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However, those with post-traumatic stress disorder (PTSD) and exposure to moral injury (MI) may exhibit altered theory-of-mind (ToM)\/mentalizing processes and experience shame which precludes one\u2019s capacity for direct eye contact. We investigated blood oxygenation level-dependent (BOLD) responses associated with direct vs averted gaze using a virtual reality paradigm in individuals with PTSD (n\u2009=\u200928) relative to healthy controls (n\u2009=\u200918) following recall of a MI vs a neutral memory. Associations between BOLD responses and clinical symptomatology were also assessed. After MI recall, individuals with PTSD showed greater activation in the right temporoparietal junction as compared to controls (T\u2009=\u20094.83; pFDR\u2009&amp;lt;\u20090.001; k\u2009=\u2009237) during direct gaze. No significant activation occurred during direct gaze after neutral memory recall. Further, a significant positive correlation was found between feelings of distress and right medial superior frontal gyrus activation in individuals with PTSD (T\u2009=\u20095.03; pFDR\u2009=\u20090.049; k\u2009=\u2009123). These findings suggest that direct gaze after MI recall prompts compensatory ToM\/mentalizing processing. Implications for future interventions aimed at mitigating the effects of PTSD on social functioning are discussed.<\/jats:p>","DOI":"10.1093\/scan\/nsad053","type":"journal-article","created":{"date-parts":[[2023,10,28]],"date-time":"2023-10-28T16:07:07Z","timestamp":1698509227000},"source":"Crossref","is-referenced-by-count":9,"title":["\u2018I am afraid you will see the stain on\u00a0my soul\u2019: Direct gaze neural processing in\u00a0individuals with PTSD after moral injury recall"],"prefix":"10.1093","volume":"18","author":[{"given":"Krysta","family":"Andrews","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, ON L8N 3K7, Canada"},{"name":"Homewood Research Institute , Guelph, ON N1E 6K9, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantelle S","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Homewood Research Institute , Guelph, ON N1E 6K9, Canada"},{"name":"Department of Psychiatry, Western University , London, ON N6C 0A7, Canada"},{"name":"Department of Psychology, Neuroscience, and Behaviour, McMaster University , Hamilton, ON L8S 4K1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Densmore","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Western University , London, ON N6C 0A7, Canada"},{"name":"Imaging Division, Lawson Health Research Institute , London, ON N6A 4V2, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breanne E","family":"Kearney","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Western University , London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherain","family":"Harricharan","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, ON L8N 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret C","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, ON L8N 3K7, Canada"},{"name":"Homewood Research Institute , Guelph, ON N1E 6K9, Canada"},{"name":"Mood Disorders Program, St. Joseph\u2019s Healthcare Hamilton , Hamilton, ON L8N 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Th\u00e9berge","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Western University , London, ON N6C 0A7, Canada"},{"name":"Imaging Division, Lawson Health Research Institute , London, ON N6A 4V2, Canada"},{"name":"Department of Medical Biophysics, Western University , London, ON N6A 5C1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Jetly","sequence":"additional","affiliation":[{"name":"Canadian Forces, Health Services , Ottawa, ON K1A 0S2, Canada"},{"name":"Department of Psychiatry, University of Ottawa , Ottawa, ON K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3758-1393","authenticated-orcid":false,"given":"Ruth A","family":"Lanius","sequence":"additional","affiliation":[{"name":"Homewood Research Institute , Guelph, ON N1E 6K9, Canada"},{"name":"Department of Psychiatry, Western University , London, ON N6C 0A7, Canada"},{"name":"Imaging Division, Lawson Health Research Institute , London, ON N6A 4V2, Canada"},{"name":"Department of Neuroscience, Western University , London, ON N6A 3K7, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"key":"2023120216134642800_R1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric 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