The DSM-5 addresses the idea of active participation as a cause of trauma under the discussion accompanying its definition of PTSD, and adds to the list of causal factors: "for military personnel, being a perpetrator, witnessing atrocities, or killing the enemy."
[16] Those who suffer, many of whom participated in violence as a matter of social expectation, find it beneficial to know that they are having a normal reaction to an abnormal situation, and are not uniquely cowardly or crazy.
[17] More vigorous studies are needed for all these suggestions, as well as common PTSD therapies that have not yet been thoroughly explored, with the distinction of perpetration versus victimization in mind.
In the 11th century, soldiers involved in the Norman conquest of England, took part in the church administered Ermenfrid Penitential, to atone for, and mentally process the violence they participated in.
A major factor in all of these events was the emotional state of US soldiers as they struggled with angry grief over buddies killed by invisible adversaries, with a desperate need to identify an 'enemy.
'[28]Referring to the definition of "atrocity-producing situation", Morag (2013) was one of the first scholars to theorize perpetrator trauma and delineate the victim-perpetrator distinction in the context of the twenty-first century new war on terror.
[30] Authors from the PTSD Journal have documented perpetrator trauma among slaughterhouse workers, stating that "these employees are hired to kill animals, such as pigs and cows that are largely gentle creatures.