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Hope For Veterans Experiencing Moral Injury

Moral Injury includes: committing, failing to prevent, or witnessing acts that transgress deeply held moral beliefs
(Litz et al., 2009)

About 27% of U.S. Combat Veterans Have Experienced a Moral Injury
(Wisco et al., 2017)

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What is Moral Injury?

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The lasting impact of perpetrating, failing to prevent, or bearing witness to acts that transgress one’s deeply held moral beliefs and expectations.

A moral injury undermines one’s belief about the goodness and trustworthiness of oneself, others, or the world.                                                                     
(Litz et al., 2009)

10 Domains of Moral Injury

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  • Guilt

  • Shame

  • Moral Concerns

  • Feeling Betrayed

  • Loss of trust

  • Difficulty Forgiving

  • Loss of Meaning/Purpose

  • Self-condemnation

  • Religious Struggles

  • Loss of faith/hope

                                               

                                                        (Koenig et al., 2018)

The rupture of a moral injury is an agonizing realization of knowing goodness because of its absence.

Example of a Moral Injury 
(3 mins)

Veterans speak about the hurt of a Moral Injury

"It was always on my mind"

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Potential Morally Injurious Events

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I saw things that were
morally wrong


​I violated my own morals by
failing to do something that
I felt I should have done
 

(Nash et al., 2013)

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Potential Morally Injurious Events

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I acted in ways that violated my
own moral code or values


​I was betrayed by others that
I once trusted 
 
                                 
(Nash et al., 2013)

The hurt of a moral injury can be taken

Acts​

  • Committed

  • Omitted

  • Witnessed

"Specific to me was the moral injury that came about when I recognized the ways in which I had participated in dehumanizing others."
~O.E.F. Combat Veteran Mark Cunningham

PTSD & Moral Injury Compared 

(6 mins)

  • Moral injury is distinct from PTSD

  • There is some overlap in emotional symptoms

  • Moral Injury and PTSD often co-occur

  • Moral injury can lead to PTSD

​​​       (Barnes et al., 2019; Currier et al., 2015).

Post Traumatic Stress               Moral Injury

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  • Exposure to life-threatening event

  • Fear/threat based

  • Hypervigilance

  • Startle Response

  • Emotional

  • Diagnosis 

  • Nervous System

  • Impacts sense of safety

  • Depression

  • Anger

  • Self-medication

  • Isolation

  • Insomnia

  • Nightmares

  • Suicidality

  • Anxiety

  • Avoidance

  • Negative thoughts

  • Lack of pleasure

  • Intrusive memories

  • Exposure to event that challenges beliefs       

  • Shame

  • Guilt

  • Regret

  • Spiritual 

  • Experience 

  • Social Support System

  • Impacts sense of self

PTSD and Moral Injury have nuanced differences. Moral injury is considered more of a spiritual problem with a profound internal struggle and a strong sense of self-condemnation. PTSD is more of an outward struggle- with hypervigilance and being on the lookout for danger.

 

For example, one of the shared symptoms above “isolation” may occur for different reasons.

A person with PTSD may feel unsafe at a crowded event, and the person with a Moral Injury may be isolating more as self-punishment, feeling they don’t deserve to go to an enjoyable event.

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