(Moral Injury, Transcendent, Existential, Religious Trauma, and Abuse of Consciousness)
Definition and Core Concepts
Existential-spiritual trauma encompasses psychological, emotional, spiritual, and relational wounds arising from experiences that profoundly disrupt an individual’s core beliefs, ethical foundations, spiritual identity, or sense of existential meaning. This integrated trauma category includes previously distinct yet related concepts:
- Moral Injury: Psychological wounds arising from participation in, witnessing, or being unable to prevent acts that violate one’s deeply held moral or ethical beliefs, resulting in profound guilt, shame, and moral distress (Litz et al., 2009).
- Existential Trauma: Deep disturbances in meaning-making and purpose, triggered by experiences that challenge fundamental existential assumptions about safety, meaning, or personal control over one’s life (Yalom, 1980).
- Transcendent Trauma: Injuries resulting from the disruption of one’s spiritual or transcendent beliefs about life, the sacred, or connections with higher spiritual realities, leaving individuals feeling spiritually alienated, abandoned, or disillusioned (Tedeschi & Calhoun, 2004).
- Religious Trauma: Emotional, psychological, and spiritual damage inflicted through harmful religious contexts, characterized by manipulation, coercion, spiritual authoritarianism, doctrinal rigidity, or abusive practices within religious or spiritual communities (Winell, 2011).
- Abuse of Consciousness: Trauma resulting specifically from experiences involving deliberate manipulation, coercion, or control over an individual’s autonomy, thoughts, beliefs, or consciousness itself—often occurring within cultic environments, totalitarian settings, or severely controlling relationships. Abuse of consciousness undermines the individual’s capacity for autonomous thinking, decision-making, and spiritual discernment, severely impacting personal identity, self-worth, and existential trust (Lalich & Tobias, 2006; Hassan, 2015).
Existential-spiritual trauma stands apart from other trauma forms due to its unique impact on the moral conscience, spiritual identity, and core beliefs, whereas traditional forms of trauma primarily disrupt fear-based neural fear circuits. Neurobiological research supports this distinction. For instance, functional MRI studies reveal that recalling morally injurious events activates brain regions associated with self-related processing—including the dorsomedial prefrontal cortex (dmPFC), posterior insula, and dorsal anterior cingulate cortex (dACC)—areas that are not typically engaged in more conventional PTSD (Lloyd et al., 2021) Moreover, script-driven moral injury recall has been found to increase midbrain-default mode network connectivity, further highlighting the involvement of self-referential, ethical, and emotive networks distinct from classic threat responses observed in PTSD.
These findings suggest that existential-spiritual trauma results in a neurobiological signature unique to moral and identity-based injuries. Such wounding is not solely driven by fear or overwhelm; it often involves intense self-evaluation, shame, betrayal, and rupture of one’s moral and spiritual framework. Overlaps may occur—hyperarousal, numbing, dissociation—but the core injury is fundamentally different: it penetrates the architecture of conscience and meaning, rather than merely triggering survival alarm systems. Consequently, this form of trauma requires a distinct therapeutic category, one that integrates existential, moral, and spiritual restoration alongside traditional psychotrauma treatments. By delineating existential-spiritual trauma as its own category, clinicians are better equipped to recognize and address its deep moral wounds, thus providing more precise and respectful care for those who suffer at the intersection of trauma and existential distress.
Diagnostic Criteria and Instruments
Currently, existential-spiritual trauma (including moral injury, religious trauma) is not explicitly listed in standard diagnostic manuals (DSM-5, ICD-11). Nevertheless, clinical recognition relies on structured diagnostic tools and careful clinical observation of characteristic existential-spiritual disturbances:
- Moral Injury Questionnaire (MIQ): Measures emotional, psychological, spiritual, and relational symptoms arising specifically from morally injurious events (Currier et al., 2015).
- Existential Concerns Questionnaire (ECQ): This questionnaire assesses existential distress, disruptions in meaning, purpose, and core belief systems, facilitating targeted therapeutic interventions (van Bruggen et al., 2018).
- Religious Trauma Scale (RTS): Identifies distress and symptoms associated explicitly with harmful religious experiences, authoritarian spiritual contexts, or spiritual abuse (Stone, 2013).
These instruments provide vital clinical clarity, identify characteristic existential and spiritual wounds, and facilitate specialized interventions.
Therapeutic Interventions for Existential-Spiritual Trauma
Effectively addressing existential-spiritual trauma requires integrative therapeutic interventions explicitly focused on ethical reconstruction, existential meaning-making, spiritual repair, relational healing, and compassionate self-integration:
1. Adaptive Disclosure (AD)
Adaptive Disclosure involves structured therapeutic conversations fostering moral and ethical clarity, emotional integration of morally injurious events, and ethical reconciliation (Litz et al., 2009).
2. Existential Psychotherapy and Meaning-centered Approaches
Integrative existential therapy (Yalom, 1980) and meaning-centered psychotherapy (Frankl, 1963; Breitbart et al., 2010) explicitly facilitate the reconstruction of meaning, existential exploration, and rediscovery of personal purpose following profound existential disruption.
3. Spiritually-Informed Psychotherapies
Spiritually integrated psychotherapy (Pargament, 2007) and Compassion-Focused Therapy (Gilbert, 2014) help individuals reconstruct healthy spirituality, resolve spiritual disillusionment, and cultivate compassionate relational frameworks.
4. Relational and Attachment-focused Interventions
Attachment-based therapies (e.g., Dyadic Developmental Psychotherapy, Emotionally Focused Therapy) address relational wounds from moral injury, betrayal, spiritual manipulation, and attachment disruptions, restoring relational safety and emotional repair.
5. Restorative and Community-Based Approaches
Community-oriented interventions—such as collective rituals, moral repair dialogues, and restorative justice processes—address collective moral and spiritual injuries, fostering community support, meaning-making, and restorative healing (Saul, 2013).
6. Compassion Pathways Framework (Rivas, 2024)
The Compassion Pathways Framework systematically guides therapeutic intervention by facilitating compassionate awareness, emotional and spiritual attunement, relational repair, and ethical self-integration. It addresses existential-spiritual wounds explicitly through structured stages and is available in both evangelical and catholic context editions for Christian people.
- Compassionate Awareness: Recognizing and validating emotional and spiritual wounds.
- Ethical and Existential Clarity: Facilitating compassionate self-reflection to restore disrupted ethical frameworks and existential coherence.
- Spiritual and Relational Attunement: Rebuilding trusting relationships through compassionate connection, emotional safety, and authentic self-expression.
- Integration and Empowerment: Fostering ongoing compassionate resilience, ethical purpose, and empowered, meaningful living.