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Are moral injury and PTSD the same?

 

Moral Injury in the Context of War

Shira Maguen, PhD and Brett Litz, PhD

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What is moral injury?

Like psychological trauma, moral injury is a construct that describes extreme and unprecedented life experience including the harmful aftermath of exposure to such events. Events are considered morally injurious if they “transgress deeply held moral beliefs and expectations” (1). Thus, the key precondition for moral injury is an act of transgression, which shatters moral and ethical expectations that are rooted in religious or spiritual beliefs, or culture-based, organizational, and group-based rules about fairness, the value of life, and so forth.

Are moral injury and PTSD the same?

More research is needed to answer this question. At present, although the constructs of PTSD and moral injury overlap, each has unique components that make them separable consequences of war and other traumatic contexts.

  • PTSD is a mental disorder that requires a diagnosis. Moral injury is a dimensional problem – there is no threshold for the presence of moral injury, rather, at a given point in time, a Veteran may have none, or mild to extreme manifestations.
  • Transgression is not necessary for PTSD to develop nor does the PTSD diagnosis sufficiently capture moral injury (shame, self-handicapping, guilt, etc.).

Consequently, it is important to assess mental health symptoms and moral injury as separate manifestations of war trauma to form a comprehensive clinical picture, and provide the most relevant treatment. One example of a moral injury specific measure is the Moral Injury Events Scale (12).

“What is Moral Injury?” from the VA

PTSD Research Quarterly 2012

Military personnel serving in war are confronted with ethical and moral challenges, most of which are navigated successfully because of effective rules of engagement, training, leadership, and the purposefulness and coherence that arise in cohesive units during and after various challenges. However, even in optimal operational contexts, some combat and operational experiences can inevitably transgress deeply held beliefs that undergird a service member’s humanity. Transgressions can arise from individual acts of commission or omission, the behavior of others, or by bearing witness to intense human suffering or the grotesque aftermath of battle. An act of serious transgression that leads to serious inner conflict because the experience is at odds with core ethical and moral beliefs is called moral injury.

NYTimes Opinion Page: The Moral Injury

NYTimes: The Opinion Pages | OP-ED COLUMNIST   Source


David J. Morris returned from Iraq with a case of post-traumatic stress disorder. The former Marine turned war correspondent was plagued by nightmares. His imagination careened out of control; he envisioned fireballs erupting while on trips to the mall. His emotions could go numb, but his awareness was hypervigilant. Images and smells from the war were tattooed eternally fresh on his brain, and he circled back to them remorselessly.

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