PTSD and Moral Injury: Are They the Same Thing?

You have likely heard of PTSD before. But you may or may not be aware of the term “moral injury.” 

Moral injury is a designation that emerged in the 1990’s based on psychiatrists’ work with Vietnam era veterans. Today, “soul repair” and “soul wound” are terms that are also in use by researchers and institutions in the U.S. who are exploring moral injury and pathways to recovery. 

While not classified as a mental disorder like PTSD, moral injury is a problem that can have profound effects on emotional, psychological, behavioral, social, and spiritual functioning.

Both moral injury and post-traumatic stress disorder (PTSD) begin with an event that is often life threatening or harmful to self or others and there is a great deal of overlap between the two. Yet there are also very clear distinctions.

Moral Injury

Moral injury is defined as “a violation of deepest-held beliefs and expectations causing moral confusion.” Moral injury can occur in response to acting or witnessing behaviors that go against an individual’s values and moral beliefs. The result of moral injury impacts your beliefs and values and separates you from a sense of trust in others or yourself. Besides having its roots in wartime, moral injury can result from things that happen in everyday life. Potentially morally injurious events include sexual trauma, betrayal by trusted others, homicide, suicide of a loved one, and sometimes either hearing or reading about traumatic events.

PTSD

Post-traumatic stress disorder is classified as a mental health condition because of the effect it has on the brain, especially the amygdala and limbic system, The impact is that the individual suffering from PTSD feels separate from a sense of safety in the world. PTSD can last for months or years, with triggers that can bring back memories of the trauma accompanied by intense emotional and physical reactions. Treatment includes different types of trauma-focused psychotherapy as well as medications to manage symptoms.

Serenity Wellness Treatment Modalities

Due to the overlapping and co-occurrence of moral injury and PTSD, treatments are often similar for each. 

Mindfulness and talk therapy, religious dialogue, art, writing, discussion and talking circles, as well as spiritual gatherings are currently favored outlets for acknowledging and confronting moral injury. 

At Serenity Wellness & Counseling Center, we employ a variety of techniques for the treatment for both moral injury and PTSD. 

While the treatment of one condition does not necessarily address the other condition, every treatment we employ with our patients is defined by the individual according to their beliefs and needs. One method that is proving very successful in the treatment of both conditions is Eye Movement Desensitization and Reprocessing (EMDR)

EMDR therapy shows that the mind can heal from psychological trauma much as the body recovers and heals from physical trauma.  When you cut your hand, your body works to close the wound.  If a foreign object or repeated injury irritates the wound, it festers and causes pain.  Once the block is removed, healing resumes.  EMDR therapy demonstrates that a similar sequence of events occurs with mental processes.  

What once took years to recover from in traditional psychotherapy can now be accomplished much more quickly – sometimes in a matter of months. 

Because moral injury is subjective and personal, it is a burden that is carried silently by those who suffer. Research on moral injury is younger than research on PTSD. Yet, the impact on individuals and communities at large may be much greater. 

Resources: https://moralinjuryproject.syr.edu/about-moral-injury/

https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.19020036#:~:text=Moral%20injury%20is%20not%20classified,functioning%20(15%E2%80%9318).

https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.19020036#:~:text=Moral%20injury%20is%20not%20classified,functioning%20(15%E2%80%9318).

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