of exposure
N (%)		 McNemar’s
χ2 		Odds
Ratio
Moral injury self Moral injury others 129 57 (44.2%) 72 (55.8%) 31 (24.0%) 98 (76.0%) 12.02*** 3.00
Moral injury self Loss 176 79 (44.9%) 97 (55.1%) 130 (73.9%) 46 (26.1%) 30.12*** 0.24
Moral injury self Threat 246 101 (41.1%) 145 (58.9%) 197 (80.0%) 49 (19.9%) 77.80*** 0.09
Moral injury others Loss 91 23 (25.3%) 68 (74.7%) 24 (26.4%) 67 (73.6%) 34.24*** 0.10
Moral injury others Threat 146 37 (25.3%) 109 (74.7%) 115 (78.8%) 31 (21.2%) 64.45*** 0.08
Loss Threat 235 166 (70.6%) 69 (29.4%) 198 (84.3%) 37 (15.7%) 14.13*** 0.36
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Individual comparisons were limited to female partners of service members who reported experiencing both event types in the respective comparisons. Odds ratios reflect the likelihood of the partner reporting awareness of Exposure 1 relative to Exposure 2. ***p < .001.

How is service members’ perceived seriousness and distress about deployment experiences associated with the likelihood of partners’ being told about these types of exposures?

As presented in Table 2, logistic regression results suggest that, for most types of exposure, the more serious the service member rated the type of exposure, it was more likely that the partner reported that the service member had told them about this type of exposure. Specifically, there were significant positive associations between seriousness of the experience and partners’ report of being told of the experience for PMIE-self and threat, a positive nonsignificant association for PMIE-other, but a significant negative association for loss. Indicators of service member distress (e.g., guilt, grief, feeling haunted) were associated with greater likelihood of their partners being told about this type of exposure for PMIE-self (which was contrary to hypothesis), loss, and threat. With respect to PMIE-other, only anger at the time of the event and being haunted in the past month were associated with significantly greater likelihood of the partner reporting being told about this type of event.

Table 2.

Logistic regression results reflecting associations between service members’ distress and their partners reporting being told of the type of exposure.

  B SE Wald OR OR 95% CI
Moral Transgressions-Self          
 Perceived seriousness 0.36*** 0.10 13.56 1.43 1.18, 1.73
 Intensity of guilt or shame at time of event 0.33* 0.13 6.65 1.39 1.08, 1.78
 Intensity of guilt or shame in the past month 0.38** 0.13 8.59 1.46 1.13, 1.88
 Haunted/occupied mind in the past month 0.39* 0.15 6.60 1.47 1.10, 1.97
Moral Transgressions-Other          
 Perceived seriousness 0.23 0.15 2.58 1.26 0.95, 1.68
 Intensity of anger at time of event 0.45** 0.15 8.81 1.57 1.17, 2.11
 Intensity of horror at the time of event 0.17 0.13 1.63 1.18 0.91, 1.53
 Intensity of anger in the last month 0.14 0.16 0.81 1.16 0.84, 1.58
 Intensity of horror in the last month 0.03 0.18 0.03 1.03 0.73, 1.46
 Haunted/occupied mind in the past month 0.46* 0.20 4.96 1.58 1.06, 2.35
Loss          
 Perceived seriousness −0.32* 0.11 8.22 0.73 0.59, 0.90
 Intensity of guilt in the past month 0.45** 0.15 9.37 1.56 1.17, 2.07
 Intensity of grief at time of event 0.39*** 0.11 11.94 1.48 1.19, 1.86
 Intensity of guilt in the past month 0.46*** 0.14 11.22 1.58 1.21, 2.06
 Intensity of grief in the past month 0.45** 0.15 9.37 1.56 1.17, 2.07
 Haunted/occupied mind in the past month 0.52** 0.17 9.97 1.68 1.22, 2.33
Threat          
 Perceived seriousness 0.50*** 0.11 22.45 1.64 1.34, 2.02
 Intensity of anxiety at time of event 0.39*** 0.11 13.70 1.48 1.20, 1.83
 Intensity of anxiety in the past month 0.34** 0.13 6.80 1.41 1.09, 1.82
 Haunted/occupied mind in the past month 0.30* 0.15 4.21 1.35 1.01, 1.79
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Results reflect separate logistic regressions with each variable reflecting service member distress entered as a single predictor. OR = Odds ratio. ***p < .001; **p < .01; *p < .05.

How do partners appraise these events and react to learning aboutthese exposures?

As presented in Table 3, partners who were told by the service member about their exposure to respective event types tended to rate the events as moderate to high with respect to seriousness. Ratings of the extent to which learning about the exposure haunted the partners’ mind in the past month tended to be consistent across exposure types and relatively low. Similarly, partners tended to rate past-month emotional distress as low with respect to PMIE-other (i.e., anger, horror) and threat (i.e., anxiety). With respect to PMIE-self, although ratings that the event was upsetting to hear about were moderate, there was low endorsement that learning about the event negatively changed the partner’s opinion of the service member and moderate endorsement that their opinions positively changed. Similarly, PMIE-other was moderately upsetting to hear about, but there was low endorsement that the partner’s opinion about the service member changed either negatively or positively.

Table 3.

Descriptives reflecting partner reactions to knowing about service members’ exposures.

Exposure Type Reaction M SD
Moral Transgressions-Self Perceived seriousness 3.70 1.22
Upsetting to hear about 3.57 1.25
Positively changed opinion of partner 2.24 1.42
Negatively changed opinion of partner 1.30 0.73
Haunted/occupied partner’s mind 1.57 0.76
Moral Transgressions-Other Perceived seriousness 3.46 1.11
Upsetting to hear about 3.34 1.23
Intensity of anger about experiences past month 1.71 1.11
Intensity of horror about experience past month 1.59 0.97
Positively changed opinion of partner 1.86 1.22
Negatively changed opinion of partner 1.29 0.68
Haunted/occupied partner’s mind 1.48 0.62
Loss Perceived seriousness 2.41 1.37
  Haunted/occupied mind in the past month 1.86 1.00
Threat Perceived seriousness 4.13 1.03
  Intensity of anxiety in the past month 2.02 1.19
  Haunted/occupied mind in the past month 1.72 0.92
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The possible range for each reaction was 1-5, with higher values reflecting greater endorsement of the reaction.

Discussion

In this analysis from a larger longitudinal study of Army couples, we evaluated the extent to which female intimate partners report being told by their service member husbands about the husbands’ exposure to PMIEs and the partners’ reactions to this knowledge. Consistent with our first hypothesis, we found that fewer partners indicated that they were told about service members’ exposures of PMIEs by self and PMIEs by others relative to exposure to loss and threat. This finding is consistent with prior work that has documented a lower willingness to disclose PMIEs to others and concerns about potential consequences of disclosing PMIEs (e.g., legal and career harm, judgment by friends, family, and civilians; La Fleur et al., 2020; Nazarov et al., 2024). These results may inform one potential reason for the associations between reports of PMIEs and difficulties with intimate relationship functioning that have been documented in prior literature (Fernandez & Currier, 2023; Maguen et al., 2022). Depending on factors such as the health of the relationship, disclosure of PMIEs (and other deployment stressors) may be helpful for service members to receive meaningful support. That is, prior research suggests that intimate partners can provide valuable support to address the emotional impacts of deployment stressors (Olson et al., 2018; Welsh et al., 2015).

We did not find support for our second hypothesis, which was that higher ratings of guilt and shame regarding PMIEs by self would be associated with a lower likelihood of partners reporting that they were told by their service member spouse of such events. Instead, service members’ greater intensity of guilt and shame about such events, along with greater reports of such events being serious and haunting them, was associated with greater likelihood of partners’ reporting they were told of such events. In fact, across deployment exposure types, distress about the experience was generally associated with greater likelihood of the partner reporting being told of the exposure, except for some aspects of distress regarding exposure to PMIEs by others. Although we did not directly test this, it could be that greater distress from military stressors generally contributes to more difficulties within one’s intimate relationship (e.g., conflict, withdrawal), which may prompt conversations and service members’ disclosure. Alternatively, it may be that more serious and upsetting events are more likely to hit a threshold for the service member where they feel more of a need to disclose. This finding may also align with research suggesting that greater trauma-related distress and functional impairment are associated with help-seeking (see Smith et al., 2020 for a review).

A somewhat differing pattern of results was observed for PMIE-other than was observed for other exposure types, in that only two indicators of distress were significantly associated with the partner’s report of being told of the exposure. It may be that more serious or horrific events perpetrated by others have a mix of being more disclosed (e.g., due to emotional needs) or less disclosed (e.g., due to operational, legal, or career concerns; Nazarov et al., 2024), and thus overall associations were attenuated. Of note, we also observed that perceived seriousness of loss was associated with less likelihood of partners reporting being told of the loss, which was in the opposite direction of other exposure types. The reasons for the reverse direction for loss are unknown, but it may be that partners are more likely to be informed by others, or may be in the position of informer, when more serious losses occur for a service member.

With respect to partner reactions, we found that, on average, partners generally experienced moderate levels of perceiving the event to be serious and feeling upset to hear about PMIEs. On average, partners reported low levels of negative change in their opinion of the service member after being told of such an event. Although descriptive and exploratory, this finding aligns with prior qualitative research among veterans involved in PTSD treatment and their intimate partners, which suggests that many partners may be motivated to better understand the veteran’s trauma-related experiences, how it impacts them, and how they can best provide support (Rando & Thompson-Hollands, 2022). However, in recognition that some partners may experience high levels of distress and/or strong negative reactions to disclosures, it is important to establish boundaries around disclosure, with appropriate caution about the level of detail needed to address individual and relationship goals (Monson & Fredman, 2012).

For service members who have not told their intimate partner about such events, inhibited disclosure may be related to either unfounded and/or founded concerns about judgment. This may be particularly salient for those in distressed relationships, given that service members in more distressed relationships are less likely to disclose stressful deployment experiences to their partners (Balderrama-Durbin et al., 2013). These are important considerations given that disclosures that are received negatively by partners are associated with greater trauma-related distress for individuals (Dworkin et al., 2019). Heightened service member distress may also contribute to greater distress among partners in response to disclosures (Campbell & Renshaw, 2012). In addition to interpersonal concerns, some non-disclosure to intimate partners may reflect service members’ efforts to avoid distressing reminders of the event(s) they experienced during deployment. Indeed, avoidance is a key mechanism that maintains clinically elevated levels of psychological distress (e.g., PTSD) and functional impairment (e.g., relationship difficulties; Pineles et al., 2011; Rodriguez et al., 2012). Given that this study uses a convenience sample that was not specifically recruited for clinical distress and that electing to participate as a couple may indicate more comfort in sharing difficult experiences, overall results should be interpreted with caution with respect to the adaptiveness of disclosing deployment exposures to intimate partners, particularly PMIEs given that they may be uniquely sensitive in nature.

Due to the preliminary nature of the current study, further research is needed before translating to clinical practice. Specifically, our findings suggest a need to examine the value of assessing for and facilitating healthy disclosures of PMIEs to intimate partners within a clinical context as a potential way to bolster service members’ social support and reduce individual and relationship distress related to PMIEs. Future clinical research may specifically examine PMIE disclosure to partners in the context of Cognitive-Behavioral Conjoint Therapy for PTSD (Monson & Fredman, 2012), which includes therapeutically supported steps for service members to disclose aspects of deployment experiences to partners in a way that considers the emotional impact on the partner, increases the likelihood of effective partner support in response to the disclosure(s), and promotes healthy meaning-making of the event(s) for both members of the couple. This treatment may be particularly powerful for those who go on to develop clinically significant symptoms of moral injury due to exposure to PMIEs. In fact, the social-functional model of the treatment of moral injury indicates that the “main goal is to help individuals build, restore, and maintain supportive and healing relationships and social experiences” (Litz & Walker, 2025). Future research may also examine outcomes of disclosure to intimate partners during enhanced Adaptive Disclosure (AD-E; Litz et al., 2024), an intervention developed specifically to address the unique needs of individuals who experience moral injury and includes consideration of optional disclosure to loved ones, contingent on factors such as the likelihood of a successful experience.

The current study has several strengths, including a novel examination of intimate partners’ awareness of and reactions to service members’ exposure to PMIEs and other deployment exposures. There are also limitations. With respect to measurement, we were unable to conclusively determine that service members and partners were reporting on the same exposures or similarly labeling them as moral injuries, threats, or losses. We also used one-item indicators to assess different aspects of distress focal to specific deployment experiences; this constrained certain emotions to specific experiences and impeded the ability to aggregate and directly compare emotional experiences across different exposure types. In addition, the sample only included mixed gender couples comprised of service members in the Army who identify as male and civilian partners who identify as female, which precludes generalizability of findings to more diverse couples. Finally, selection factors of our sample (intact couples with likely greater openness regarding military and relationship experiences) may seriously limit the generalizability of results.

Fundamentally, the current study does not assess moral injury; rather, it includes items that assess reports of exposure to PMIEs. At the time that the larger study was initiated, there were relatively few measurement tools to assess moral injury. More comprehensive and psychometrically sound measures have since been developed, and the conceptualization of moral injury is evolving (see Houle et al., 2024; Litz & Walker, 2025, for reviews). In addition, future research should obtain more detailed reports about disclosure (e.g., depth, frequency, timing) from both partners to facilitate greater understanding of both partners’ experiences. A better understanding of reasons for non-disclosure could inform the degree to which reasons are legal or operational versus interpersonal. Future research may also consider examining how measures of mental health symptomatology relate to disclosure of deployment exposures to intimate partners. This would allow for greater understanding as to how moral injury, PTSD, depression, and other psychological disorders are interrelated. Samples with greater sociodemographic diversity and nonmilitary related moral injury should also be examined to better address how these processes generalize to other populations. Finally, future longitudinal research examining how specific deployment exposures interact with psychological distress and relationship processes over a longer period post-deployment would inform key mechanisms in these associations.

Funding Statement

This work was made possible by a research grant that was awarded and administered by the Office of the Assistant Secretary of Defense for Health Affairs and the United States Army Medical Research and Material Command (USAMRMC), under Contract Number: (Award # W81XWH-12-1-0090).

Disclosure statement

Steffany J. Fredman receives royalties from Guilford Press for her published treatment manual on cognitive-behavioral conjoint therapy for PTSD. She also receives payment for providing workshops on couple therapy for PTSD. No other authors have competing interests to disclose. The views expressed in this article are those of the authors and do not necessarily represent the views of the Veterans Affairs or the U.S. Government.

Data availability statement

The data that support the findings of this study are available upon reasonable request to the senior author, Elizabeth Allen, Ph.D. at elizabeth.allen@ucdenver.edu

References

  1. Balderrama-Durbin, C., Cigrang, J. A., Osborne, L. J., Snyder, D. K., Talcott, G. W., Slep, A. M. S., Heyman, R. E., Tatum, J., Baker, M., Cassidy, D., & Sonnek, S. (2015). Coming home: A prospective study of family reintegration following deployment to a war zone. Psychological Services, 12(3), 213–221. 10.1037/ser0000020 [DOI] [PubMed] [Google Scholar]
  2. Balderrama-Durbin, C., Snyder, D. K., Cigrang, J., Talcott, G. W., Tatum, J., Baker, M., & Smith Slep, A. M. (2013). Combat disclosure in intimate relationships: Mediating the impact of partner support on posttraumatic stress. Journal of Family Psychology, 27(4), 560–568. 10.1037/a0033412 [DOI] [PubMed] [Google Scholar]
  3. Campbell, S. B., & Renshaw, K. D. (2012). Distress in spouses of Vietnam veterans: Associations with communication about deployment experiences. Journal of Family Psychology, 26(1), 18–25. 10.1037/a0026680 [DOI] [PubMed] [Google Scholar]
  4. Campbell, S. B., & Renshaw, K. D. (2013). PTSD symptoms, disclosure, and relationship distress: Explorations of mediation and associations over time. Journal of Anxiety Disorders, 27(5), 494–502. 10.1016/j.janxdis.2013.06.007 [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carter, S. P., Renshaw, K. D., Curby, T. W., Allen, E. S., Markman, H. J., & Stanley, S. M. (2020). Protective buffering by service members during military deployments: Associations with psychological distress and relationship functioning. Family Process, 59(2), 525–536. 10.1111/famp.12426 [DOI] [PubMed] [Google Scholar]
  6. Chestnut, R. P., Richardson, C. B., Morgan, N. R., Bleser, J. A., Perkins, D. F., Vogt, D., & Finley, E. (2020). Moral injury and social well-being: A growth curve analysis. Journal of Traumatic Stress, 33(4), 587–597. 10.1002/jts.22567 [DOI] [PubMed] [Google Scholar]
  7. Currier, J. M., Farnsworth, J. K., Drescher, K. D., McDermott, R. C., Sims, B. M., & Albright, D. L. (2017). Development and evaluation of the Expressions of Moral Injury Scale-military version. Clinical Psychology & Psychotherapy, 25(3), 474–488. 10.1002/cpp.2170 [DOI] [PubMed] [Google Scholar]
  8. Dworkin, E. R., Brill, C. D., & Ullman, S. E. (2019). Social reactions to disclosure of interpersonal violence and psychopathology: A systematic review and meta-analysis. Clinical Psychology Review, 72, 101750. 10.1016/j.cpr.2019.101750 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A functional approach to understanding and treating military-related moral injury. Journal of Contextual and Behavioral Science, 6(4), 391–397. 10.1016/j.jcbs.2017.07.003 [DOI] [Google Scholar]
  10. Fernandez, P. E., & Currier, J. M. (2023). Exploring the role of moral injury outcomes in intimate relationship functioning among U.S. combat veterans. Psychological Trauma: Theory, Research, Practice, & Policy, 16(7), 1229–1232. 10.1037/tra0001553 [DOI] [PubMed] [Google Scholar]
  11. Houle, S. A., Ein, N., Gervasio, J., Plouffe, R. A., Litz, B. T., Carleton, R. N., Nazarov, A., Liu, J. J. W., Ashbaugh, A. R., Callaghan, W., Thompson, M. M., Easterbrook, B., Smith macdonald, L., Rodrigues, S., Bélanger, S. A. H., Bright, K., Lanius, R. A., Baker, C., … Richardson, J. D. (2024). Measuring moral distress and moral injury: A systematic review and content analysis of existing scales. Clinical Psychology Review, 108, 102377. 10.1016/j.cpr.2023.102377 [DOI] [PubMed] [Google Scholar]
  12. Knobloch, L. K., Monk, J. K., & MacDermid Wadsworth, S. M. (2023). Relationship maintenance among military couples. Journal of Social and Personal Relationships, 40(3), 734–772. 10.1177/02654075221105025 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Knobloch, L. K., & Owens, J. L. (2024). Moral injury among first responders: Experience, effects, and advice in their own words. Psychological Services, 21(3), 500–508. 10.1037/ser0000838 [DOI] [PubMed] [Google Scholar]
  14. Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Teng, E. J., Haynes, K., & Pearce, M. (2018). The Moral Injury Symptom Scale-Military version. Journal of Religion & Health, 57, 249–265. 10.1007/s10943-017-0531-9 [DOI] [PubMed] [Google Scholar]
  15. La Fleur, R., McDonald, M., Senecal, G., & Coey, C. (2020). The impact of moral injury and disclosure of military experiences on veterans. Journal of Humanistic Psychology. 10.1177/0022167820972214 [DOI] [Google Scholar]
  16. Litz, B. T., Contractor, A. A., Rhodes, C., Dondanville, K. A., Jordan, A. H., Resick, P. A., Foa E. B., Young‐McCaughan, S., Mintz, J., Yarvis, J. S., & Peterson, A. L. (2018). Distinct trauma types in military service members seeking treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 31(2), 286–295. 10.1002/jts.22276 [DOI] [PubMed] [Google Scholar]
  17. 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. 10.1016/j.cpr.2009.07.003 [DOI] [PubMed] [Google Scholar]
  18. Litz, B. T., & Walker, H. E. (2025). Moral injury: An overview of conceptual, definitional, assessment, and treatment issues. Annual Review of Clinical Psychology, 21(1), 251–277. 10.1146/annurev-clinpsy-081423-022604 [DOI] [PubMed] [Google Scholar]
  19. Litz, B. T., Yeterian, J., Berke, D., Lang, A. J., Gray, M. J., Nienow, T., & Rusowicz-Orazem, L. (2024). A controlled trial of adaptive disclosure-enhanced to improve functioning and treat posttraumatic stress disorder. Journal of Consulting & Clinical Psychology, 92(3), 50–164. 10.1037/ccp0000873 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Maguen, S., Griffin, B. J., Copeland, L. A., Perkins, D. F., Richardson, C. B., Finley, E. P., & Vogt, D. (2022). Trajectories of functioning in a population-based sample of veterans: Contributions of moral injury, PTSD, and depression. Psychological Medicine, 52(12), 2332–2341. 10.1017/S0033291720004249 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Maguen, S., Lucenko, B. A., Reger, M. A., Gahm, G. A., Litz, B. T., Seal, K. H., & Marmar, C. R. (2010). The impact of reported direct and indirect killing on mental health symptoms in Iraq war veterans. Journal of Traumatic Stress, 23(1), 86–90. 10.1002/jts.20434 [DOI] [PubMed] [Google Scholar]
  22. Monk, J. K., & Nelson Goff, B. S. (2014). Military couples’ trauma disclosure: Moderating between trauma symptoms and relationship quality. Psychological Trauma: Theory, Research, Practice, & Policy, 6(5), 537–545. 10.1037/a0036788 [DOI] [Google Scholar]
  23. Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for PTSD: Harnessing the healing power of relationships. Guilford Press. [Google Scholar]
  24. 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. 10.7205/MILMED-D-13-00017 [DOI] [PubMed] [Google Scholar]
  25. Nazarov, A., Forchuk, C. A., Younger, W. A., Plouffe, R. A., Trahair, C., Roth, M. L., Tuka, A., Shirazi, Z. A., Davis, B. D., & Richardson, J. D. (2024). Beliefs about confidentiality and attitudes toward disclosure of moral injuries among military personnel. Psychological Injury and Law, 17(4), 371–382. 10.1007/s12207-024-09521-8 [DOI] [Google Scholar]
  26. Nelson Goff, B. S., Summers, K., Hartman, K., Billings, A., Chevalier, M., Hermes, H., & Monk, K. (2015). Disclosures of war deployment experiences: A qualitative study of the relationship impact on military couples. Military Behavioral Health, 3(3), 190–198. 10.1080/21635781.2015.1055865 [DOI] [Google Scholar]
  27. Olson, J. R., Welsh, J. A., Perkins, D. F., & Ormsby, L. (2018). Individual, family, and community predictors of PTSD symptoms following military deployment. Family Relations, 67(5), 615–629. 10.1111/fare.12343 [DOI] [Google Scholar]
  28. Paige, L., Renshaw, K. D., Allen, E. S., & Litz, B. T. (2019). Deployment trauma and seeking treatment for PTSD in US soldiers. Military Psychology, 31(1), 26–34. 10.1080/08995605.2018.1525219 [DOI] [Google Scholar]
  29. Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A. (2011). Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship? Journal of Abnormal Psychology, 120(1), 240–246. 10.1037/a0022123 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Rando, A. A., & Thompson-Hollands, J. (2022). Veteran and romantic partner goals for family involvement in PTSD treatment: A qualitative study of dyads. Couple and Family Psychology: Research and Practice, 11(3), 193. 10.1037/cfp0000229 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Rodriguez, P., Holowka, D. W., & Marx, B. P. (2012). Assessment of posttraumatic stress disorder-related functional impairment: A review. Journal of Rehabilitation Research & Development, 49(5), 649–666. 10.1682/JRRD.2011.09.0162 [DOI] [PubMed] [Google Scholar]
  32. Smith, J. R., Workneh, A., & Yaya, S. (2020). Barriers and facilitators to help-seeking for individuals with posttraumatic stress disorder: A systematic review. Journal of Traumatic Stress, 33(2), 137–150. 10.1002/jts.22456 [DOI] [PubMed] [Google Scholar]
  33. Stein, N. R., Mills, M. A., Arditte, K., Mendoza, C., Borah, A. M., Resick, P. A., Litz, B. T., Belinfante, K., Borah, E. V., Cooney, J. A., Foa, E. B., Hembree, E. A., Kippie, A., Lester, K., Malach, S. L., McClure, J., Peterson, A. L., Vargas, V., & Wright, E. (2012). A scheme for categorizing traumatic military events. Behavior Modification, 36(6), 787–807. 10.1177/0145445512446945 [DOI] [PubMed] [Google Scholar]
  34. Vogt, D., Vaughn, R., Glickman, M. E., Schultz, M., Drainoni, M. L., Elwy, R., & Eisen, S. (2011). Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of US OEF/OIF veterans. Journal of Abnormal Psychology, 120(4), 797–806. 10.1037/a0023452 [DOI] [PubMed] [Google Scholar]
  35. Welsh, J. A., Olson, J., Perkins, D. F., Travis, W. J., & Ormsby, L. (2015). The role of natural support systems in the post-deployment adjustment of active duty military personnel. American Journal of Community Psychology, 56(1–2), 69–78. 10.1007/s10464-015-9726-y [DOI] [PubMed] [Google Scholar]
  36. Wisco, B. E., Marx, B. P., May, C. L., Martini, B., Krystal, J. H., Southwick, S. M., & Pietrzak. (2017). Moral injury in U.S. combat veterans: Results from the national health and resilience in veterans study. Depression and Anxiety, 34(4), 340–347. 10.1002/da.22614 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available upon reasonable request to the senior author, Elizabeth Allen, Ph.D. at elizabeth.allen@ucdenver.edu

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