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DISTRESS AFTER ACTS AGAINST YOUR VALUES
Have You Ever Done Or Seen Something That Went Against Your Values?
The US Department Of Veterans Affairs Links That To Moral Injury
Moral Injury Is Assumed To Be Another Name For PTSD
The Two Overlap Without Being The Same Thing
Moral Injury Can Be Driven By A Violation Of Values Rather Than Fear
Even So It Is Not An Official Diagnosis
Researchers Also Disagree On Which Events Should Count
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OKAY BACK FROM THE BARRACKS 🪖
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WHAT COUNTS AS A MORAL INJURY 🧭
For A Moral Injury A Person Must Feel A Transgression Occurred
The Feeling Is That They Or Someone Else Violated Their Moral Beliefs
A Canadian Glossary Sorts The Events That Cause It Into Three Kinds
Acts Of Commission Are What Someone Has Done
Omission Covers What Someone Has Failed To Do
Betrayal Is The Third Kind
Veterans Affairs Gives Examples From War
Killing Or Harming Others Is One
Officers Deciding On The Survival Of Others Is Another
So Is Failing To Report A Violation Of Ethics
Events Like These Are Called Potentially Morally Injurious
Studies Of Deployed Service Members Documented These Events
Between 24 And 40 Percent Reported At Least One
That Kind Of Event Is Necessary But Not Sufficient For Moral Injury
Hallmark Reactions Include Guilt Shame Betrayal Disgust And Anger
Guilt Is Distress And Remorse About The Event
Shame Is When The Belief About The Event Extends To The Whole Self
Moral Injury Is One Of Three Related Terms
A Moral Dilemma Is Usually Understood As The Least Severe
Between Them Comes Moral Distress
Of The Three Moral Injury Is Considered The Most Debilitating
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WHERE IT OVERLAPS WITH PTSD ⚖️
A PTSD Diagnosis Needs A Qualifying Event
It Means Exposure To Death Or Threatened Death
Actual Or Threatened Serious Injury Also Counts
So Does Actual Or Threatened Sexual Violence
Moral Injury Has No Agreed Event Requirement Like That
Veterans Affairs Describes Significant Overlap Between The Two
Either One Can Exist Without The Other
Moral Injury Can Occur Without Meeting The Criteria For PTSD
Guilt And Shame Are Core Features Of Moral Injury
They Are Also Symptoms Of PTSD
Morally Injurious Events Can Lead To Different Symptom Profiles
The Comparison Is To Events That Cause A Fear Based Reaction
One Study Looked At Perpetration Based Events
In These A Person Acted Outside Their Own Values
They Were Tied To More Re-Experiencing Than Life Threatening Ones
More Guilt And Self-Blame Were Linked To Them As Well
Reporting Perpetration Also Went With Greater Suicidal Ideation
That Held After Adjusting For PTSD Depression And Substance Use
An International Trauma Society Suggests A Question For Clinicians
It Applies When Guilt Or Shame Or Anger Persists After Trauma
Is The Distress Mainly Fear Or A Perceived Violation Of What Is Right?
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WHY IT IS NOT A DIAGNOSIS 📋
Moral Injury Is Not Listed As A Diagnosis In The DSM-5-TR
That Is The Diagnostic And Statistical Manual Of Mental Disorders
Moral Injury Is Not In The World Health Organization's ICD-11 Either
The Same Applies To Moral Distress And Moral Dilemma
That Canadian Glossary Calls All Three Evolving Concepts
The DSM-5-TR Does Include A Related Code
It Covers Moral Religious Or Spiritual Problems
The Code Does Not Label The Distress As A Disorder
Clinicians Can Use It To Document Morally Laden Distress
It Is Recorded Alongside But Distinct From Psychiatric Diagnoses
Research On Moral Injury Has Grown Since 2009
A 2025 Review Counted Articles With Moral Injury In The Title
It Found 2569 Citations From 2009 To October 2024
Before 2009 There Were Two On PubMed
Google Scholar Had 40 Before That Year
That Review Also Assessed The Research So Far
It Found No Clear Understanding Of Moral Injury As A Distinct Concept
No Trial Had Tested A Treatment Using Moral Injury As The Outcome
So There Was No Evidence That Any Therapy Worked For It Specifically
Treatments For Moral Injury Were Still In A Formative Stage
