Perpetration in combat, trauma, and the social psychology of killing: An integrative review of clinical and social psychology literature with implications for treatmen

Conventional cognitive behavioral clinical approaches to combat trauma neglect the significant contribution of perpetration of violence and killing in combat in the development of combat PTSD and combat stress injuries. The importance of emotions highly correlated with perpetration induced traumatic stress, such as guilt, are overlooked in the standard evidence based models of treatment. This critical synthesis of clinical and social psychology literature identifies these deficits in the current PTSD literature and contrasts alternative perspectives of etiology and treatment that remedy these deficits. In addition, the social psychology literature presents conceptualizations of psychological and social processes at work in contexts of organized killing including the combat environment. Mechanisms of moral disengagement are examined in the literature as a model for understanding complex socio-cognitive processes involved in rationalizing moral transgressions, such as killing. It is proposed that mechanisms of moral disengagement which attempt to protect soldiers from moral culpability while enabling their participation in killing ultimately contribute to negative psychological consequences and trauma. Particularly, dehumanization processes and the effects of the obedience to authority situation are discussed as elements of the combat context with specific salience to the traumatic impact on soldiers. The critical synthesis of these literatures advances alternative perspectives on combat trauma. Implications for clinical applications in treatment with soldiers and veterans are provided.