The Silent Battle: Understanding Moral Injury in Our Military and Veteran Community

When we think of the challenges faced by our military and Veteran community, we often focus on physical injuries or post-traumatic stress disorder (PTSD). However, there's another, less visible wound that many carry: moral injury. This profound psychological wound is increasingly recognized as a significant issue affecting those who have served our country.

What Is Moral Injury?

According to an article in Springer Nature, moral injury is not currently recognized as a mental health disorder, but rather a deep, psychological wound that occurs when someone witnesses or takes part in something that goes against their core moral beliefs. This can happen in high-stakes situations, such as combat, where split-second decisions are made and having to grapple with those consequences afterward. For many service members and Veterans, these experiences leave lasting emotional, spiritual, and psychological scars.  

How Is Moral Injury Different from PTSD?

While PTSD and moral injury share some similarities, they are distinct. PTSD includes symptoms like hyperarousal—feeling constantly on edge—which is not a core feature of moral injury. A person can experience moral injury without meeting the criteria for PTSD.

The distress from moral injury also differs from PTSD. PTSD is often triggered by fear-based trauma, whereas moral injury stems from events that violate a person’s values. Research shows that people who commit acts against their moral beliefs (perpetration-based events) experience more guilt, self-blame, and intrusive memories than those facing life-threatening trauma.

According to an article from The National Library of Medicine, moral injury is also strongly linked to suicidal thoughts and behaviors. Even after accounting for PTSD, depression, and substance use, those who report moral injury—are at higher risk of suicidal ideation and attempts.

Recognizing these differences is key to providing the right support. While PTSD treatments focus on fear and anxiety, moral injury requires approaches that help individuals process guilt, rebuild their sense of self, and find meaning after difficult experiences.

Signs and Symptoms of Moral Injury

According to the U.S. Department of Veterans Affairs, moral injury can present in many ways, and no two experiences are alike. Individuals struggle with deep feelings of guilt and shame, often feeling responsible for actions or decisions made in high-pressure situations. Others experience anger or a sense of betrayal—whether directed at themselves, leadership, institutions, or even society. Social withdrawal can follow, as relationships feel strained and isolation takes hold. For some, moral injury leads to a crisis of faith or a struggle to find meaning, resulting in spiritual or existential distress. Others may turn to self-destructive behaviors, such as substance use or reckless decision-making, and in severe cases, experience thoughts of suicide.

Finding Support and Healing from Moral Injury

An article from the U.S. Department of Veteran Affairs, states that different therapies are being explored for moral injury, most of which involve working with a therapist to process past events and develop coping strategies. There are no medications specifically for moral injury, but studies are examining whether PTSD treatments can also help.

Several therapies are being tested for service members and Veterans:

• • Acceptance and Commitment Therapy (ACT, adapted for moral injury): A 12-session group treatment focused on living according to personal values. ‍
• • Adaptive Disclosure: A 12-session individual therapy using guided discussions with compassionate moral authority to process guilt and make amends. ‍
• • Impact of Killing: A 10-session therapy following PTSD treatment that helps with self-forgiveness and honoring violated values. ‍
• • Moral Injury Group: A 12-session therapy co-led by a chaplain and psychologist, ending with a public ceremony where participants share their stories. ‍
• • Trauma-Informed Guilt Reduction Therapy: A 6-session individual therapy aimed at reframing guilt and shame while reinforcing personal values. ‍
• • Building Spiritual Strength: An 8-session group therapy, often led by a chaplain, addressing struggles with faith and forgiveness.

The Path Forward

Moral injury is a profound and often overlooked challenge faced by many service members and Veterans. While it may not leave visible scars, its emotional and psychological impact can be just as deep as any physical wound. Recognizing the signs of moral injury and understanding how it differs from PTSD is crucial in providing the right support and care.

Healing is possible. Through therapy, community, and personal reflection, those affected can begin to process their experiences, rebuild their sense of self, and find a path forward. No one should have to carry this burden alone—help is available, and seeking support is a courageous step toward healing.  

What resources are available for a veteran struggling with moral injury?

1. 1. Veteran Crisis Line or call by dialing 988, then pressing 1. You can also connect by texting 838255.  

2. 2. Vet Centers (confidential support)

3. 3. Vets4Warriors (24/7 confidential peer support)

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