Moral injury occurs when a situation or event is perceived to violate an individual’s moral values, leading to emotional, psychological, social and/or spiritual distress. You might experience moral injury after perpetrating, failing to prevent or witnessing events contradictory to your own personal beliefs and deeply held moral values. 

Although moral injury often occurs in the context of trauma, morally injurious events do not necessarily involve a threat to life; instead, they threaten your deeply held moral values and beliefs system.

The concept of moral injury was first introduced in the 1990s, based on work with veterans who served in the Vietnam War. Focused on failures by leadership, the original definition of moral injury was “a betrayal of what’s right, by someone who holds legitimate authority, in a high-stakes situation.” Later, the definition of moral injury was revised based on work with post-9/11 veterans to include moral injury stemming from the affected individual’s own actions.

Initially, the concept of moral injury was examined in the context of combat. However, there is growing recognition that other situations or occupations can put people at risk for moral injury. For example—refugees, journalists, military family members, first responders, police officers and health care providers may also be exposed to potentially morally injurious events.

Morally injurious events

Unlike traumatic events that lead to post-traumatic stress disorder (PTSD), situations and events that may result in moral injury do not always involve life-threatening injuries, accidents or violence. Examples of the types of events that may lead to moral injury include:

•   Something you have done or failed to do
•   Something someone else has done or failed to do to you or for you (i.e., someone in a position of power or a peer)
•   Something you have witnessed
•   Something you learned about after it happened

It’s important to note that not all individuals who are exposed to morally injurious situations or events will develop moral injury.

Signs and symptoms of moral injury

Although moral injury can present with effects on behavioral, social, psychological and spiritual functioning, it isn’t a mental health condition in its own right and cannot be formally diagnosed. Additionally, while moral injury often co-occurs and has symptom overlap with post-traumatic stress disorder (PTSD), it is distinct from PTSD. Learn more about the differences between moral injury and PTSD here. [link to blog: Moral Injury vs. PTSD]

Signs and symptoms of moral injury include avoidance, reliving the event that led to moral injury, substance abuse and negative emotions. If you are suffering from moral injury, you might:

•   Avoid people, places, conversations and situations that remind them of the event that caused moral injury
•   Relive the moral injury through involuntary, painful memories, as though the event is occurring again
•   Abuse drugs or alcohol in attempt to cope with lingering effects from the past event
•   Feel overwhelming guilt, shame, self-condemnation, loss of trust or faith or remorse as a result of experiencing moral injury

Negative emotions may vary depending on the type of morally injurious event. For example, you might feel shame or guilt regarding an act of perpetration, or you might feel anger in response to a betrayal or loss.

Moral injury symptoms don’t need to control you. Pyramid Military Therapy’s counseling team can help you achieve relief from major moral injury symptoms.

Moral Injury in Veterans and Military Service Members

Among veterans and military service members, moral injury is widely reported, especially in those with PTSD symptoms. According to a recent study published in Frontiers in Psychology, 24 percent of a sample of veterans who were deployed to a combat zone after the 9/11 attacks reported moral injury as a result of their own actions, and 45 percent experienced moral injury induced by the actions of others.

For example, veterans and military service members might experience moral injury after the following:

•   The killing of civilians, enemy combatants or children during war
•   Betrayal by formerly trusted leaders or fellow service members
•   Witnessing a violation of one’s moral values without intervening or reporting
•   Failing to perform a duty or freezing during combat
•   Violating rules of engagement

Get help today

Moral injury is a common issue for veterans of war and military service members, particularly those who have endured trauma during their time in service. Pyramid Healthcare’s Military Therapy & Recovery Programs use a clinically integrated approach to address underlying trauma and moral injury at their cores. Contact us to learn more about our treatment programs.