Moral Injury and PTSD: Often Co-Occurring Yet Mechanistically Different

Haleigh A. Barnes, Ph.D., Robin A. Hurley, M.D., Katherine H. Taber, Ph.D. Published Online:23 Apr 2019 https://doi.org/10.1176/appi.neuropsych.19020036

The concept of moral injury has recently emerged in the research literature as a separate aspect of trauma exposure, distinct from posttraumatic stress disorder (PTSD) (15). Moral injury is not classified as a mental disorder. It is a dimensional problem that can have profound effects on critical domains of emotional, psychological, behavioral, social, and spiritual functioning (1518).

The definitions of moral injury have evolved considerably since its introduction in the 1990s, although a consensus definition has not yet emerged (11161822). The original definition, which was based on work with Vietnam era veterans, focused on failures by leaders. This type of moral injury required that three circumstances be present: “a betrayal of what’s right, by someone who holds legitimate authority, in a high-stakes situation” (20). A later definition of moral injury, which was based on work with Iraq and Afghanistan era veterans, focused on moral failures by the individual (16). This type of moral injury requires that the individual has experienced a potentially injurious event by “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations” and the moral/ethical violation resulted in “lasting psychological, biological, spiritual, behavioral, and social impact” (16). As this definition makes clear, it is important to separate experiencing a potentially morally injurious event from developing moral injury. This is similar to PTSD. Experiencing a trauma (criterion A) does not inevitably lead to developing PTSD. Whether a moral injury develops is determined by how the individual interprets the potentially injurious event. The appraisal process determines whether the event generates significant dissonance with the individual’s belief system and worldview (11162225).

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About S. R. Zelenz 67 Articles
S.R. Zelenz has worked in education for 20 years. Working with students from all walks of life, cultures, races, and social diversity, Zelenz’s research in Educational Leadership led to finding a better way to approach learning for students with trauma histories. Many were juvenile offenders, gang members, diagnosed with varying behavioral disorders, or had family histories of violence, murder, or narcissistic parenting. This research could not be effectively accomplished without further understanding: how epigenetic trauma inheritance may be impacting these students; how brain development from trauma may be impacting their behavioral and emotional development; as well as deep understanding of psychology and its varying classifications for behavioral and personality disorders. The goal is to find solutions for changing the conversation and making a real difference for these students. She has also worked with nonprofits of varying focus areas for the last 25 years. Her undergraduate degree in Arts Administration and Music prepared her for managing nonprofits of any size as well as procuring funding so that they can achieve their goals. Pairing her nonprofit background with her education background, she has been able to make a difference for over 200 nonprofits worldwide, written curriculum for schools across the globe, and assisted many arts organizations through performance and management.