Moral injury is a wound to your deepest sense of right and wrong. It leaves you feeling disconnected and alienated from others, often feeling guilty, ashamed, and angry.

Healthcare workers, first responders, military, and law enforcement personnel are often exposed to morally critical events in which ethical values and moral beliefs are violated. They may feel betrayed by their institution or forced to do something that they believed was morally questionable. At times, they may have witnessed the immoral acts or brutality of others or experienced something that just shouldn’t have happened. While related to the effects of trauma, the experience of moral injury evokes a unique distress generated by valuative judgments that often lead to persistent psychological and spiritual/existential anguish. Core characteristics include intense and persistent feelings of guilt, shame, anger, despair, disorientation, meaninglessness, global resentment, loss of faith and an ability to trust, as well as maladaptive avoidant behaviors like alcohol excess, self-harm, and suicidality (Currier et al., 2019; Drescher et al. 2011; Farnsworth et al. 2017; Frankfurt & Frazier, 2016; Koenig et al., 2018) Litz et al. 2009; Maguen et al., 2017; Nash et al. 2013). 

Currier, J. M., Foster, J. D., & Isaak, S. L. (2019). Moral injury and spiritual struggles in military veterans: A latent profile analysis. Journal of Traumatic Stress, 32(3), 393–404. https://doi.org/10.1002/jts.22378

Drescher, K., Foy, D., Litz, B., Kelly, C., Leshner, A., & Schutz, K. (2011). An exploration of the viabilityand usefulness of the construct of moral injury in war veterans. Traumatology, 17(1), 8–13. https://doi.org/10.1177/1534765610395615

Farnsworth, J. K., Drescher, K. D., Evans, W., & Walser, R. D. (2017). A Functional Approach to Understanding and Treating Military‐related Moral Injury. Journal of Contextual Behavioral Science, 6(4), 391–397. https://doi.org/10.1016/j.jcbs.2017.07.003

Frankfurt, S. B., Frazier, P., & Engdahl, B. (2017). Indirect Relations Between Transgressive Acts and General Combat Exposure and Moral Injury. Military Medicine, 182, e1950–e1956.https://doi.org/10.7205/MILMED-D-17-00062

Koenig, H. G., Ames, D., Youssef, N. A., Oliver, J. P., Volk, F., Teng, E. J., Haynes, K., Erickson, Z. D., Arnold, I., O’Garo, K., & Pearce, M. (2018). The moral injury symptom scale-military version. Journal of Religion and Health, 57(1), 249–265. https://doi.org/10.1007/s10943-017-0531-9

Litz, B. T., Stein, N., Delaney, E., Lebowitz, L., Nash, W. P., Silva, C., & Maguen, S. (2009). Moral Injury and Moral Repair in War Veterans: A preliminary model and intervention strategy. Clinical Psychology Review, 29(8), 695–706. https://doi.org/10.1016/j.cpr.2009.07.003

Maguen, S., Burkman, K., Madden, E., Dinh, J., Bosch, J., Keyser, J., … & Neylan, T. C. (2017). Impact of Killing in War: A randomized, controlled pilot trial. Journal of Clinical Psychology, 73(9), 997-1012. https://doi.org/10.1002/jclp.22471

Nash, W. P., & Litz, B. T. (2013). Moral Injury: A mechanism for war-related psychological trauma in military family members. Clinical Child and Family Psychology Review, 16(4), 365–375. https://doi.org/10.1007/s10567-013-0146-y